Laura Helle’s research while affiliated with University of Turku and other places

Aims To meet the flexible learning needs of pathology residents preparing for national board examinations, a joint distance learning approach was developed using both asynchronous and synchronous activities with whole slide images, drawing on empirical educational research on online distance learning. Methods In a case study of an implementation of the designed joint distance learning approach with a geographically dispersed group of pathology residents in Finland, the participants’ perceptions were measured with a 12-item questionnaire covering the value of the learning opportunity, the quality of the sociocognitive processes and their emotional engagement and social cohesion. Communication during the online session was also recorded and analysed to provide objectivity to the self-report data. Results The effectiveness of joint online learning for knowledge acquisition and preparation for national board examinations was highly rated. However, despite strong emotional engagement during synchronous activities, participants reported minimal interpersonal interaction, which was also reflected in the recordings of the online session. Conclusion Using a technology integration framework and guided by the principles of self-determination theory, joint distance learning is emerging as a beneficial addition to postgraduate pathology programmes in preparation for national examinations. However, to realise the full potential of interpersonal interaction, participants should be prepared for an appropriate mindset.

When teaching infection prevention and control (IPC), nursing education tends to focus on skills and fostering good practice rather than challenging students’ thinking. Therefore, students’ misconceptions about IPC receive less attention than they deserve. The purpose of the study was to make an inventory of student nurses’ misconceptions about IPC before instruction and to make these misconceptions visible to teachers. The study was conducted in one vocational institute in Finland and is based on the answers of 29 practical nurse students before IPC training. The students took an online test requiring them to justify their answers to two multiple-true–false questions: 1) What is the main route of transmission between patients in healthcare facilities, and 2) What is the most effective and easiest manner to prevent the spreading of pathogens, e.g., multi-resistant bacteria in long-term care facilities? Analysis of the students’ written justifications resulted in three mental models: 1) the Household Hygiene Model manifesting lay knowledge learned in domestic situations, 2) the Mixed Model consisting of lay knowledge, enriched with some professional knowledge of IPC, and 3) the Transmission Model manifesting a professional understanding of IPC. The first two mental models were considered to be misconceptions. Only one of the participants showed a professional understanding (i.e., the Transmission Model). To conclude, student nurses manifested systematic patterns of misconceptions before instruction. Unless the students are confronted with their misconceptions of IPC during instruction, it is likely that these misconceptions will impede their learning or make learning outcomes transient.

Microscopy is an essential basis for exploring and understanding pathological disease mechanisms. As a discipline, pathology is highly dependent on visual imaging technologies. Currently, digital pathology is a standard method with special advantages in both clinical histopathological diagnostics as well as the education of (undergraduate and postgraduate) medical students and pathology residents. However, to date, the available digital applications lack features to optimally support online collaborative learning and teaching of histopathology, such as possibilities for learners to individually perform tasks (e.g. annotate) on digital slides, opportunities for groups to reflect on their work and to receive feedback from more knowledgeable peers or supervisors. Such shortcomings have recently become more imminent, due to shifts toward more online learning in pathology education. Therefore, the cLovid (collaborative learning of viewing and decision-making skills) project set out to build an integrated online learning system featuring: (1) an open-source webmicroscope (an extension to the OMERO viewer) with enhanced features for annotating whole-slide images, allowing integration with assessment and feedback software; (2) an online assessment software-e.g., VQuest, in our design-for constructing assignments using various types of responses (e.g. marker questions, which are ideal for visual domains), suitable for developing image interpretation skills through active learning with large images; and (3) an open-source software dashboard (PRISMA) for synthesizing and visualizing students' responses in tasks using various types of responses, allowing teachers to provide collective feedback to groups of students, as well as a joint platform for communication for both on-site and remote settings. Subsequently, the project team carried out two teaching pilots to demonstrate how this system can be used for teaching with guided activity, collaboration, feedback, reflection and possibilities for the teachers to model diagnostic reasoning. The teaching examples involved the pathology curriculum of second-year undergraduate medical students (N=70) in two European universities and the training of pathology residents (N=16) in Finland. In this paper, we present the development of the integrated system for online teaching and learning of histopathology and exemplify its use in the two scenarios. Lessons learned from the teaching pilots will be discussed.

Changes in working life require knowledge, which is sometimes radically different from existing expertise. Learning based on existing knowledge is not sufficient. Some knowledge is difficult to learn because it is counterintuitive. Research on conceptual change has extensively studied this type of learning challenges while students are learning scientific and mathematical concepts. However, theories of conceptual change have not been widely applied in expertise research. This study re-analyses earlier studies on medical image diagnosing and explores how theories of conceptual change explain the findings. Unlike science learning, the knowledge needed for the medical diagnosis processes did not exclusively consist of one or a few well-defined scientific concepts, but rather involved a system of various types of knowledge and practical skills.

Goodwin’s notion of professional vision suggests that learning to see in professionally relevant ways includes appropriating the visual practices within a domain. This observational study aimed to analyze how experts communicate these visual practices to novices to help them make meaning of domain-specific representations. Informed by a sociocultural perspective and founded on conversation analysis and ethnomethodology, video-recorded discourse and interaction between one expert in radiology and four laypeople were analyzed. The findings indicate three visual practices the medical expert uses to teach the novices how to see: highlighting, rotating, and zooming. The qualitative analyses suggest that learning to see professionally can be described as the mastering of expert practices in a focal domain. Implications for visual expertise research are discussed.

