All Lymph Hist Questions Active Learning: Histology Laboratory Teaching in a Whole Class Setting Utilizing Virtual Slides Robert A. Bloodgood, Department of Cell Biology, UVa School of Medicine 1. Background and Rationale: Changes in the medical curriculum, increase in class size and problems with faculty staffing of small groups have put pressure on laboratory teaching and driven the need to experiment with ways to present laboratory material in a whole class setting without completely sacrificing the active learning and small group work that was the hallmark of the traditional histology labs. This poster presents an example of how this approach was piloted for one topic in the Next Generation curriculum, histology of the lymphoid tissues and organs, within the Microbes and Immune System (MIS) during Fall 2011 (Class of 2015). 2. Description of the Educational Innovation: The goal of this session was to provide a morphological framework for the cellular and molecular and clinical immunology which was one of the major focuses of the MIS organ system. Students were provided a handout and powerpoint on lymphoid histology for self-study prior to the session (there is no information available on how many students utilized these resources ahead of time). Selected lymphoid microscope slides (representing normal examples of: 1.Thymus, 2. Spleen, 3. Tonsil, 4. Peyer’s Patches, 5.Lymph Node, 6. Lymph Node- Germinal Center, 7. Appendix, 8. Lymphoid nodule in lung) were turned into Virtual Slides using an Aperio slide scanner and entered into the UVa MMDB, where they were made available using Aurora web server software (Panel 6). A Word file instruction sheet (Panel 7) containing links to the 8 slides and assignment of 4 of the slides to even numbered tables and the other 4 slides to odd numbered tables was put on the course web site and made available to the students at the beginning of the 50 min session in the Learning Studio in the Medical Education Building (Panel 5). Students were instructed to work in groups of three using a single student laptop. Each group of 3 students was given the task of learning to identify the four lymphoid tissues or organs assigned to them and to complete a work sheet (Panel 8) on which they listed three criteria that allowed for the unique identification of each of these lymphoid tissues/organs. The student groups were given about 25 minutes to complete this task while a single instructor circulated around the room providing assistance to the groups. In the next phase of the exercise (20 min), random tables were called upon to provide 2 students to come to the podium and present one of the tissues/organs, using the Virtual Slide projected onto all 5 screens in the room, and to describe the unique characteristics allowing identification of that tissue/organ. Other students asked questions during these student presentations. One slide (the lymph node germinal center slide used for immune cell type identification) was presented by the instructor and tables participated in immune cell type identification using laser pointers distributed to each table (last 5 min). After the exercise was completed, a master table (Panel 9) of identifying characteristics for each lymphoid tissue/organ was compiled by the instructor from the student work sheets and e-mailed to the class and posted on the organ system web site. 3. Evaluation of the Educational Innovation: Feedback and data about this exercise were collected from the following sources: 1. System Leader, 2. Instructor/Content Thread Leader, 3. Report of the objective observer assigned to the session, 4. Medical student work sheets, 5. Medical student feedback on system evaluations and 6. Performance of assessment questions with comparison to the performance of the same questions in a traditional laboratory teaching setting. The Objective Observer rated this session as 100% active learning and rated it on Bloom’s taxonomy as: Create: 0%, Evaluate 0%, Analyze: 45%, Apply: 45%, Understand: 5%, Remember: 5%. Average assessment question performance (Panel 10) was very similar to that seen when the material was taught in traditional small lab groups with individual instructors and using individual student microscopes and group video microscopes. The small sample sizes did not allow for meaningful statistical analysis. Only a limited amount of student feedback showed up in the organ system evaluations. Examples of the major comments: “The Histology session was very informative and useful…. The histology section was interactive and educational. I liked the structure of the handout and then the class lecture/discussion on different cell types…the lymphatics histology should have been 2 hours… we only got through a small portion of the lymph organs that we are expected to know so I think having a second hour would have been nice.” Suggestions for improving the activity are given in Panel 4 below. 