The analysis of histological section preparations in histology and pathology serves as an example of how the digital transformation is taking place at medical universities. In both areas of specialisation, the traditional method of analysing histological sections by using microscopes is increasingly being replaced by the use of digitised histological sections and computer-assisted image analysis. Medical universities need to consider this development and prepare students to adapt to the resulting changes by moving from teaching microscopic to digital analysis in histology and pathology.

The project “Digital Microscopy in Teaching 2.0” supports the inter-university and interdisciplinary exchange of knowledge about data formats and software products that are used to acquire, annotate, and evaluate digital slides. Exchanging the evaluation results of the different products has led to a standardisation of the software landscape; in turn, this has allowed data from the partner institutions to be exchanged more easily. At the same time, the project prepares students for the educational shift that will take place from traditional methods of analysing histological sections using microscopes to the more advanced methods of producing digitised histological sections and conducting computer-assisted image analysis.

Teaching medical students has been dominated by microscopy for many decades. Due to the increase in digital possibilities in recent years, a shift has occurred in histology and pathology from classical to digital microscopy.

Thus, histological images were and remain an essential part of medical education. Technical advances in the digitalisation of histological sections have now opened up new avenues for using digitised images in medical education. In addition, software solutions are now available that can be used to annotate the digital images with additional data, which allows teachers to promote interactive learning and, at the same time, test interactive skills. Moreover, such interactively animated digital teaching content can be accessed from different devices (mobile devices, notebooks, PCs) in higher quality than with the standard microscopes used in courses.

The use of digitalised images also makes it possible to use artificial intelligence-based analysis methods that can be incorporated into the course content. This allows teachers to encourage students to take a critical approach to these new technologies and to present practical examples, as well as help students to develop related digital skills.

Aims of the initiative:

The analysis of histological section preparations in histology and pathology serves as an example of how the digital transformation is taking place at medical universities. In both areas of specialisation, the traditional method of analysing histological sections by using microscopes is increasingly being replaced by the use of digitised histological sections and computer-assisted image analysis. Medical universities need to consider this development and prepare students to adapt to the resulting changes by moving from teaching microscopic to digital analysis in histology and pathology.

Work packages of the initiative:

Work package 1: Establishment of a common data management infrastructure

Work package 2: Common teaching data set

Work package 3: Interactive annotation of digital teaching content

Work package 4: Integration of the digital specimen collection (3D Virtual Slides) available at the Department of Anatomy and Cell Biology at the Ludwig Maximilians University of Munich

Work package 5: Testing of the interactive digital teaching content

Work package 6: Initiation of teaching with digital teaching content

Current project status:

The project was successfully carried out, and some of the initial project objectives were achieved ahead of schedule. The schedule for project activities was adjusted in response to the COVID-19 pandemic, namely in that some activities were carried out earlier than planned due to the intrinsic need for digitalisation to support "distance learning".

Medical University of Graz (histology): A slide scanner has been acquired. Since then, more than 3000 sections have been digitalised. The adaptation and optimisation of the evaluation software used to quantify staining is in full operation. Market analyses to identify a suitable teaching software as well as suitable PCs for teaching are in progress. Several software tests have been performed, and a PS variant will be purchased for further testing on site (lecturers and students).

Medical University of Graz (pathology): To date, approximately 400 sections have been digitalised and categorised for histopathology courses. In addition, areas relevant for diagnosis were marked. Due to the high resolution of the images, the workstations used by people doing the annotation work were equipped with high-resolution monitors to enable them to annotate the specimens efficiently. Currently, preparations to integrate the student workstations into the Med Uni Graz network are underway. A data security solution has been put in place and has already been tested for collaborative data exchange and data access functions within the EU project OpenQKD.

Johannes Kepler University Linz: The scanner has been acquired. Fifty per cent of the scanner costs were covered by the budget for the higher education institution structural resource project, and 50% were covered by third-party funds. The scanner will be available for teaching (pathology, neuropathology, histology) as well as for research. Other activities: the digital Pathology-Histology course (videos, microscopy prep work) will also be held in the summer semester. Prof. Maren Engelhardt has held the Professorship for Anatomy since spring 2021. Prof. Engelhardt and Prof. Langer are working together on the Histology course (anatomy – currently making sectional preparations), which will be digitally prepared together with the Pathology-Histology course.

University of Veterinary Medicine Vienna: A virtual server with scalable storage space is available for data storage and management. The software CaseViewer is being used as a platform. For the Histology course, 100 sectional slides were digitalised; for the Pathohistology course, 46 sectional slides; and for the Clinical Rotation course, 14 sectional slides. In several online-only courses, remote access was largely unproblematic. Video recordings of the virtual pathohistology exercises were made available to the participating students via the teaching platform used at the University of Veterinary Medicine.

Medical University of Vienna: The working group set up to carry out the project activities evaluated the CytoMine software as the most suitable after a market analysis had been carried out. A suitable server configuration was set up with the help of the university’s IT service, the software was tested on a trial basis in teaching settings, and the additional options needed were defined for further work. Currently, the requirements for annotation and integration in Moodle are being determined. The trial operation should be completed by WS 2022/23, and teaching should be fully migrated to the new virtual platform. The specimen collection has been further expanded and can be considered as complete enough for routine teaching activities. More activities in the areas of histological and histopathological teaching are planned.

Medical University of Innsbruck: The digital specimen collection (3D Virtual Slides) of the Ludwig Maximilian University of Munich has been integrated. For this purpose, tutors and lecturers were trained to use the Biolucida software so they could annotate the slides. At the same time, information events, demonstrations, and training sessions for students, staff, key users, and teachers were offered, and documentation was prepared. Furthermore, a teaching concept and a curriculum were developed and successfully used in the winter semester 2021/22.

Potential synergies with other universities:

Overall, promoting the inter-university, interdisciplinary exchange of data formats and software products that can be used to acquire, annotate, and evaluate digital preparations has helped all involved project partners to increase their knowledge. Exchanging the evaluation results for the different products resulted in a standardisation of the software landscape; this, in turn, allowed data from the partner institutions to be more easily exchanged.

MUG and MUV are jointly participating in the EU research programme IMI BigPicture on the topic of digital pathology. This will improve networking and enable them to have synergistic effects with several universities and professional societies in Europe.