Design of the Elective
We designed a 2-week online elective with the overarching goal that learners, by focusing on the study of several malignant tumors and their precursor lesions, would acquire an enhanced knowledge of malignant diseases and therefore the basis for robust understandings of oncologic pathology and oncology. The elective was available for any student who had successfully completed our foundational sciences curriculum. Students passing the elective would gain appropriate credit as determined by institutional policy.
The elective included a total of 6 interactive, synchronous live sessions using Zoom videoconferencing (3 sessions per week). We decided to accept a maximum of 10 students per elective iteration, believing that an instructional approach based on small groups best suited our program, supporting increased student participation and positive learning outcomes.
Two WCM-Q and Department of Pathology and Laboratory Medicine WCM-NY faculty members developed 9 clinicopathological cases with corresponding virtual slides from the University of Leeds Virtual Pathology Slide Library (http://www.virtualpathology.leeds.ac.uk/slides/library/). This open access collection of slides is digitized and curated by trained pathologists and stored with anonymized clinical information, used for teaching and training. Slides can be viewed on standard computer screens and mobile devices and are globally accessible. All cases included an initial clinical vignette describing a patient presentation and diagnostic imaging and laboratory results, followed by biopsy and/or surgical excision histopathological findings. The cases also presented illustrations of gross specimens, immunohistochemical images, and for some, descriptions and results of advanced molecular studies. The cases focused on uterine cervical, colonic, pulmonary, and mammary oncologic pathology, and included a list of differential diagnoses, with the University of Leeds Slide Library virtual slides illustrating alternative but meaningful and related pathological entities.
As our foundational sciences curriculum at WCM-Q includes general and systemic pathology, our students had already acquired a basic knowledge of pathology. We accordingly created cases that were somewhat more complex than those our learners had already studied, so they would continue incorporating new information and constructing new understandings in pathology throughout this elective.
We included in all cases 2 types of questions aimed at topics addressed during the sessions: first order basic queries and more complex United Stated Medical Licensing Examination (USMLE) type items. Students were expected to answer these questions to the best of their knowledge drawn from readings and general preparation. We included the USMLE items with the following 3 objectives: first and most importantly, to ensure students had learned their materials and increased their knowledge; second, to strengthen their self-directed learning (SDL) and subsequent self-assessment skills; and third, to contribute to their preparation for the USMLE Step 1, an exam taken by most of our learners prior to graduation.
We decided to interactively teach and connect with the students via the Zoom videoconferencing platform. Zoom allows for screen sharing and remote control by any participant––a significant plus, we believed, that could enhance learner autonomy and self-discovery skills by granting students full control to point out specific areas while describing pathology or radiology images. In addition, we also chose to make use of the built-in Zoom polling as another way to increase student contributions during case discussions.
As we planned the elective, we decided that students would be expected to independently prepare for these Zoom sessions by reviewing the cases and digital slides, completing assigned readings, and answering all questions in advance (asynchronous SDL). This independent preparation was factored into the students’ assessment. Therefore, in order to support our students’ success, the program comprised two components of approximately equal importance: a preparatory asynchronous SDL step followed by synchronous interactive sessions with live Zoom discussions.
The elective was hosted on the WCM-Q Canvas Learning Management System (LMS). Each iteration included a unique centralized site on Canvas, allowing for faculty and learner interaction, student submissions, access to teaching files, images, and other documents, and assessment of students after completion of the elective.
Students were also tasked with writing a final 500-word summary review of a case discussed during the elective, addressing all significant pathological and related clinical issues. The review was open-ended, and no written rubric was provided to the students; instead, they were given verbal instructions at the beginning and end of the elective.
A final written assessment of each student’s performance included several items graded on a 5-point Likert type rating scale, including formative and summative comments. In addition, the faculty provided oral formative feedback to the students through one-on-one Zoom meetings. The final course grade was assigned as Pass/Fail.
This project was submitted to the WCM-Q Institutional Review Board (IRB) and determined IRB exempt.