4. Suggested Improvements: Better student attendance Longer time period for the exercise Additional faculty to circulate among the tables and assist the 3 person working groups Finish the exercise with some Virtual Slide unknowns in order for students to test their identification skills using the criteria they developed for each lymphoid tissue/organ Schedule the lecture on "Functional Anatomy of the Immune System” before this session 5. MEB Learning Studio where the activity was conducted 7. Instruction sheet provided at time of the exercise 8. Worksheet used for the exercise 9. Compiled table of lymphoid tissue/organ characteristics that emerged from this exercise; this was compiled by the instructor and provided to the medical students after the exercise was completed. MIS Lymphoid Histology Exercise: (Work in Groups of 3 using a single laptop; use laptop with biggest screen) Study the following Virtual Slides and complete the double-sided Work Sheet that you will find at each table: Even Tables: 1. Thymus, 2. Spleen, 3. Tonsil, 4. Peyer’s Patches Odd Tables: 1. Lymph Node, 2. Lymph Node-Germinal Center, 3. Appendix, 4. Lung Thymus: http://pix.med.virginia.edu:8081/mediaapi/viewer?filename=/home/mscope/slides/high/14000/59Thymus.svs Lymph Node: http://pix.med.virginia.edu:8081/mediaapi/viewer?filename=/home/mscope/slides/high/14000/57LymphNodeThick.svs Lymph Node – Germinal Center: http://pix.med.virginia.edu:8081/mediaapi/viewer?filename=/home/mscope/slides/high/15000/lymphnode22.svs Spleen: http://pix.med.virginia.edu:8081/mediaapi/viewer?filename=/home/mscope/slides/high/15000/Spleen20.svs MALT – Tonsil: http://pix.med.virginia.edu:8081/mediaapi/viewer?filename=/home/mscope/slides/high/14000/58Tonsil.svs MALT: Appendix: http://pix.med.virginia.edu:8081/mediaapi/viewer?filename=/home/mscope/slides/high/14000/Appendix1.svs MALT: Peyer’s Patches (use right most of the three images): http://pix.med.virginia.edu:8081/mediaapi/viewer?filename=/home/mscope/slides/high/14000/84DuodenumJejunumIleum.svs MALT: Lung: http://pix.med.virginia.edu:8081/mediaapi/viewer?filename=/home/mscope/slides/high/14000/140LungHuman.svs 1o or 2o Lymphoid Organ Organ or Tissue Defining Histological Features Primary Thymus 1. Connective Tissue Capsule 2. Cortex versus Medulla 2. Continuous Cortex; no lymphoid nodules 3. Thymic corpuscles (Hassall’s Corpuscles) in medulla 4. Epithelial cell framework Secondary Lymph Node 2. Afferent and efferent lymphatics 3. Cortex versus Medulla 4. Cortex has lymphoid nodules and paracortex 5. Medulla has medullary cords and medullary sinuses 6. High endothelial venules (HEVs) in paracortex 7. reticular cell and reticular fiber framework Spleen 2. Red pulp versus white pulp 3. Lymphoid nodules spread out throughout the organ 4. Central arteries in lymphoid nodules 5. Many macrophages 6. Splenic sinusoids in red pulp 7. Reticular cell and reticular fiber framework 8. Open and closed blood circulation MALT -Tonsil 1. Only partially encapsulated 2. Covered with stratified squamous epithelium 3. Deep crypts 3. Many lymphoid nodules throughout – mostly secondary nodules 4. Efferent but no afferent lymphatics 5. Found in oral cavity and oropharynx MALT-Appendix 1. No capsule 2. Tightly packed lymphoid nodules in mucosa and submucosal 3. Mucosa of simple columnar epithelium with lots of goblet cells 4. Crypts of Lieberkuhn but no villi 5. Outpocketing of the large intestine (colon) MALT-Peyer’s Patches 1. Found associated with the ileum portion of the small intestine 3. Non-encapsulated lymphoid tissue MALT-diffuse lymphoid tissue 1. Single lymphoid nodules found in almost any connective tissue but especially located close to lumens in the body (GI track; urogenital track; Respiratory track) 2. Can be located in mucosal or submucosal connective tissue 3. Non-encapsulated 6. Example of a Virtual Slide in the Aurora mScope viewer 10. Performance of the lymphoid assessment questions used for this activity with comparison to past performance under traditional small group laboratory teaching MMDB ID# 2011 Experiment (NxGen) 2010 Traditional Lab (NxGen) 2009 Trad Lab Old Curr 2008 2007 2006 2005 2004 2003 All Admin 18342 85% (.10) 85% 18338 88% (.17) 89% (.29) 94% (.19) 100% (.00) 92.8% 18337 95% (.14) 95% (.12) 97.8% (.08) 95.9% 18339 86% (.24) 72% (.54) 87% (.30) 91% (.35) (.31) All Lymph Hist Questions 88.5% (n=4) (n=5) 89.8% 78.2% 86.8% 85.4% 84.8% 85.2% 90.6% 84.6% (n=44) Funding: David Harrison Distinguished Teaching Award. The Commonwealth of Virginia Equipment Trust Fund paid for the Aperio Virtual Slide Scanner.