Development and evaluation of an online integrative histology module: simple design, low-cost, and improves pathology self-efficacy

Figures & data

Figure 1. Module Screenshots. (A) Sample screenshot from the bronchus review video. In this frame, the normal thickness for the submucosal glands was reviewed and the names of two conditions were provided that involve changes to the thickness. (B) Sample screen shot from a drag and drop review activity. The user was instructed to move eight specimen images into the corresponding boxes. (C) Answers to drag and drop review activity shown in (B). Histology images were obtained from the Virtual Microscopy Database under an Attribution-NonCommercial-ShareAlike 4.0 Creative Commons License (CC). Image (A) was edited to add arrows and percent

Figure 2. Study Timeline

Study data were collected at two time points (phases). The data collected in each phase is listed in gray in the last line of each box. *Day ‘T’ represents the day during which the pathology laboratory session occurred.

Table 1. Pre-laboratory self-efficacy scores

	Pathology Self-Efficacy			General Self-Efficacy
A. Self-Efficacy Scores by Module Use
Module Use (n = 95)	Median	IQR^§	MW^†	Median	IQR^§	MW^†
Users (n = 62)	24	21–24	p = .02*	8	7–9	p = .70
Non-users (n = 33)	22	19–24		8	7–8
B. Self-Efficacy Scores by Preparedness Rank
	Pathology Self-Efficacy			General Self-Efficacy
Preparedness Group (n = 95)	Median	IQR^§	KW^‡	Median	IQR^§	KW^‡
Least Prepared (n = 20)	24	22–24.25	p = .46	8	7.75–9.25	p = .42
Moderately Prepared (n = 49)	23	21–24		8	8–9
Most Prepared (n = 26)	22	20–24.75		8	7–9
C. Self-Efficacy Scores by Lectures Watched
	Pathology Self-Efficacy			General Self-Efficacy
Lectures Watched (n = 95)	Median	IQR^§	KW^‡	Median	IQR^§	KW^‡
0–1 Lectures (n = 13)	24	23–25	p = .76	8	8–10	p = .27
2–3 Lectures (n = 18)	23	21–24		8	7–8
4–5 Lectures (n = 26)	23	20.25–24		8	8–9
6–7 Lectures (n = 38)	22.5	20.25–24		8	7–9
D. Self-Efficacy Scores by Self-Study Hours
	Pathology Self-Efficacy			General Self-Efficacy
Self-Study Hours (n = 95)	Median	IQR^§	KW^‡	Median	IQR^§	KW^‡
0 Hours (n = 21)	23	21–24	p = .59	8	8–9	p = .08
1–5 Hours (n = 56)	24	21–24		8	7–9
6–10 Hours (n = 16)	22.5	20.75–25.25		8	7–9
11–15 Hours (n = 2)	20.5	20.25–20.75		5	5–5
>15 Hours (n = 0)	–	–		–	–

^§Interquartile range; ^†Mann-Whitney U test; ^‡Kruskal-Wallis rank sum test; *Significant difference for alpha value set to .05

Figure 3. Pathology Self-Efficacy versus General Self-Efficacy

There is a significant positive correlation between pathology self-efficacy and general self-efficacy among participants (r(93) = 0.64, p < 0.001, Spearman rank correlation test).

Table

Video	Normal Histology Featured	Pathology Correlation
1. Respiratory Epithelium	Respiratory epithelium is classified as pseudostratified ciliated columnar from the nasal cavity to distal bronchi (exceptions: nasal vestibules, olfactory region, lingual side of epiglottis, true vocal fold)	Squamous metaplasia is a feature of chronic bronchitis Squamous metaplasia can lead to squamous dysplasia and squamous cell carcinoma
	Tall ciliated cells & function	Smoking interferes with ciliary action, preventing mucus clearance
	Scattered goblet cells & function	Goblet cell hyperplasia is a feature of chronic bronchitis and asthma
	Short neuroendocrine/Kulchitsky cells & function	Origin of neuroendocrine tumors e.g., small cell carcinoma, carcinoid
2. Bronchus	Lumen clear of neutrophils	Neutrophils in lumen seen in bronchopneumonia
	Visible basement membrane	Thickened basement membrane seen in asthma
	Mucosa can have sparse lymphoid tissue (BALT^1) composed of lymphocytes and histiocytes.	Mucosal inflammation seen in bronchitis: Neutrophils = acute inflammation Plasma cells & lymphocytes = chronic inflammation
	Thin layer of crisscrossing smooth muscle bundles in mucosa	Smooth muscle layer thickening seen in asthma
	Submucosal glands occupy ~40% of the distance between epithelium and cartilage	>40% in chronic bronchitis, sometimes asthma
3. Bronchiole	Largest bronchioles: Ciliated simple columnar epithelium with scattered goblet cells Smallest bronchioles: ciliated simple cuboidal. Scattered club (Clara) cells & function.
	No inflammatory cells in mucosa	Mucosal inflammation seen in bronchiolitis
	Thin layer of mucus on epithelial cells but mucus should not clog lumen	Mucus can clog lumen in asthma patients
	Thin layer of crisscrossing smooth muscle bundles	Smooth muscle layer thickening is feature of asthma
4. Alveolus	Approximate diameter is 200um	Alveolar space enlargement seen in emphysema
	The only normal structure within the lumen is the alveolar macrophage. Alveolar macrophage function	Inflammatory exudate within the lumen seen in bacterial pneumonia and ARDS^2 Cellular debris in lumen seen in ARDS Exudate of neutrophils, erythrocytes, and fibrin in lumen seen in bacterial lobar pneumonia in hepatization stage. Clear, acellular fluid in lumen seen in pulmonary edema
	Type I and II pneumocytes & function. Alveolar wall lined by type I and II pneumocytes only.	Neoplastic cells in alveolar wall can lead to adenocarcinoma Pink bands (hyaline membranes) lining the inside of the alveolus can be seen in ARDS and in severe viral pneumonia.
	Thin alveolar septum comprised of type I pneumocytes and their basement membrane sandwiching: Continuous capillaries and their basement membrane Interstitium (rich in elastic, and reticular fibers)	Thickened interalveolar septum seen in viral pneumonia (interstitial pneumonia). Increased mononuclear cells (lymphocytes, plasma cells) present in thickened alveolar walls in viral infection. Fibrosis or increased inflammation in the interstitium can lead to interstitial lung disease

^aBALT: Bronchus-associated lymphoid tissue; ²ARDS: Acute respiratory distress syndrome

Table

Statement	Strongly disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Strongly agree
I will be able to achieve most of the goals in respiratory histopathology that have been set for me.	□	□	□	□	□
When facing difficult tasks in respiratory histopathology, I am certain that I will accomplish them.	□	□	□	□	□
In general, I think that I can obtain outcomes that are important for histopathology.	□	□	□	□	□
I believe I can succeed at most any endeavor to which I set my mind.	□	□	□	□	□
I will be able to successfully overcome many challenges in respiratory histopathology.	□	□	□	□	□
I am confident that I can perform effectively on many different tasks in respiratory histopathology.	□	□	□	□	□
Compared to other people, I can do most tasks in histopathology very well.	□	□	□	□	□
Even when things are tough, I can perform quite well.	□	□	□	□	□

¹This self-efficacy survey has been modified for tasks related to histopathology from an original validated self-efficacy survey by Gilad Chen, Stanley M. Gully, and Dov Eden published in Organizational Research Methods (Vol. 4, No. 1) pp. 62–83, copyright © 2001 SAGE Publications, Inc. Reprinted by Permission of SAGE Publications, Inc.