Open Access

As you sow, so shall you reap: Is there a “golden standard” to teach histology?

Szabolcs Felszeghy[1], Gregory Gilbert[2], Ali Koskela[3], Petteri Nieminen[4], Reijo Sironen[5], Sanna Pasonen-Seppänen[4], Erkko Sointu[6], David Morton[7], Anitta Mahonen[4]

Institution: 1. University of Eastern Finland, 2. SigmaStats® Consulting, LLC., 3. Institute of Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 4. Institute of Biomedicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 5. Clinical Pathology, Institute of Clinical Medicine, Kuopio University Hospital, 6. School of Educational Sciences and Psychology, Philosophical Faculty, University of Eastern Finland, 7. Department of Neurobiology and Anatomy, University of Utah School of Medicine
Corresponding Author: Dr Szabolcs Felszeghy ([email protected])
Categories: Curriculum Planning, Students/Trainees, Teaching and Learning
Published Date: 16/12/2019
Keywords: Collaborative learning; Dental education; Medical education; Histology education; Knowledge retention; Whole-slide imaging platform


Preamble: At the University of Eastern Finland (Kuopio, Finland) we implemented teaching methods with our medical and dental students that show effectiveness through objective and subjective measures. Our strategic vision and mission for education is summarized in Supplementary File 1. The question discussed below is: What teaching methods, systems, and approaches ensure the most effective knowledge transfer and class conditions for medical and dental graduates during histology education?


A new, more effective and thought-evoking teaching program to medical and dental students was adopted in the Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland in 2016. According to our study, histology learning and participation improved compared to traditional microscope-based teaching when virtual microscopy was combined with a student-centered approach (Felszeghy et al. 2017). The following salient points from this article promote student engagement and learning: student centered learning, collaborative learning, peer-to-peer learning and peer-to-peer teaching (Felszeghy et al. 2019). These points that have been made since the publication of the MedEdPublish article are broadly applicable and warrant a response to generate further discussion.


Dr. Ronald M Harden points out the online method used by Felszeghy et al. (2017) is a method promoting student-centered learning (Felszeghy et al., 2017; Felszeghy et al., 2019). The advantages of this have been previously noted and it has been successfully applied in a virtual environment and the majority of students exposed to this methodology excelled on the final exam (Kukolja-Taradi et al., 2008). Additionally, students expressed increased satisfaction with the virtual learning environment for the following reasons: improved quality of communication with peers and tutors, better assessment, increased flexibility with their learning environment, and more convenient and seamless access to course materials. The study concluded that virtual learning may be a successful model for promoting a student-centered curriculum (Kukolja-Taradi et al., 2008). Another study examined the gap between current medical curricula and optimal learning opportunities indicating virtual learning methods increased student-centered clinical learning (Changiz, Yamani and Shaterjalali, 2019). In summary, virtual learning is inherently student-centered and thus should be given more consideration in educational practice.


Harden and Jennings suggest virtual learning promotes collaborative learning. Similar to student-centered learning, the benefits of collaborative learning have been noted (Laal and Ghodsi, 2011). Cole et al. observed virtual learning supported collaborative learning and may develop critical appraisal skills (Cole et al., 2017). Their study noted different groups developed a preference for the way they worked collaboratively. Virtual learning platforms were used in ways facilitating students` learning. Further, authors noted virtual learning promoted collaboration leading to positive principles of case-based learning. Additionally, collaborative learning coupled with virtual learning was considered to have the potential to be a meaningful way of identifying high-quality, relevant, context-specific resources for student learning. Wihlborg and Friberg (2016) demonstrated that virtual learning enables faculty to collaborate internationally. Faculty working internationally and created an opportunity for students at two universities to collaborate resulting in students’ learning about activities, such as patient safety, from another perspective (Wihlborg and Friberg, 2016).