It is intuitively appealing to try to combine eye-tracking data and verbal reports when investigating medical image interpretation. However, before collecting such data, important decisions must be made, including exactly when and how to collect the verbal reports. The purpose of this methodological article is to reflect on the pros and cons of different solutions and to offer some guidelines to investigators. We start by exploring the ontology of vision and speech production and the epistemology of eye movements to grasp what fixations and verbal reports actually reflect. We are also interested in the major constraints of the two systems. Second, we elaborate on two dominant investigational approaches to verbal accounts: concurrent think-aloud and Chi’s explanations. Later, we move on to other approaches. Third, we present and critically evaluate studies from the literature on medical image interpretation, specifically ones that have sought to contrast or integrate eye-movement data and verbal reports. Fourth, we conclude with some practical guidelines and suggestions for further research.

Purpose To establish potential markers of visual expertise in eye movement (EM) patterns of early residents, advanced residents, and specialists who interpret abdominal computed tomography (CT) studies. Materials and Methods The institutional review board approved use of anonymized CT studies as research materials and to obtain anonymized eye-tracking data from volunteers. Participants gave written informed consent. Early residents (n = 15), advanced residents (n = 14), and specialists (n = 12) viewed 26 abdominal CT studies as a sequence of images at either 3 or 5 frames per second while EMs were recorded. Data were analyzed by using linear mixed-effects models. Results Early residents' detection rate decreased with working hours (odds ratio, 0.81; 95% confidence interval [CI]: 0.73, 0.91; P = .001). They detected less of the low visual contrast (but not of the high visual contrast) lesions (45% [13 of 29]) than did specialists (62% [18 of 29]) (odds ratio, 0.39; 95% CI: 0.25, 0.61; P < .001) or advanced residents (56% [16 of 29]) (odds ratio, 0.55; 95% CI: 0.33, 0.93; P = .024). Specialists and advanced residents had longer fixation durations at 5 than at 3 frames per second (specialists: β = .01; 95% CI: .004, .026; P = .008; advanced residents: β = .04; 95% CI: .03, .05; P < .001). In the presence of lesions, saccade lengths of specialists shortened more than those of advanced (β = .02; 95% CI: .007, .04; P = .003) and of early residents (β = .02; 95% CI: .008, 0.04; P = .003). Irrespective of expertise, high detection rate correlated with greater reduction of saccade length in the presence of lesions (β = -.10; 95% CI: -.16, -.04; P = .002) and greater increase at higher presentation speed (β = .11; 95% CI: .04, .17; P = .001). Conclusion Expertise in CT reading is characterized by greater adaptivity in EM patterns in response to the demands of the task and environment. (©) RSNA, 2016 Online supplemental material is available for this article.

Over the years, the role and extent of the basic sciences in medical curricula have been challenged by research on clinical expertise, clinical teachers, and medical students, as well as by the development and diversification of the medical curricula themselves. The aim of this study was to examine how prior knowledge of basic histology and histopathology among students predicts early learning of diagnostic pathology. Participants (N=118, representing 91% of the full student cohort) were medical students at the University of Turku, Finland. Data were collected during two preclinical courses that students attended in their first and second years of medical school. The measurements included tests on biomedical and clinical knowledge and a performance test in diagnostic pathology. Second-year performance on the diagnostic pathology examinations was predicted by the students' prior knowledge of histology, but not by the students' prior knowledge of histopathology. Although earlier research has demonstrated similar results in studies with shorter longitudinal designs, the present study demonstrates that the effect remains even if there is a considerably long time delay (a year) between the measurements, thus confirming the long-term value of basic science studies in the preclinical phase. Anat Sci Educ. © 2013 American Association of Anatomists.

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The present eye-movement study assessed the effect of expertise on eye-movement behaviour during image perception in the medical domain. To this end, radiologists, computed-tomography radiographers and psychology students were exposed to nine volumes of multi-slice, stack-view, axial computed-tomography images from the upper to the lower part of the abdomen with or without abnormality. The images were presented in succession at low, medium or high speed, while the participants had to detect enlarged lymph nodes or other visually more salient abnormalities. The radiologists outperformed both other groups in the detection of enlarged lymph nodes and their eye-movement behaviour also differed from the other groups. Their general strategy was to use saccades of shorter amplitude than the two other participant groups. In the presence of enlarged lymph nodes, they increased the number of fixations on the relevant areas and reverted to even shorter saccades. In volumes containing enlarged lymph nodes, radiologists' fixation durations were longer in comparison to their fixation durations in volumes without enlarged lymph nodes. More salient abnormalities were detected equally well by radiologists and radiographers, with both groups outperforming psychology students. However, to accomplish this, radiologists actually needed fewer fixations on the relevant areas than the radiographers. On the basis of these results, we argue that expert behaviour is manifested in distinct eye-movement patterns of proactivity, reactivity and suppression, depending on the nature of the task and the presence of abnormalities at any given moment. (Article available from http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0066169)