Online Integrative Histology Module Improves Self‐efficacy for Medical Students with Lower Course Performance
Authors: Schoenherr Daniel T. , Dereski Mary O. , Bernacki Kurt D. , Hafez-Khayyata Said , Attardi Stefanie M. 
Published: April 2020

Vertical integration of basic and clinical sciences is an important aspect of medical curriculum enhancement. Oakland University William Beaumont School of Medicine (OUWB) sought to better integrate histology with pathology in a respiratory system course. Individuals born 1981–1999, reflecting the age range of OUWB students, are shown to prefer self‐paced, interactive learning environments with immediate feedback on their learning progress, best achieved by utilizing online resources. As such, an online module was the chosen method for improving histology‐pathology integration. The objectives of this study were to (1) design and implement a histology‐focused online module that prepares students for a respiratory pathology laboratory session; (2) determine if the module facilitated short‐term knowledge gain; and (3) determine if module use or previous course performance affected students’ self‐efficacy in the pathology laboratory. First year medical students (N=128) were invited to complete an online histology review module consisting of 1‐minute screencasts, image‐based matching activities, and pre/post module quizzes with immediate feedback. Students then participated in a mandatory pathology laboratory. A validated self‐efficacy survey was administered immediately prior to the aforementioned activities to measure students’ confidence in their abilities to meet the situational demands of pathology. To determine incoming student performance, the average scores of mandatory course assessments completed before the study were collected. Post‐module quiz scores were significantly higher than pre‐module scores (n=32, p=0.002, two‐group Wilcoxon signed rank test), indicating short term knowledge gain. Prior to the pathology laboratory, module users (n=14) did not report significantly different self‐efficacy compared to non‐users (n=20) (p=0.15, Mann‐Whitney U test). For module users, there was no significant correlation between course performance and pre‐laboratory self‐efficacy (n=14, p=0.59, Spearman rank correlation); however, a positive relationship was significant for those that did not use the module (n=20, p=0.01, Spearman rank correlation), suggestive of a self‐efficacy discrepancy between higher and lower performing students that did not use the module, but not among the module users. Further investigation into course performance showed no significant difference in pre‐laboratory self‐efficacy in the top half of performers between module users (n=9) and nonusers (n=10) (p=0.90, Mann‐Whitney U test), while module users (n=5) in bottom half of performers reported significantly higher self‐efficacy compared to non‐users (n=10) in the same group (p=0.02, Mann‐Whitney U test). Module use facilitated short‐term gain in knowledge of respiratory histology. While module use did not significantly affect all participants’ self‐efficacy, it did correlate with significantly higher self‐efficacy among lower performers in the class compared to those that did not use the module. These findings suggest that modules of this nature may be of greater benefit for students who initially have lower academic performance.