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Indian J Pathol Microbiol. 2019 Jan-Mar;62(1):84-90. doi: 10.4103/IJPM.IJPM_241_18.

Randomized cross-over study and a qualitative analysis comparing virtual microscopy and light microscopy for learning undergraduate histopathology.

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Department of Pathophysiology, Windsor University School of Medicine, St. Kitts and Nevis.
Department of Public Health and Preventive Medicine, St. George's University School of Medicine, St. George's, Grenada.



Virtual microscopy (VM) use in teaching and learning is increasing worldwide. However, there is a paucity of information comparing it to light microscopy (LM) in learning undergraduate histopathology. We investigated whether VM or LM had a higher impact on student learning and performance in histopathology. In addition, we investigated whether students preferred VM over LM, and whether VM use provided a platform to fulfill the Accreditation Council for Graduate Medical Education core competencies.

Materials and Methods:

We used a sequential exploratory mixed method study design. A qualitative phase inquiring about student preference for VM or LM was followed by a randomized cross-over study. Student preference was measured by an online survey based on a Likert scale. In the cross-over study, students were randomized to either the VM or the LM arm, and their mean scores in standardized exams were compared after using VM and LM.


A total of 152 students completed the qualitative study and a total of 64 students participated in the cross-over study. Eighty-three percent (83%) of the students preferred to use VM over LM. Students who used VM scored significantly (P < 0.001) higher [(87.1% vs. 72.4%) and (85.3% vs. 76.1%)], respectively, in both phases of the cross-over study compared to those who used LM.


Using VM to learn histopathology has significantly increased student learning and performance compared to using LM.


Competency-based education; digital histopathology; light microscopy; undergraduate medical education; virtual microscopy; whole slide imaging

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