Histopath: Pictures vs. Real life

[KLPM]

This is potentially a very stupid question (actually I can already smell the stupidity). I am not in any sort of pathology program.

I am wondering whether real life microscopy examination of tissue specimens is "easier" than looking at pictures in books. Because a lot of the time there would be a low power picture which will say something like "[Insert name of condition]. There is [A] and a background of lymphocytic infiltrates" or it had be something like "[insert name of condition. Note the prominent cytological atypia". The fact I cannot see some of these features, is it due to my personal lack of experience or is it because low power pictures do not show them that well? I suspect it is a mixture of both but I just want some input from people who do this for a living.

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[WEBB PINKERTON]

This is potentially a very stupid question (actually I can already smell the stupidity). I am not in any sort of pathology program.

I am wondering whether real life microscopy examination of tissue specimens is "easier" than looking at pictures in books. Because a lot of the time there would be a low power picture which will say something like "[Insert name of condition]. There is [A] and a background of lymphocytic infiltrates" or it had be something like "[insert name of condition. Note the prominent cytological atypia". The fact I cannot see some of these features, is it due to my personal lack of experience or is it because low power pictures do not show them that well? I suspect it is a mixture of both but I just want some input from people who do this for a living.

No comparison. Real life microscopy is FAR easier. I find it very difficult to see some of the features in a picture as well.

 

[icpshootyz]

Many textbooks do a terrible job of annotating their images. Ideally there would be arrows, etc indicating each feature, but space is limited and it takes time to do that for each image. You learn far more at the scope, especially with a good teaching attending during residency, than you will just from a textbook.

 

[pianoguy05]

Heh...in a sense, this question is the crux of a rather complex debate in medical education. If you ask old-timer histologists/pathologists, they'll tell you microscopy any day of the week, and physicians should be trained to use microscopes. I, incidentally, agree with this philosophy...I think virtual slides are terribly difficult to learn from and markedly disengaging. Ph.D.'s in Medical Education (a degree which I whole-heartedly believe is made up and a waste of time, energy and space) are arguing the opposite, generally, citing evidence that there's no difference, and med students/physicians don't need the in depth histo/histopath training that microscopy can provide.

That said, I agree with the above -- some books will do a good job, but there's really no comparison en general or any substitute to engaging at a microscope and pushing glass. jmo.

 

[KLPM]

I think that main concern of mine is because I haven't seen enough pathology so I don't know if I can't see something because you really can't see it at that magnification and the author is more stating what you EXPECT to see or because I can't identify it even if it's staring at me while waving a flag saying look here.

 

[Euchromatin]

Heh...in a sense, this question is the crux of a rather complex debate in medical education. If you ask old-timer histologists/pathologists, they'll tell you microscopy any day of the week, and physicians should be trained to use microscopes. I, incidentally, agree with this philosophy...I think virtual slides are terribly difficult to learn from and markedly disengaging. Ph.D.'s in Medical Education (a degree which I whole-heartedly believe is made up and a waste of time, energy and space) are arguing the opposite, generally, citing evidence that there's no difference, and med students/physicians don't need the in depth histo/histopath training that microscopy can provide.

That said, I agree with the above -- some books will do a good job, but there's really no comparison en general or any substitute to engaging at a microscope and pushing glass. jmo.

I don't think there is anything wrong with still images or virtual slides for medical students to learn histology vs. real microscopes and glass - I think the most significant factor is time spent with a good teacher who can point out all of the relevant features and give the students the opportunity to ask questions.

The only time I used a microscope during medical school was to look at gram stains during our micro labs. All of the histology/histopath teaching was done with either digital photographs or virtual slides and I learned the material very well. I think the key factor, however, was the fact that our histology lectures were good and they were followed up by small group sessions in which the instructor went through lots and lots of images/slides and identified all of the key structures/tissue layers/cell types/etc. for us.

I think the time spent with an experienced person providing teaching is most crucial. Whether the source material is on "real" glass slides or on a computer screen is of much less significance (and virtual slides have the benefit of not getting faded, dirty, lost, etc; they allow for more clear-cut labeling of more layers/cells/features than one could to with a marking pen on a real slide and they can be viewed remotely).

 

[KLPM]

I think the time spent with an experienced person providing teaching is most crucial. Whether the source material is on "real" glass slides or on a computer screen is of much less significance (and virtual slides have the benefit of not getting faded, dirty, lost, etc; they allow for more clear-cut labeling of more layers/cells/features than one could to with a marking pen on a real slide and they can be viewed remotely).

I agree that having an experienced person is probably the thing I found most helpful during histology labs. I remember our labs used to be run with a professor plus about 5 PhD students. You can really tell those who know their stuff from those who are still somewhat clueless. Our professor was good since he wasn't just knowledgeable but also a great teacher. Some of the PhD students weren't that helpful when it came to slides not directly to the areas they were studying.

For instance we had this one girl who was doing research on ovarian follicles so when we had slides on the female reproductive organs she could give really handy hints not written in textbooks about how to identify various structures. On the other hand when we had say GI stuff she still knew her stuff but just not to the same degree and not nearly as helpful.

Personally I found having glass slides that let me view the same specimen at different magnifications really helped. A quick scan at low-power to appreciate the general architecture and then increasing powers to see the detailed morphology of different structures was helpful for me.

 

[KCShaw]

Any given image in any given textbook may or may not be worth a fart. Some are great, some are confusingly or outright misleadingly terrible, and a lot are in between. It varies. Considerably.

Similar can be said of actual glass slides, minus the labeling issues, where it's still easy to be distracted by the wrong things. Unfortunately most virtual slide systems are still too slow to be of "great" value, but they're often not bad for their intended purely mid educational purpose, even though occasionally they have the same problems as the printed image or glass slide. If you need to see a lot of variations of the same or similar things, then glass slides and a good teacher are still probably the most efficient for a student (though not cheap for the system). After that, virtual slides or static images can suffice if good labels and explanations are available.

 

[KLPM]

Any given image in any given textbook may or may not be worth a fart. Some are great, some are confusingly or outright misleadingly terrible, and a lot are in between. It varies. Considerably.

What do you mean by that?

Histology teaching wasn't very good in my medical school in first year so I tried to learn it by myself. I was always confused about whether I was looking at the right thing. "Is that really the lamina propria" or "Is that really a lymphocyte" or "Is that a goblet cell?" But then in second year we had a really good instructor who pointed all that stuff out. I am sure it takes some degree of experience to be a good slide reader. Not everything is clear cut in histopathology.

 

[KCShaw]

I mean books, like the people who write them, are prone to at least occasional errors. Sometimes they are propagated errors -- someone else told them something and they think it's right, but it's not -- some are typos or miscommunications or misprints, etc. To be honest, sometimes a really good simple sketch with proper labeling is a better "image" than a picture of an actual tissue slide. Tissue is prone to the variations of real life, whether it's the tissue itself or something that happens to it between the time it's removed from a body and the stained slide is imaged, not to mention imaging issues or artifacts, and while those are the kinds of things you have to learn about to be a pathologist, if you're just trying to pass med school exams there's no point learning to deal with that stuff.

That said, you can only learn from what you have, and you generally have to assume that it's accurate, even if the quality sucks. Don't waste time if it doesn't make sense -- find a different book or image, or find someone who knows enough to show you.