Outcomes of Remote Pathology Instruction in Student Performance and Course Evaluation

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has disrupted undergraduate medical education, including preclinical class-based courses, by requiring social distancing and essentially eliminating in-person teaching. The aim of this study was to compare student performance and satisfaction before and after implementation of remote instruction in a first-year introductory pathology course. Assessments (3 quizzes, 1 practical exam, and 1 final) were compared between courses given before (January 2020) and during (January 2021) the COVID-19 pandemic, in terms of mean scores, degree of difficulty, and item discrimination, both overall and across different question types. Students’ evaluations of the course (Likert scale-based) were also compared between the 2 years. Significantly higher mean scores were observed during remote instruction (compared to the prior, in-person year) on verbatim-repeated questions (94.9 ± 8.8 vs 89.4 ± 12.2; P = .002) and on questions incorporating a gross specimen image (88.4 ± 7.5 vs 84.4 ± 10.3; P = .007). The percentage of questions that were determined to be moderate/hard in degree of difficulty and good/very good in item discrimination remained similar between the 2 time periods. In the practical examination, students performed significantly better during remote instruction on questions without specimen images (96.5 ± 7.0 vs 91.2 ± 15.2; P = .004). Finally, course evaluation metrics improved, with students giving a higher mean rating value in each measured end point of course quality during the year of remote instruction. In conclusion, student performance and course satisfaction generally improved with remote instruction, suggesting that the changes implemented, and their consequences, should perhaps inform future curriculum improvements.

Virtual Pathology Education in Medical Schools Worldwide during the COVID-19 Pandemic: Advantages, Challenges Faced, and Perspectives

“…Our literature review revealed that the remote delivery of pathology courses worldwide was generally followed by highly positive student evaluations, as reported by several authors [3,5,9,10]. Notably, evaluation scores were often improved, compared to the previous years when traditional on-site delivery had taken place [5,9]. Medical students regarded the remote delivery of classes as flexible and less time-consuming, while they appreciated that teaching materials (e.g., session recordings and virtual slides) were available to access anytime and from anywhere [4,10].…”

“…Our literature review revealed that the remote delivery of pathology courses worldwide was generally followed by highly positive student evaluations, as reported by several authors [3,5,9,10]. Notably, evaluation scores were often improved, compared to the previous years when traditional on-site delivery had taken place [5,9].…”

“…A study by Waugh et al compared two student cohorts completing the same pathology curriculum, one with remote delivery (during the pandemic) and a prior one taught face-to-face; there was a significant improvement in the mean practical examination overall mark (65.36% ± 13.12% to 75.83% ± 14.84%, p < 0.05) for the online student cohort [ 6 ]. Likewise, in another study, pathology students attending a virtual pathology course performed significantly better in their practical questions devoid of images (96.5 ± 7.0 vs. 91.2 ± 15.2; p = 0.004) and on questions coupled with gross pathology images (88.4 ± 7.5 vs. 84.4 ± 10.3; p = 0.007), as compared to students completing the on-campus course the previous year [ 5 ]. Lastly, Krasowski et al reported similar examination scores among three consecutive years of preclinical pathology teaching, the last of which was conducted virtually [ 27 ].…”

“…A number of studies reported the presence of technical issues hindering the online delivery of pathology classes, such as the suboptimal internet connection. A high internet speed and bandwidth are necessary, especially while examining digital pathology slides [ 5 , 9 , 10 , 21 , 29 ]. Notably, our recent study revealed that a suboptimal internet connection was associated with a worse final examination performance ( p = 0.04), while the former was also independently associated with enhanced perceived stress levels [ 3 ].…”

“…Recently, there has been a tendency to include more case studies and exercises highlighting clinicopathological correlations into pathology teaching, in order to integrate with other courses within the medical school curriculum and emphasize pathology’s clinical significance in medicine’s multidisciplinary setting [ 1 , 2 , 3 ]. In general, pathology courses run for a whole semester or more when designed for preclinical medical students [ 3 , 4 , 5 , 6 ]. Notably, in some medical schools, senior medical students can additionally choose to attend a more advanced pathology elective which could be 2- to 4- weeks duration.…”