By Zev Leifer

The Talmud (Taanis 7a) quotes Rabbi Chanina who declared that, “I have learned much from my teachers, more from my colleagues and most from students.”  There is a tendency amongst educators, in general and more so, I suspect, amongst medical educators (given their many years of training and vast experience) to take a top-down approach.  This approach assumes that we have a contractual relationship wherein “I have the knowledge and we are here so that I can share it with you”.

In contrast, the digital age has humbled many of “our” generation since the best advice when faced with a new piece of digital equipment or software, is to “ask a ten-year old” (even an anonymous ten-year old).  But our students?!  I submit that example is a challenge – to ego and to the “Central Dogma of Education” that information flow is unidirectional.

I would like to share some of my experiences teaching digital pathology, to perhaps update that notion…

For the past 35 years I have been teaching Pathology Lab at the New York College of Podiatric Medicine.  For most of that time, the classical techniques of diagnostic pathology – analyzing a glass slide of a tissue slice to determine if normal or pathological, or pathological to what extent – has been by looking at the slide in a microscope.  Now the world has changed.  For the professional pathologist and, by extension, for the aspiring pathology student, it is all digital.  The slide is digitized and, with appropriate software, made available on the computer which acts as microscope.

So far, nothing has changed in the basic process of slide analysis and learning the discipline.

My challenge was to ask: “What else?” Given this new tool and new capability, what else could we do now that we never could do before?

I came to my students to take it to the next step.  Beyond ego, beyond classical views of information flow directionality, beyond any concern of a change in relationship, or authority, or respect, or emotional excuses to hold back – I plunged in and put it to them.  “Teach me what you know!”

Now, I am not a total newbie to computers and their uses.  My contribution was to know and teach them that they could bring up a slide of normal tissue and a slide of pathological tissue side-by-side.  I taught them that they need not be limited to the slides in our course collection but could access digital slides at other educational institutions, to see a better presentation or one with noteworthy features.

But their fingers were flying and their output was far beyond what I was teaching and I asked them to share their knowledge and skill (which they grew up with, almost from the womb).  They taught me (so that now I can teach others) to cut and paste a section of the slide and to save it to a document.  They could annotate the slide – put in arrows, or circle the region of interest or underline it or add text.  They save it to a document which can be shared with the group – as Word document or PowerPoint, by email or DropBox.  It is the classroom forerunner of skills such as telepathology and teleconferencing that they will encounter later in their professional lives.

The Central Dogma of Molecular Biology” has been upended by Reverse Transcriptase.  The “Central Dogma of Education” has been upended by accepting and embracing the understanding that information flow is reversible.

Zev Leifer, PhD, is of Professor of Microbiology and Pathology at New York College of Podiatric Medicine.  The son of two teachers, he has been very successful in training over 2,500 podiatrists in the past 35 years.

Reference
Leifer Z. The use of virtual microscopy and a wiki in pathology education: Tracking student use, involvement, and response. J Pathol Inform 2015;6:30.