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  Table of Contents    
Year : 2021  |  Volume : 64  |  Issue : 3  |  Page : 524-527
Evolution of pathology teaching for MBBS students during COVID-19 pandemic lockdown: Moving from a real to a virtual classroom

1 Department of Pathology and Lab Medicine, AIIMS, Bhopal, Madhya Pradesh, India
2 Department of Medicine, AIIMS, Bhopal, Madhya Pradesh, India

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Date of Submission06-Jun-2020
Date of Decision24-Sep-2020
Date of Acceptance17-Feb-2021
Date of Web Publication28-Jul-2021


Background: The COVID-19 pandemic lockdown has forced university hospitals to forego traditional classes and embrace online teaching platforms as the sole modality of medical education. Herein, we describe our experience of shifting from the arena of a real to a virtual classroom during the lockdown phase. Materials and Methods: The institutional subscription of G-suite was used for creating a virtual Google classroom. Google Calendar, Google Meet, and Google Forms were used for notification of schedules, conducting theory and practical classes, and conducting assessments, respectively. The learner-centric SNAPPS model was adapted for an interactive case-based learning (CBL) program using multimedia tools. Students' perspective on online education was assessed based on their responses to a validated questionnaire. Results: The conduction of online classes, particularly the live practical classes and the CBL program got the maximum affirmative (up to 85%) responses. Students of the same batch also performed better in a test following the online CBL (77.03% vs 73.3%, P = 0.03, paired t-test statistically significant) compared to a test before it. However, access to laptops and poor Internet connectivity were significant causes of concern for nearly 40% of students. Conclusion: The use of virtual classroom has proved to be an efficient method for continuing teaching of Pathology to MBBS students in times of lockdown when face-to-face conventional teaching was not possible. The experience indicated that in the future a judicious mixture of traditional and online classes may be a more effective educational design for teaching Pathology to MBBS students.

Keywords: COVID-19, lockdown, MBBS, pathology, teaching, virtual

How to cite this article:
Mukhopadhyay S, Joshi D, Goel G, Singhai A, Kapoor N. Evolution of pathology teaching for MBBS students during COVID-19 pandemic lockdown: Moving from a real to a virtual classroom. Indian J Pathol Microbiol 2021;64:524-7

How to cite this URL:
Mukhopadhyay S, Joshi D, Goel G, Singhai A, Kapoor N. Evolution of pathology teaching for MBBS students during COVID-19 pandemic lockdown: Moving from a real to a virtual classroom. Indian J Pathol Microbiol [serial online] 2021 [cited 2022 Dec 6];64:524-7. Available from:

   Introduction Top

The concerns over transmission of COVID 19 have enforced a global shutdown of educational institutes through a national level advisory. One of the key pillars of prevention of viral spread is social distancing. To continue to provide high-standard undergraduate and postgraduate medical education and effective clinical training in these times of social distancing is a big challenge for any institution. Online education has been in practice even before the global pandemic and in itself is nothing new; however, the way the application and utility of online teaching tools have been realized during this pandemic is unparalleled.[1],[2] Many educational institutes have also been quick to take recourse to online training for their students so that they need not miss classes from their regular curriculum during the pandemic.[3],[4] We also responded to this challenge of continuing effective medical education through distance learning using a variety of web-based tools and mobile applications along with the development of novel methods for teaching pathology to undergraduate students.

In this article, we describe our experience of adapting familiar online tools and technology for continuing curriculum-based medical education during the lockdown. We also present an assessment of the efficacy of the online education system through a questionnaire-based student response.

   Materials and Methods Top

Traditional classroom-based teaching methods require the congregation of students and teachers under one roof; whereas in the current model, it was completely replaced by an online teaching module. The institutional subscription of G-suite was used for accessing the online platform of Google Classroom ( as a virtual classroom for MBBS students of our institute. Institutional email addresses of students were used to create a class group for the 96 students of the fourth semester of the MBBS batch. Through the use of Google Calendar, the students were prenotified of the dates for lectures and assignments. The teachers had access to unlimited 1 GBPS bandwidth Wi-Fi connection and the hardware and software tools required for online teaching.

Following is a brief description of the teaching–learning methods that were adopted through the use of prevailing technology and online tools:

I. Didactic Lecture—PowerPoint presentations for didactic lectures were uploaded on to the Google Classroom stream. The basic tenets of multimedia learning have been shown to improve cognitive learning.[5] Multimedia learning was implemented in the PowerPoint presentations for the lecture classes with audio (voiceover of faculty) and video recordings. Short YouTube videos emphasizing the key concepts of the lecture topic were also attached with the PowerPoint presentations.

II. Practical/Demonstration classes—To keep in sync with the experience of a regular practical class, live sessions with Google Meet were executed. Using the webcam and microphone facility on desktops and laptop devices, the teachers demonstrated gross specimens. For histopathology study, peripheral blood smears, bone marrow aspirates, and slides were live streamed from a microscope-mounted camera (Olympus BX43) using the PractoRes software for the students.

