Virtual Microscopy: Application to Pathology Small Group Problem Solving Mary Jean S. Uy-Kroh, Kiran Sajja, Dawn M. Dawson Institute of Pathology INTRODUCTION 2.5x KEY LESSONS LEARNED Biologic Basis of Disease (Year One Pathology) has incorporated Virtual Microscopy Features • This new methodology of learning may not be well six small group “ disease focused” problem solving PowerPoint received by more traditional teachers and modules to integrate lecture and laboratory learning. The 5x departments. 0.63x • To ensure that the material is easily accessible and modules include clinical and laboratory findings along with Simulation of low to high histopathologic photomicrographs. magnification screening accurate, continual evaluation, integration and Virtual microscopy is a state of the art computer based imaging for interactive discussion. cataloging of the virtual image database is necessary. Scanning tool Screen capture mode tool with enormous potential impact on biomedical research, • Protecting electronic educational propriety for both allows for selection and teaching and clinical practice. This tool was developed as part of faculty and students without hindering access and use annotation of images for an NIH-funded technology project creating compressed scanned 10x small group and lecture of virtual microscopy is critical. images of entire microscope slides and is now available online presentations.. through MicroBrightField®, Inc. We present a plan for implementing this tool into a live multidisciplinary format and a model for integration of virtual NEXT STEPS http://vmicroscope.cwru.edu/showMe.jsp?instGUID=60D42DAC- microscopy into other committees. D39F-6506-34F2-3886CBDED1BB • Develop a brief and user friendly orientation program for virtual microscopy system. Comparative learning Weblink to Year 1 Gastrointestinal committee- • Implement and improve virtual microscopy and small PROBLEMS Histology of liver and hepatobiliary tract group PowerPoint modules in BBD Year One Use of traditional microscopes and glass slides is the established Committee. teaching method for histology and histopathology in • Create a teaching template for other Committees to medical education. Inherent problems with this current method incorporate virtual microscopy for their particular include: organ system. • Access and expense of quality microscopes. • Preparation and maintenance of multiple “similar” specimens for all students. • Classroom size that can be accommodated with an adequate number of trained instructors. • Microscopy skills and interactive/group discussion CONSULTATION • How would you feel most comfortable learning to Steatohepatitis Normal liver http://syllabus.cwru.edu/LectureFrame.asp?Code=y1c5s2i23 utilize the virtual microscopy program? OBJECTIVES • What problems do you envision using virtual Multidisciplinary information linkages 1. Identify key differences between normal and abnormal microscopy in your curriculum? histologic findings that distinguish a given disease process. 2. Correlate the histopathologic findings with the known Instructional PowerPoint modules are presented in • How would you enhance your curriculum using this stepwise “animated” fashion to encourage discussion. tool? biochemical pathway abnormalities that cause and/or result from the changes observed. Steatohepatitis, cont. 3. Apply virtual microscopy skills and utilize the web linkages to Power Point Module facilitate: On physical examination, you palpate a liver generation of differential diagnosis, edge. No other physical findings are present. ACKNOWLEDGEMENTS participation in discussion and medicine.ucsd.edu/clinicalmed/ abdomen.htm We would like to acknowledge the following faculty acquisition of knowledge in pathology. Blood tests are remarkable only for mild members for their guidance in the implementation of this elevations in transaminases (ALT, AST). Clinical reference text (lab values) project: Insulin Increased lipolysis Dr. Nicolas Ziats and Dr. Richard Henson (SCTL mentors), METHODS You schedule the patient for a liver Increased uptake core biopsy. Fatty acids Leptin of fatty acids adipocytes Dr. Joseph Miller (Anatomy) 1. Screen virtual slide database for image substitution into using PC-1 Rad Faculty of the Scholars Collaboration in Teaching and existing PowerPoint modules of “Steatohepatitis” and TNF-a TNF-a Learning Program of 2003-2004. “Wound healing” as pilot programs. Fatty acids Rad PC-1 cytochrome P-450 4A/2E1 Mitochondrial b-oxidation overload Leptin 2. Identify and create pertinent hyperlinks to web and online Captured portion of Fatty acids SOM lectures. virtual image can be Lipid peroxidation Fatty acids accumulate glycolysis annotated for Hyperinsulinemia KEY REFERENCE 3. Test wireless computer capability in small classrooms. specific structure Synthesis of fatty acids Insulin 4. Design and organize training sessions and written manual for identification with hepatocyte Romer DJ, Suster, S. Use of virtual microscopy for students and faculty. weblinkage. apolipoprotein B-100 didactic live-audience presentation in anatomic Triglycerides accumulate pathology. Ann Diagn Pathol 7 (1):67-72,2003. 5. Evaluate effectiveness of module for increasing students’ understanding of pathology and the disease process. Mechanism for insulin-resistant steatohepatitis. Animated online PowerPoint figure. Modified from module reference article-Fig 2B.Angulo P, NEJM 346(16), 2002.
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