A 2005 study demonstrated virtual learning also had a positive effect on self-directed learning (Thomas and Storr, 2005). In this study, students participated in a virtual bulletin board, providing an additional tool for problem solving. Academic gains seen in this study were consistent with knowledge building on Bloom’s Taxonomy (Thomas and Storr, 2015). Gains at the knowledge level were the type of gains seen in Felszeghy et al.’s study (Felszeghy et al., 2017). In a different study, Benedict et al. (2013) demonstrated students overwhelmingly supported self-directed learning (Benedict, Schonder and McGee, 2013). The majority of students noted using virtual patient cases allowed them to complete cases prior to class and that the virtual patient cases promoted self-directed learning when they replaced lectures. The same study also observed that virtual learning promoted learning through repeating self-directed study. Benedict et al. concluded that using virtual learning to replace lectures aligns with several accreditation standards and educational outcomes in terms of health science education, expecting their programs to promote opportunities to develop lifelong learning skills and provide opportunities for students to transition from dependent to active, self-directed learners (Medina et al., 2013). In short, Felszeghy et al. histology teaching method further demonstrated the effectiveness of self-directed learning (Felszeghy et al., 2017).


Lastly, Jennings and Wan noted the virtual learning method used in Felszeghy et al. (2017) also promotes student engagement. In a study by Hussain et al. researchers found when virtual learning was used, student engagement correlated positively with assessment scores (Hussain et al., 2018). Previous literature indicates the more engaged students are in their own learning, the better they perform on assessments (Carini, Kuh and Klein, 2006; Fredin, Fuchsteiner and Portz, 2016; Korobova and Starobin, 2015). The increase in engagement in a course using virtual learning may be due to increased access to course content and course participation when compared to lecture-based courses (Hussain et al., 2018). In this study, students who were not as engaged in the course tended to have lower scores on the first assessment and tended to not be in the virtual learning group. Virtual landscape and gamification appear to be at least as effective, and in many studies, more effective for improving interest, knowledge, skills, and satisfaction, reviewed by McCoy et al. (McCoy, Lewis and Dalton, 2016).

Take Home Messages

In conclusion, Felszeghy et al. (2017) showed positive results when implementing virtual learning environment as an important element of the contemporary histology curricula (Felszeghy et al., 2017). Harden, Jennings, and Wan noted four types of learning of this intervention previously not explicitly stated, but common to all virtual and game-based learning as follows: student-centered learning, faster collaborative learning curve, peer-to-peer learning and teaching, and the benefits of games to student increased engagement (Felszeghy et al., 2019). There are many advantages to virtual learning and it is supported by what might be considered best practices in education. Educators should strive to use best practices more often and support these interventions with further empirical evidence.

Notes On Contributors


Designed the letter: F. Sz; GE. G and they contributed equally to this work. Wrote the draft version of the manuscript: F. Sz; GE. G; AK, P. N; D. M. All authors read and approved the final version of the manuscript.


Authors’ information

SZABOLCS FELSZEGHY, D.D.S., Ph.D., is a senior researcher working at the Institute of Biomedicine, School of Medicine at the University of Eastern Finland, Kuopio, Finland. He teaches anatomy and histology and has a high interest in technology-enhanced learning to support learner gain; his research interest is in age-related macular degeneration.

GREGORY GILBERT, Ph.D. is a biostatistician with Learning Sciences, Adtalem Global Education. He also holds appointments as an Adjunct Assistant Professor in the Center for Teaching & Learning, Ross University School of Medicine. He has extensive experience in survival analysis, longitudinal data analysis including the use of mixed models, psychometrics, and G theory.

ALI KOSKELA, M.Sc., is a graduate (Ph.D.) student at the Institute of Medicine at the University of Eastern Finland. He is keen on active learning strategies to promote critical thinking, and his research interest is in molecular mechanisms of age-related macular degeneration.

PETTERI NIEMINEN, M.D., Ph.D., is an assistant professor of anatomy and embryology at the Institute of Biomedicine, School of Medicine at the University of Eastern Finland, Kuopio, Finland. He teaches anatomy, histology and embryology, is responsible for the anatomy curriculum, and his research interest is in molecular biology.

REIJO SIRONEN M.D., Ph.D., is pathologist, senior Researcher at Clinical Pathology, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland. He teaches medical and dental studnet, is involved in the curriculum development, and his research interest is in molecular pathology and genetics of cancer.

