Educating the Digital Generation

Digital pathology has been on the scene for several years now, and we can find plenty of literature about its implementation and advantages in education – but there is a distinct lack of concrete methodologies. How exactly do we apply digital pathology to benefit students?

As with most medical professions, the theoretical aspect of pathology is mostly taught using traditional study and memorization. But with digital pathology, we can do much more. And I feel we must take advantage of everything that it has to offer our new students from the “digital generation”. We should all be striving to share a vision of pathology that radiates unparalleled attractiveness – and that means integrating technology into our learning environments.

On the surface, that integration seems like a simple enough adjustment; create online tutorials or links to web content with digitized preparations to reinforce the knowledge acquired in class. But in our hospital, we wish to go further.

In 1999, Europe set new standards for medical education. The requirements change the way medicine is studied from a traditional model based on knowledge acquisition to one more focused on acquiring professional competencies (1) – skills, aptitudes and values. Alongside this change, the evaluation system is also shifting; we’re seeing increasing deployment of objective structured clinical examination (OSCE) formats. From an educational point of view, this implies reduced lecture hours in favor of supervised practical training – and that’s where clinical simulation comes into play.

Simulation offers students a more realistic view of our daily work while providing them with skills of undoubted value. It also improves patient safety and quality of care by allowing learners to practice techniques in a risk-free environment. Without simulation, the first time students carry out new techniques will be on patients.

My colleagues and I have been developing clinical simulation programs in fine needle aspiration (FNA) with phantom models (WO/2016/185077 and WO/2017/109241) since 2013. We work with third-year medical students from the University of Murcia (and international exchange students through IFMSA – the International Federation of Medical Students’ Associations). Each student is exposed to a clinical experience and individualized scenario that includes anamnesis, physical examination, asepsis/antisepsis measures, and finally the FNA procedure to obtain optimal material for study. A facilitating teacher accompanies the students throughout the procedure and enriches each case with digitized preparations – both cytological smears and biopsies – for an understanding of not only the procedure, but also each disease. The combination of simulation and digital facilitation ensures that each student acquires puncture skills with context.

But FNA isn’t the only use for simulation. Starting in 2014 (and achieving full development two years later), we implemented simulation workshops in macroscopic dissection using handmade silicone task simulators fabricated to resemble surgical tumor resections. Students have the task of correlating the surgical specimen with the request form, carrying out measurements, and conducting the gross – that is, describing the specimen and margins, sectioning, and including in cassettes. Each sample is also accompanied by a histological correlation and final resolution of the clinical case, using whole slide imaging (WSI) in large-format monitors to understand aspects such as macroscopic management, assessment of surgical margins, microscopic visualization and diagnosis, and prognostic significance.

In my opinion, the training of medical professionals must, of course, include theoretical knowledge – but, vitally, it should also include technical skills obtained through practical experience. The importance of that hands-on education is sometimes underestimated by teaching staff, who don’t or can’t offer appropriate methodologies with truly useful and standardized knowledge for the student. Often, they only show what a professional is doing at a particular moment, resulting in non-uniform practical training among students and a missed opportunity to better “show off” our specialty and attract potential new pathologists.

That said, I acknowledge that the implementation of this model is difficult. It requires time, greater economic investment, more teachers, more equipment and better infrastructure. At present, the high ratio of medical students to teachers can make it hard to offer these types of time-consuming, interactive activities; unfortunately, it favors a traditional form of teaching that is increasingly insufficient for the acquisition of competencies and clinical skills. With so many different constraints to balance, simulation presents a challenge for teachers (who may never have been taught how to teach) – but also an opportunity like never before. Perhaps the ability to rise to this challenge is truly the “art of teaching.”