Virtual histopathology–essential education tools to ensure pathology competence for tomorrow’s medical interns

Introduction:
In elucidating disease mechanisms, histopathology – studied through microscopic examination of tissue biopsies / resections – is a fundamental science in determining patient diagnosis, prognosis and subsequent management. With the advent of high resolution image-capturing devices and portable vivid displays, there is a discernible shift from glass slides to virtual microscopy. Virtual microscopy can be viewed and manipulated using computer-based software which mimics the traditional light microscope. However, although virtual microscopy use has become more prevalent in clinical practice, its role in medical education needs to be reviewed further.
Rationale:
Virtual histopathology (VHP) has potential applications in both medical education and clinical diagnostic pathology. Rare / complex diseased tissues images, captured through VHP, can be immortalized for collaborative diagnoses by pathologists across the world and also used as important teaching tools. With inclusion of annotated text, busy interns - working in non-teaching hospitals with limited/no access to pathology teaching facilities - can still remain updated on pathology proficiencies via their smartphones and tablets.
Objective:
To critically evaluate literature on virtual histopathology resources and review resources specifically contextualised for self-directed continuous professional education for junior doctors.
Methodology:
A comprehensive search of the databases was undertaken, including Cochrane Library, Google Scholar, PubMed and OpenSearch and number of peer reviewed journal articles focusing on virtual histopathology and education were analysed. The search terms comprised “Digital” or “Virtual” AND “Histopathology” AND “Education” or “Learning” or “Teaching” or “Training”. MeSH terms included: “Audiovisual aids; Computer graphics; Computer-Assisted Instruction/methods; Cytodiagnosis; Education; Distance/methods; Education, Medical Graduate/methods; Humans; Learning; Microscopy; Pathology/education; Pathology, Surgical/methods; Questionnaires; Teaching/methods; Textbooks as Topic User-Computer Interface”.
Results and discussion:
Initially, over 400 results were generated through PubMed and, after using a “Human” only filter, over 300 results remained. Each subsequent article was selected after screening abstracts which matched the search terms and reviews were limited to articles with fully downloadable papers. Findings were then tabulated and analyzed according to the following themes:Integration with anatomical pathology, resolution, size, magnification, manoeuvrability of virtual fields, annotations/labelling, mobile device friendliness, utility and integration with cytology. Majority of the papers were related to VHP for diagnostic purposes and education for pathology speciality trainees; followed by medicine (dermatopathology) speciality trainees. Limited papers were obtained for undergraduate and internship histopathology education.
Conclusion:
This data show that, despite evidence of integration into pathology diagnostic practices, literature on VHP tools developed specifically for undergraduate, and internship pathology education purposes is lacking. A digital histopathology repository can serve as an education tool, enhance pathology / laboratory medicine competencies and also allow collaborative diagnosis. This ultimately will lead to improved patient care and clinical outcomes as practised by future doctors.