Webconference mixed with virtual slides as a pedagogical tool to improve pathology practice in the French Midi-Pyrenees area

The pathology is a discipline located between basic science and clinical practice. Tissue and / or cellular injury could be seen as a triptych with in upstream pathophysiological mechanism and in downstream the resulting symptoms. In recent years, pathology, an essential step of clinical diagnosis, is being more complex integrating complementary technics (e.g. molecular biology), creating new classifications or new recommendations. So pathologists’specialization in one field is becoming a necessity. Unfortunately, since 1999, the French pathologists growth rate is negative and demographic previsions estimates that in 2050 pathologists’ population should decrease by 50%. This crisis in vocations obliged pathologists to provide continuing education to their peers, share experiences but also to reform the teaching of the discipline during medical studies to make it more accessible and attractive. The development of digital imaging in this both areas has been a greatly helpful. In France, a group of pathologists established in 1977 under the name ADICAP (“association for the development of informatics in pathology”) helped the creation of adequate informatics tools [ 1 ]. Worldwide, the pathologists were among the first to use tools of telemedicine, especially in countries with difficult geographical conditions such as Norway or Canada. However, for 25 years, the difficulties of digital transmission and the static and selective state (selection bias in the sent fields) of numeric photography had left this technology underutilized [ 2 ]. In the 2000s, development of the virtual slides technology (virtual slides scanner) and of telepathology, allowed diversification and wider use of digital imaging in pathology. It had been now widely used in Canada to exchange views particularly in cases of diagnostic emergency as extemporaneous examinations [ 1 ]. In 2010, physicians in three Northern Ontario communities had been virtually linked at all times to pathology specialists allowing frozen section examination on line [ 3 ]. It had been also used for teaching and universities, particularly in the U.S. and Switzerland, where virtual imaging have replaced conventional microscope. In France these technologies are progressively taking place both in the field of education and in the exchange of expertise. In Toulouse-Rangueil hospital, the pathology department has chosen to focus on education as the training provided to senior pathologists and to medical students. Slides were scanned on « NDP Nanozoomer » Hamamatsu, in Rangueil University Hospital, in Toulouse. The virtual slides were loaded in to a computer server, in Toulouse-Paul Sabatier University. Hamamatsu provided the program patch with the NDP viewer, as a pilot program. The Paul Sabatier University (TICE department, Direction of Technology and Information Systems) provided to the university community a web conferencing platform Adobe Connect Pro. This platform, web-based, used Flash technology present on 98% of computers. It offered not only a videoconferencing service but also a collaborative workspace (document sharing, screen or application sharing, instant messaging, whiteboard...) organized in modules. This type of system offered flexibility and brought a wealth of services in a nomadic environment. All medical data are anonymous. Virtual meetings between pathologists: To access the platform, only an internet-connected computer, a webcam and a microphone was needed (Figure 1 ). The access was secured by a code. Virtual class visible by the senior pathologist in training. We integrated the virtual slide in presencial sessions in small numbers (30 students per group, promoting divided into 5 groups, 10 sessions). Each student had a microscope and glass slides with a representative lesion. Each slide was previously scanned. The virtual slide was projected and commented on by a teacher. The student had to the area of interest selected by the teacher at low magnification and then at higher magnification leading to the diagnosis. Questionnaire of satisfaction was distributed to students and teachers at the end of the first teaching session and at the end of the sessions cycle (10th session). To enable students to visualize the virtual slide out of teaching session, a web-site is in process. It would allow the student to access to digital slides but also to recapitulative picture, with a brief explanation and a summary of what to remember. Normal tissue slides would also be available. Student would access the site through a custom code. It is not yet planned to grant access beyond the teaching year or to allow students external of our University to access the site. Thinking is still in progress on these points.

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