SANNA PASONEN-SEPPÄNEN, M.Sc., Ph.D., is docent in cell biology at the Institute of Biomedicine at the University of Eastern Finland, Kuopio, Finland. She has taught histology to medical students for over 15 years, and her research interest is the role of hyaluronan in cancer.

ERKKO SOINTU, Ph.D. (Educ.), is a tenure-track postdoctoral researcher in the School of Educational Sciences and Psychology at the University of Eastern Finland, Joensuu, Finland. His research interests are teaching and learning in higher education (flipped classroom/learning) and information and communication technology in higher education (particularly in preservice teacher education).

DAVID MORTON, Ph.D., is a professor of Anatomy in the Department of Neurobiology and Anatomy, University of Utah School of Medicine, Salt Lake City, UT. His interests include the use of active learning exercises to promote learning and the use of digital technology in cadaver-based medical and dental education.

ANITTA MAHONEN, M.Sc., Ph.D., is docent and chair of the Institute of Biomedicine, School of Medicine at the University of Eastern Finland, Kuopio, Finland. She oversees all functions of the institute, including oversight of the academic programs, guiding future departmental growth, facilitating collaborations, and supporting research efforts.


Szabolcs Felszeghy and Gregory Gilbert hold joint first authorship.


Benedict, N., Schonder, K. and McGee, J. (2013) 'Promotion of self-directed learning using virtual patient cases', Am J Pharm Educ, 77(7), pp.151. https://doi.org/10.5688/ajpe777151


Carini, R.M., Kuh, G.D. and Klein, S.P. (2006) 'Student engagement and student learning: Testing the linkages', Res High Educ, 47(1). pp.1-32. https://doi.org/10.1007/s11162-005-8150-9


Changiz, T., Yamani, N. and Shaterjalali M. (2019) 'The challenge of planning learning opportunities for clinical medicine: a triangulation study in Iran', BMC Med Educ, 19(292), https://doi.org/10.1186/s12909-019-1719-3


Cole, D., Rengasamy, E., Batchelor, S., Pope, C., et al. (2017) 'Using social media to support small group learning', BMC Med Educ, 17(201). https://doi.org/10.1186/s12909-017-1060-7


Felszeghy, S., Pasonen-Sappanen, S., Koskela, A. and Mahonen A. (2017) 'Student-focused virtual histology education: Do new scenarios and digital technology matter?', MedEdPublish, 6(40). https://doi.org/10.15694/mep.2017.000154


Felszeghy, S., Pasonen-Seppänen, S., Koskela, A., Nieminen, P., et al. (2019) 'Using online gamebased platforms to improve student performance and engagement in histology teaching', BMC Med Educ, 19(1). https://doi.org/10.1186/s12909-019-1701-0


Fredin, A., Fuchsteiner, P. and Portz, K. (2016) 'Working Toward More Engaged And Successful Accounting Students: A Balanced Scorecard Approach', Am J Bus Educ, 8(1). pp 49. https://doi.org/10.19030/ajbe.v8i1.9016


Hussain, M., Zhu, W., Zhang, W. and Abidi, S.M.R. (2018) 'Student engagement predictions in an elearning system and their impact on student course assessment scores', Comput Intell Neurosci, 6347186. https://doi.org/10.1155/2018/6347186


Korobova, N. and Starobin, S. (2015) 'A comparative study of student engagement, satisfaction, and academic success among international and American students', J Int Students, ,5(1). pp. 72-85. http://lib.dr.iastate.edu/etd/12367/ (Accessed:1st Sept, 2019)


Kukolja-Taradi, S., Dogas. Z., Dabic. M. and Drenjancevic, P.I. (2008) 'Scaling-up undergraduate medical education: Enabling virtual mobility by online elective courses', Croat Med J, 49(3), pp. 344-351. https://doi.org/10.3325/cmj.2008.3.344


Laal, M. and Ghodsi, S.M. (2011) 'Benefits of collaborative learning', Procedia - Soc Behav Sci,  31(2011), pp. 486-490. https://doi.org/10.1016/j.sbspro.2011.12.091


