A Virtual Microscopy Learning Platform - a High Quality, Innovative and Interactive Tool for Training Haematologists of the Future: A UK Pilot Study

Introduction:Virtual microscopy (VM) allows a whole slide once scanned, to be visualised, navigated and annotated at different magnifications on a digital viewing platform. Advantages for trainees are numerous; slides can be viewed simultaneously by large numbers of students or accessed remotely at the student’s time and place of preference. In the UK all Haematology trainees are required to be competent in diagnostic evaluation of blood films, bone marrow aspirates and trephines. The drive towards laboratory centralisation, increasing automation and full shift working patterns has decreased access to traditional small group teaching using a multi-headed microscope. VM has the potential to realise new modes of training delivery and to prepare haematologists for the advent of VM as a mainstream diagnostic tool.

Aim: To review the utility and acceptability of incorporating virtual microscopy into a virtual learning environment (VLE) for haematology trainees.

Methods: Over a 6 month period a VLE has been developed centred on the use of VM comprising of:

• basic morphology tutorials including interactive learning modules and instructional videos

• annotated image bank

• clinical case scenario simulation

• mock examination practice

Curriculum mapped content was created to develop acquisition of morphological skills from first principles. 4 interactive modules take users through a step-wise approach to examining a blood film, recognising normal appearances, identifying morphological abnormalities and interpreting their findings in the film report. Case scenarios, requiring trainees to identify morphological abnormalities and put these into clinical context were developed using structured questioning, providing instant feedback on performance at each stage of the case. Additional resources include an annotated image bank of >250 slides and mock examination cases.

The use of VM to support large group teaching was piloted at an afternoon for haematology trainees in London. Haematopathology slides were made available on-line prior to the session with videos introducing an approach to examining trephines and lymph nodes. Questions to facilitate examination of the slides were built in to promote learning. The interactive session was facilitated by trainees using the VLE site and case discussions made available on-line for future reference.

Informal feedback on the site was encouraged alongside its development and formal surveys were undertaken to evaluate the quality and utility of the VLE both for self-directed and large group teaching.

Results:

The VLE was piloted to 40 trainee haematology physicians and 10 biomedical scientists only 1 of whom had previous experience of VM. 100% of participants viewed the experience as ‘useful’ or ‘very useful’ and would recommend to other colleagues. Junior trainees particularly valued the structured tutorials on blood film reporting and annotated practice cases. The novel application of the VLE for simulating haematological emergencies presenting with laboratory abnormalities (e.g. APML) was found to be invaluable by new trainees in preparation for out of hours work.

88 trainees attended the large group teaching session. Slides were viewed on-line by 53/88 (60%) trainees in preparation. 78% of trainees rated the training experience as 5/5 (very good). Free text comments included: “pre-course material very useful; really liked the digital microscopy; the most useful day this year”. The use of VLE in this context has been incorporated into future training events.

When comparing to light microscopy the key benefits of VM identified by users were:

• Accessibility

• Ability to return to review material as desired

• Annotation of digital images

• Ability to compare different slides side by side within the same screen window

• Availability of slides of rare diagnoses.

Overall, image quality was rated as equivalent to viewing glass slides. Technicalities of viewing the slides (panning, changing magnification and adjusting focus) were easier using a light microscope compared to the digital microscope interface.

Conclusions:Incorporation of VM into a VLE is an innovative and effective platform for transforming haematology training for the 21^st century. Its versatility, quality and accessibility facilitate its implementation into a wide range of learning settings. Minor technical limitations can be easily addressed to improve the user experience.