May 31, 2023

Going global with Hematopathology: how an online teaching platform could revolutionize the field

Programs: Postgraduate, Agile education, Research: Hematopathology, Disruptive Innovation, Dynamic Collaboration

Dr. Rumina Musani with Pathology staff and students at Mansoura University, Mansoura, Egypt.

By Lauren Ohh & Jenni Bozec

Dr. Rumina Musani, Assistant Professor in the Department of Laboratory Medicine and Pathobiology in the Temerty Faculty of Medicine, and Hematopathologist at University Health Network (UHN), unexpectedly took on the role of Hematopathology Program Director shortly after becoming full-time staff in 2012. This motivated her to pursue a master’s degree in Health Professional Education. Musani was then presented with the opportunity to teach in Nairobi due to a lack of dedicated hematopathology teaching in the area. She taught a “mini course” in hematopathology using glass slides, which despite being the standard teaching tool, proved to be inconvenient and difficult to preserve throughout international travel.

During her capstone project, Musani received more teaching invitations. This time, she aimed to make the teaching process more efficient by way of online learning using Knowledge Forum, an online platform developed by Dr. Marlene Scardamalia and Dr. Carl Bereiter at the Ontario Institute for Studies in Education (OISE). She was able to connect the residents at the University of Toronto to those in Kenya and used this opportunity to evaluate the platform as a teaching method. She found that the online platform was useful but wasn’t optimal for the content she aimed to teach. “I didn't want just a repository or a quiz. I wanted there to be collaborative discussion,” she explained.

She is currently pursuing a PhD in Medical Education at OISE and using the opportunity to take her teaching experimentation a step further. Working with PeppeR developers Dr. Jim Hewitt and Dr. Clare Brett, Musani developed online learning specific to hematopathology. The platform required modification to teach Hematopathology but Musani believed that she could overcome the challenges and create a way to teach her field effectively online.

Piloting the online learning platform

Rumina teaching hematology technologists at the The Aga Khan Hospital, Kisumu, Kenya

Later, Musani received another invitation to teach in Kenya. She prepared a prototype of her online platform to measure whether it could be effective. If successful, her platform would certainly broaden LMP’s global footprint; an objective in the LMP Strategic Plan.

She also planned a teaching trip to Egypt, Tanzania, Kenya, and Uganda, and using the platform, and relevant cases to teach as a part of a pilot study. The urgent demand for teaching in the hospitals she planned to visit made them the ideal population for testing her ideas.

Musani noted interesting challenges throughout the pilot.

Challenges of digitizing slides

Without the traditional, physical slides, Musani had to use digital images. Unfortunately, while these are available in pathology, hematopathology’s images are more challenging to digitize as they need a higher resolution and magnification. Musani joked, “we’re like princesses because we have very special requirements,” referencing the largely liquid-based content in her field.

To overcome this, Musani made arrangements with a research laboratory in Ottawa to get what she needed scanned at 100x. The images are so huge (often 40 - 50GB per image), she then faced challenges of how to store and use them. Using the Digital Laboratory Medicine Library wasn’t a solution as she needed to combine image use with a discussion platform so learners could see the images then analyze them together. She found a solution by combining the file hosting platform from the Ottawa lab with the PeppeR platform.

She used the online learning platform to teach, then visited the sites in person to assess the experience and to understand needs and challenges.

Accessibility for online learning across different countries

Kenya, Uganda, and Egypt had the infrastructure to support online learning, however, in Tanzania, learners had difficulties opening the digital images due to bandwidth issues. The data required to open the files was too much for the infrastructure in that country as the images are so large.

Musani is currently investigating solutions to improve image transfer rates to allow for jurisdictions that struggle with this issue.

A lack of experience caused challenges in Uganda. There was such a large gap of knowledge in hematopathology that they didn’t know how to read the images. The solution to this lies in the teaching itself. With only two hematopathologists in the country, Musani’s platform is crucial to increasing their understanding of hematopathology.

Different cultural approaches to pathology

A picture of a presentation by a resident that Rumina is facilitating

In Canada, pathologists take a holistic approach by inviting discussion and collaboration and interprofessional collaboration. In many of the sites she visited during the pilot, Musani realized that collaboration with others outside pathology was limited.

“In Hematopathology, our report is quite comprehensive and includes all of the elements that were tested. If we're looking at a bone marrow case, we will look at the blood, the bone marrow, the aspirate and the tissue - which is part of the biopsy, and we'll do the flow cytometry and integrate any molecular studies or cytogenetics that are done. In other countries, what they look at depends on which system they follow. One person may read the aspirate and another the flow, and they may not talk to each other. This can result in multiple diagnoses for the same biopsy”.

Helping reinforce the value of interprofessional training would therefore be a key part of future training programs. “In teaching, all these issues really came to light,” she noted.

Next steps

“The focus of my PhD is educational technology and I’ve yet to discover a platform that would be optimal for this type of education,” said Musani. Her goal is to find the best solution by either modifying what exists or creating something new.

She intends to make education accessible to any country that needs it, providing online fellowships in the long term without the need for travel and visas. Musani commented,

Me at Mansoura University, Mansoura, Egypt

“we need to break (down) those geographical and financial barriers, I want to make this knowledge accessible to resource-poor countries”. Establishing the right online learning platform for Laboratory Medicine fields could supplement existing teaching at LMP and its partner hospital sites, cementing Musani’s plans for non-profit sharing of knowledge.

There’s a clear demand for this reliable, collaborative teaching method. She commented, “the learners were so excited. It was nice to see that they're hungry for the knowledge and happy to learn.” Upon completing their training, former learners are then able to teach others within their own institutions, creating a ripple effect. Musani said, “you pass on that knowledge and expertise and it gets passed on further - it makes a big difference”.

Dr. Michael Pollanen, Vice Chair Global Health for LMP, commented “Rumina’s work is filling an important gap in the international domain. Her efforts and achievements are transformative, the trainees loved this teaching and found it incredibly valuable for them, their institution, and their country.”