The Rise of KiKo

It’s an exciting time for digital pathology. And the platform Knowledge In Knowledge Out – affectionately named KiKo – is a prime example as to why. KiKo is a next-generation online platform that combines social media with digital pathology. Users can put “knowledge in” and gain “knowledge out,” while sharing their experiences worldwide. In 2019, KiKo was founded by Jonhan Ho, a faculty dermatopathologist and dermatopathology fellowship program director at the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania. While the KiKo platform can be used by any physician, trainee, and medical student across all subspecialties, KiKo has found a niche within the virtual dermatopathology community. The platform allows users to upload digital slides via whole slide imaging (WSI) and craft educational posts that can be shared across other social media platforms. WSI storage can be costly, but KiKo users can upgrade their storage spaces (US$10/100 GB/per month) after they’ve used up the free allowance of five GB.

In 2022, Hassell and colleagues composed a literature review that used personal experiences of authors and educators to look at the utility of digital pathology in medical education (1). According to the authors, recent literature suggests that digital pathology is well embedded in peer-to-peer and patient-centered education, and can be effectively applied in undergraduate and postgraduate training programs. From creating interactive lectures and unknown sessions, to establishing slide deck- and game-based learning curricula, WSI has changed the educational ball game and has found utility in multiple aspects of health care, such as tumor boards.

But how does KiKo promote medical education through WSI? After creating a free profile, users can upload their digital slides onto the site and tag them to different posts for case reports and unknown discussions. In other words, KiKo allows medical educators to create accessible, organized indexes (or libraries) of posts for easy navigation. These “MEGAs” (a term coined by platform co-founder Jerad Gardner – a dermatopathologist and bone/soft tissue pathologist at Geisinger Medical Center in Danville, Pennsylvania) can be on any topic. This is where KiKo’s impact on dermatopathology has seemingly grown. Dermatopathologists like Gardner (see box below) use KiKo to create educational, annotated libraries. In these libraries, they can upload teaching slides, video lectures, and high-yield differential discussions, all while sharing timely articles for the benefit of trainees anywhere in the world with internet access.

Although using social media for pathology or medical education is nothing new, KiKo’s applicability to bring digital pathology into the mix brings something new and desirable for educators, regardless of age. A recently added feature is KiKo Case Reports (KCR) – a multidisciplinary medical journal for physicians and researchers devoted to rapid communication of unique clinical patient presentations. According to Ho and colleagues, the “current scholarly communication industry is inefficient, antiquated, closed, and exploitative”(2). To that end, KCR was developed as a peer-reviewed digital journal that is “simplified, efficient, and physician crowd-sourced that rewards both authors and reviewers for scholarly contributions to medicine” in minimal time with process transparency (2). This includes publishing pathology-based case reports integrated with appropriate WSI and social media references that can be easily distributed on any platform.

There are some downsides to the current version of KiKo. Given its youth, bugs are expected, but routine updates are increasingly improving the user interface; we have to remember that KiKo is not a social media giant like X, Facebook, Instagram, YouTube, and TikTok – yet. And KCR is also nowhere near as established as highly published academic journals, such as the Journal of Cutaneous Pathology, American Journal of Dermatopathology, Modern Pathology – yet.

With KiKo’s unique ability to allow users and educators to share posts, including WSI links,  onto other platforms, it seems likely that the support of WSI-sharing media will only continue to grow as pathology (and pathology education) becomes more digitized, especially for dermatopathologists. 

Although KiKo and KCR have a long way to go to reach their full potential, they are heading in a direction that will likely influence the natural progression of pathology and dermatopathology. Exciting times indeed!