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									                      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
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:
                                                                                                                                                                                                                                                      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
                                                                                                                                                                                                                      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
                                                                                                                                                                              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

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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