title: Learning pathology using collaborative vs. individual annotation of whole slide images: a mixed methods trial.
abstract: BACKGROUND
  Students in biomedical disciplines require understanding of normal and abnormal microscopic appearances of human tissues (histology and histopathology). For this purpose, practical classes in these disciplines typically use virtual microscopy, viewing digitised whole slide images in web browsers. To enhance engagement, tools have been developed to enable individual or collaborative annotation of whole slide images within web browsers. To date, there have been no studies that have critically compared the impact on learning of individual and collaborative annotations on whole slide images.
  
  
  METHODS
  Junior and senior students engaged in Pathology practical classes within Medical Science and Medicine programs participated in cross-over trials of individual and collaborative annotation activities. Students' understanding of microscopic morphology was compared using timed online quizzes, while students' perceptions of learning were evaluated using an online questionnaire.
  
  
  RESULTS
  For senior medical students, collaborative annotation of whole slide images was superior for understanding key microscopic features when compared to individual annotation; whilst being at least equivalent to individual annotation for junior medical science students. Across cohorts, students agreed that the annotation activities provided a user-friendly learning environment that met their flexible learning needs, improved efficiency, provided useful feedback, and helped them to set learning priorities. Importantly, these activities were also perceived to enhance motivation and improve understanding.
  
  
  CONCLUSIONS
  Collaborative annotation improves understanding of microscopic morphology for students with sufficient background understanding of the discipline. These findings have implications for the deployment of annotation activities in biomedical curricula, and potentially for postgraduate training in Anatomical Pathology.
authors.affiliation: Department of Pathology, School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Sahota
authors.affiliation: Department of Pathology, School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, Australia.
authors.forename: Betty
authors.initials: B
authors.lastname: Leung
authors.affiliation: Department of Pathology, School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, Australia.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dowdell
authors.affiliation: Department of Pathology, School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney, Australia. g.velan@unsw.edu.au.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Velan
mesh_terms: D003194:Computer-Assisted Instruction; D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D006653:Histology / Q000193:education*; D006801:Humans; D007858:Learning; D008853:Microscopy / Q000379:methods*; D010336:Pathology / Q000193:education*; D015397:Program Evaluation; D013337:Students, Medical; D013663:Teaching
keywords: Annotation; Collaborative learning; Virtual microscopy; eLearning