III. Case-Based Learning (CBL)—It is a tool that can supplement lecture classes and promote self-learning and deep understanding of the subject. Based on the areas of competencies enumerated by the Medical Council of India for the undergraduate curriculum, CBL and assessment methods were designed by integrating topics from Pathology and General Medicine. In view of the restrictions imposed in the lockdown, MBBS students were unable to attend clinical outpatient departments and indoor wards. The faculty of Pathology and General Medicine tried to fill this gap in clinical learning by adapting an experiential teaching model called SNAPPS for the CBL program. It is a popular learner-centric model implemented in bedside clinics and outpatient settings of clinical departments.[6],[7],[8]

SNAPPS is a mnemonic derived from the six steps the learner has to do in this model which are as follows:

  1. S - Summarize briefly the history and findings
  2. N- Narrow the differential to two or three relevant possibilities
  3. A- Analyze the differential by comparing and contrasting the possibilities
  4. P- Probe the preceptor by asking questions about uncertainties, difficulties, or alternative approaches
  5. P- Plan management for the patient's medical issues
  6. S- Select a case-related issue for self-directed learning.

To supplant for outdoor clinics, virtual cases simulating real-life patient scenarios were created. These virtual cases depicted topics covered in the online lectures by both General Medicine and Pathology. We used free video-editing software applications for working on Android-based devices and the iMovie app on macOS devices and created short videos through the collation of open-access images from the Internet. Each video depicted a case scenario pertaining to the pathological entities that were taught in the lectures.

The students were divided into small groups of 16 students each and a case-based video was uploaded onto the virtual classroom for each group to see and summarize the history and clinical findings and narrow down on a few differential diagnoses. To analyze the cases, the students were encouraged to probe the faculty for further clinical history or specific features and ask for special laboratory tests by putting their queries on the Google Classroom stream. Laboratory test details, gross photomicrographs of surgical specimens, and histology slides pertaining to the case were uploaded onto Google stream by the faculty as per these queries. The students were then directed to self-learning through online resource materials, journal articles, textbooks, and free online pathology resources such as LibrePathology andWebpathology arrive independently at a specific diagnosis. Each case with its final diagnosis and a plan for management was finally presented by student groups as PowerPoint presentations in an interactive session with faculty of both Pathology and General Medicine through live video conferencing using Google Meet. As CBL was part of a formative assessment of students, the presence of all the students in the group was mandatory. The tiled layout in Google Meet that can show 16 people on the screen simultaneously enabled the faculty to ensure equal participation of all the students in a group.

IV. Assessment—Formative assessment of the students was done with a set of multiple-choice questions after the completion of a series of didactic lectures. Google Forms application was used for uploading the quiz and students were requested to submit their responses within a specified time limit that was monitored through the TIMIFY add-on available with Google Forms. The same quiz with jumbled questions was used after CBL sessions to compare any improvement in the subject understanding of the students. Google Forms application was also used to extract simple statistical data of how the students progressed between the two tests.

A prevalidated 5-point Likert scale questionnaire with 13 questions covering logistics, content and methodology of classes, CBL, and students' perspective on online teaching as a learning platform and two columns for suggestions and comments was administered to the students. The questionnaire itself had an option for the students to provide consent for voluntary participation and addressed issues related to the content, methodology, and duration of online classes. Suggestions for further improvement of the online education programme were invited. The anonymity of the student responses was maintained.

The statistical analysis of the responses to the questionnaire was done by calculating the percentage of responses in each category. Paired t-test was used to compare the evaluation of the students before and after the CBL session.

   Results Top

The attendance for the online classes was comparable to that of the offline classes with the prelockdown attendance for theory and practical classes being 72.04% and 80.6%, respectively, and 79.2% and 85.4% during the lockdown for the same cohort of IV semester students of our institute. The feedback from the students provided useful insights into online teaching being carried out by our department. Out of 96 students, 59 responded to the questionnaire [Table 1].
Table 1: Responses to the Questionnaire

Click here to view

The CBL sessions based on the SNAPPS technique seemed to be a success with nearly 85% responses in affirmation of its efficacy in improving the learning and understanding of basic concepts. This was also reflected in the formative assessment of the students where a significant rise was noted in the percentage of students giving correct responses after the case-based discussion (77.03% vs. 73.3%, P = 0.03, paired t-test statistically significant) compared to the test administered before.

Apart from the online CBL, the overall content of other lecture classes (66.2% affirmative responses) and practical live demonstration classes (55.4% affirmative responses) were thought to be useful and interesting and the duration of classes was optimal. Most students felt that online teaching provided them with a flexibility of routine.

However, on the flip side, a sizable number of students (~42.8%) faced difficulty with logistic issues particularly with poor Internet connectivity and limited Internet data coming as a hindrance in attending live classes.

   Discussion Top

The COVID-19 lockdown has created a paradigm shift in medical education. It has accelerated the adoption of digital technology and has shifted the seat of learning from the real classroom and patient bedside to a virtual classroom. While online teaching can possibly never supplant bedside clinics for a medical student, much of the pre- and paraclinical subjects can still be dealt in an effective way through it.