McCoy, L., Lewis, J.H. and Dalton, D. (2016) 'Gamification and Multimedia for Medical Education: A Landscape Review', J Am Osteopath Assoc, 116(1). pp. 22-34. https://doi.org/10.7556/jaoa.2016.003


Medina, M., Plaza, C., Stowe, C. et al. (2013) 'Center for the Advancement of Pharmacy Education educational ourcomes', Am J Pharm Educ,77(8), pp.162. https://doi.org/10.5688/ajpe778162


Thomas, A. and Storr, C. (2005) 'WebCT in occupational therapy clinical education: Implementing and evaluating a tool for peer learning and interaction', Occup Ther Int, 12(3), pp.162-179. PMID: 16398204. https://doi.org/10.1002/oti.3


Wihlborg, M. and Friberg, E. (2016) 'Framework for a virtual nursing faculty and student learning collaboration between universities in Sweden and the United States: A theoretical paper', Nurse Educ Today, 41, pp:50-53. https://doi.org/10.1016/j.nedt.2016.03.012




There are no conflicts of interest.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

This study followed the guidelines of the Finnish National Board on Research Integrity and no approval was needed according to the Committee on Health Research Ethics at University of Eastern Finland.

External Funding

This article has not had any External Funding


Please Login or Register an Account before submitting a Review

Ken Masters - (14/03/2020) Panel Member Icon
An interesting letter dealing with the value of virtual learning and student-centered teaching, but I feel that it strays significantly from its goals, and the authors would do well to re-shape it.

The second part of the title “Is there a “golden standard” to teach histology?” implies that this letter will deal with histology teaching. Indeed, it begins in that vein, where it discusses histology teaching.

From there on, though, it no longer discusses the teaching of histology, but discusses only virtual and student-centred teaching, and the value of such teaching. Histology is mentioned only once. Apart from the first paragraph, the entire letter could be copy-and-pasted into a letter dealing with the teaching of any medical subject. I was hoping that, at the very least, an ending paragraph would tie the previous discussion back into histology, but there is no such paragraph.

So, the authors need to decide exactly what the aim of the letter is, and then stick to it. Either it is about a way of teaching histology or it is about virtual and student-centered teaching in general. If it is a combination of both, then the thread of histology will have to run through the entire discussion of virtual and student-centered teaching. As it stands, it begins with a discussion of histology teaching, then becomes a discussion of virtual and student-centered teaching, with gamification introduced in the last sentence, and then just stops.

I look forward to Version 2 of this letter in which the authors re-shape it into something more focused.
Possible Conflict of Interest:

For transparency, I am an Associate Editor of MedEdPublish.

Barbara Jennings - (20/12/2019) Panel Member Icon
This is an interesting letter. It introduces us to the educational principles behind a new histology curriculum that is in use at the authors’ medical and dental school departments.
The authors cite their research articles explaining their evaluation of the histology programme introduced in 2016. They also cite other interesting articles about the themes that they discuss e.g. improved learning gain, and student satisfaction along with the advantages of virtual learning environments; gamification; and cased based methods. One big advantage is the collaborative potential – both for peer learners, and between faculty and learner.
I had one concern when I read the letter – the authors seemed to be responding to a forum that was probably unclear to most readers – i.e. I assumed the context/ source of the points referred to by Harden, Jennings and Wan, was the reviewer thread for one of your research papers https://www.mededpublish.org/manuscripts/1151. Perhaps the authors can clarify this for the readers?
This raises a question about post-publication peer review in general – does a reviewer thread allowing an open conversation between author and reviewers have a limited lifespan? How long do authors and readers want continue an existing conversation about a primary piece of work (e.g. via the reviewer thread linked to an article), and when is the right time to move on to a new conversation within the educational literature?
This letter is a useful summary of important themes that will be of general interest to any faculty member exploring active learning and evidence based science education. I think it will be of great interest to all colleagues who deliver applied science teaching such as pathology.

Possible Conflict of Interest:

For transparency, I am an Associate Editor of MedEdPublish. However, I have posted this review as a member of the review panel and so this review represents a personal, not institutional, opinion.