Our experience also showed that this altered teaching–learning scenario also evolved as time progressed. The didactic lecture classes initially started with the sharing of PowerPoint presentations and gradually evolved to include audio, video, and hyperlinks for related YouTube videos. This happened as the faculty too became familiar and comfortable with online tools and technology. Uninterrupted high bandwidth Internet connectivity is required for fruitful online education which may not be universally available. Keeping this in mind, instead of live streaming, didactic lectures were uploaded to give students the flexibility to download and go through lectures according to their convenience. This minimized data usage and overcame the issues regarding Internet connectivity and poor audio or video quality due to varying Internet bandwidths.

Planning the online practical classes initially appeared a daunting task. Pathology is a subject that majorly requires gross and microscopic observation of organs and tissues to detect the disease. This problem was taken care of by using video conferencing and live demonstration of specimens and slides. The live-streamed classes, both practical and the CBLs, led to better student participation. The live demonstration of slides and smears by a faculty had its advantage of wider outreach. It catered to all the students of the batch in a limited time. The level of interaction was much better than an individual student microscope or a five/ten-header microscope session could have achieved. The case-based learning session designed on the basis of the SNAPPS model also gave the students a feel of clinics during the lockdown. These stimulated self-learning and also created a better understanding of the subject.

The options of screen sharing, audio, video, and text chat on Google Meet video conferencing allowed more interaction from the students, which is not always possible in the rigid environment of a traditional lecture hall. The teachers too had an armory of modern teaching tools and technology available at the click of a button that could engage students.[9] Google Meet was also found to be an excellent platform for multidisciplinary learning by bringing together multiple teachers for one session and even guest speakers.

A quick evaluation of individual and class performances through paperless assignments at the end of each teaching module was an advantage of Google Forms. However, one of the major limitations of using Google Forms and other online modalities for the evaluation of students was that these students were unsupervised at the physical level. It gave us an insight that to ensure stricter supervision Proctorial software can be utilized.

Though with all the advantages of online teaching it has to be kept in mind that in a large class, students belong to very heterogeneous economic backgrounds or difficult geographic areas. These factors may lead to a variety of logistic issues that were apparent in our experience too. From the faculty point of view, there was, however, a certain amount of unease in forgoing the dynamism that a traditional class with the physical presence of both students and teacher has to offer. The feedback from most faculty members was that in online lectures it is difficult for teachers to gauge the attention and level of comprehension among the students and modify the teaching style according to the student's issues.

To conclude, online teaching with its improvisations has provided a pleasing and satisfactory platform for teaching Pathology to undergraduates in the challenging times of lockdown due to COVID-19. The use of the available online tools can help us in providing high-standard teaching for undergraduates in such times as a lockdown. Also, an amalgamation of both offline and online classes during routine MBBS teaching may prove to be very effective for better learning of Pathology among MBBS students.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Dash S. Google classroom as a learning management system to teach biochemistry in a medical school. Biochem Mol Biol Educ 2019;47:404-7.  Back to cited text no. 1
Back DA, Behringer F, Haberstroh N, Ehlers JP, Sostmann K, Peters H. Learning management system and e-learning tools: An experience of medical students' usage and expectations. Int J Med Educ 2016;7:267-73.  Back to cited text no. 2
Singh K, Srivastav S, Bhardwaj A, Dixit A, Misra S. Medical education during the COVID-19 pandemic: A single institution experience. Indian Pediatr 2020;57:678-9.  Back to cited text no. 3
Moszkowicz D, Duboc H, Dubertret C, Roux D, Bretagnol F. Daily medical education for confined students during COVID-19 pandemic: A simple videoconference solution. Clin Anat 2020;33:927-8.  Back to cited text no. 4
Mayer RE. Applying the science of learning to medical education. Med Educ 2010;44:543-9.  Back to cited text no. 5
Wolpaw TM, Wolpaw DR, Papp KK. SNAPPS: A learner-centered model for outpatient education. Acad Med 2003;78:893-8.  Back to cited text no. 6
Modi JN, Anshu, Gupta P, Singh T. Teaching and assessing clinical reasoning skills. Indian Pediatr 2015;52:787-94.  Back to cited text no. 7
Black CC. Experiential teaching paradigms: Adapting the medical education literature to academic pathology practice. Acad Pathol 2019;6:2374289519892553. doi: 10.1177/2374289519892553.  Back to cited text no. 8
Mukhopadhyay S, Booth AL, Calkins SM, Doxtader EE, Fine SW, Gardner JM, et al. Leveraging technology for remote learning in the era of COVID-19 and social distancing: Tips and resources for pathology educators and trainees. Arch Pathol Lab Med 2020;144:1027-36.  Back to cited text no. 9

Correspondence Address:
Garima Goel
Department of Pathology and Lab Medicine, AIIMS Bhopal, Saket Nagar, Bhopal - 462 024, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_665_20

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