Teaching and Learning Forum 99 [ Contents ]

Drag & Drop Pathology: First experiences with a new computer-based tutorial system in the Faculty of Medicine

Moira Maley, Jennet Harvey, Lawrence Yu
Department of Pathology
Nathan Scott, Department of Mechanical Engineering
The University of Western Australia
Most medical students will go into General Practice at the end of their training while only a few will specialise in Pathology. So in their paraclinical training years the class has different learning needs as well as the usual range of learning abilities.

In the past students have learned to identify specific histopathological characteristics by studying microscope slides alone. This is not an easy task because a student looking down a microscope may not understand what he or she is seeing, or why it is important; and medical students are incredibly busy during semester and run out of time.

As a result there is often a panic at the end of the semester when too many students try to use too few microscopes and slide sets.

We describe a new computer-based tutorial system established to address these problems. Students are shown digitised micrographs and are asked to "drag" markers onto the figures. Specific, diagnostic feedback is given for incorrectly placed markers. Student response has been very positive and we have anecdotal evidence that the class has found this new learning tool to be effective. Our software is JAVA based requires only web browser and internet access.


A small number of students in any year of medical studies will specialise in Pathology but all students need to understand the scientific basis of disease and how the disease status is likely to affect a patient's future. Undergraduate paraclinical training must therefore accommodate a range of learning needs and abilities. The traditional approach to teaching Pathology is for the students to examine fixed macro specimens in bottles and microscopic sections on glass slides. The information intense nature of the medical course means that the students leave their revision study till just before exams and are therefore examining specimens on their own without expert guidance. This is an inefficient practise.

In conjunction with a major review of the medical curriculum, we are developing a computer based tutorial system to facilitate asynchronous learning of integrated course material in the paraclinical sciences. This is a world wide web (www) resource which records the progress of the students through the tutorial system. Students are shown digitised images of macroscopic and microscopic material and are asked to drag markers onto them. Specific expert diagnostic feedback is given for incorrectly placed markers. This enables the students to correctly identify the required features and supplementary material provided via a multiple choice-like system further tests their understanding of the topic. The system is supported by commercial software (developed by UWA staff) called "Jellyfish". The jellyfish course server allows the teachers to monitor the progress of individual students.

The instructional tools include Java based "drag and drop" and multiple choice questions with specific diagnostic feedback. These question types are supported by a student monitoring system that allows staff to keep track of student progress. Early experience with the new course suggests that the environment is a powerful educational medium.

Materials and methods


A topic within the third year Pathology 330 course at the University of Western Australia (UWA) was chosen for presentation using the www resource provisionally named "UWA MedTut". The lecturer for the "Diseases of the Breast" topic had not taught this area previously and so all the teaching material including histopathology photomicrographs were sourced afresh. The single face to face lecture was given to an entire year of 120 students in a large lecture theatre with good liquid crystal display (LCD) projection facilities using a pentium personal computer (PC) with 64MB random access memory.

At the beginning of the lecture the students were briefed that the presentation of the topic was a trial and that the lecture material itself as well as the tutorial would be available on the www from the conclusion of the lecture. They were asked to stay on after the lecture for a brief "driving lesson" on the tutorial system. It was made clear that their performance within the tutorial system would not be used for assessment purposes.

Facilities for student access to the web were limited in this trial. There was a 6 terminal computer laboratory in the Department of Pharmacology open during working hours and five terminals with internet access in the medical library. Students with their own PCs could dial in through the UWA network and log in from home.


Images of macroscopic specimens were captured using an Olympus digital camera on loan from the Image Analysis and Acquisition Centre, UWA. Digital photomicrographs were acquired using Optimas software via a Panasonic CCD Video camera mounted on a Leitz research microscope in the Department of Pathology, UWA. These images were subsequently optimised for web display using Adobe Photoshop. The text and images used in the lecture were formatted in hypertext markup language (HTML 3.2) using HomeSite (3.0) software.

Tutorial Format

A tab delimited text file containing the names and student numbers for all students enrolled in Pathology 330 was imported into the administrative node of the JellyFish Course Server software (TM).

When the students logged into "JellyFish" (Figures 1 and 2) a set of information files were created for each student. These indicated the browser used, the course nodes accessed and the tutorial questions successfully completed with the number of attempts. These files were updated every time the students logged in. The students had been informed that although their interaction with the tutorial system would be recorded it would not be used for assessment purposes.

Figure 1

Figure 1: Login page

Figure 2 Figure 2: Greeting to individual user

The email addresses of the relevant teachers were provided on every page.

The tutorial included questions requiring the recognition of various pathological features and multiple choice-type questions.

Figure 3 Figure 3: Design of trial tutorial

Multiple choice questions

The multiple-choice questions often involved graphics, as shown in Figure 4 and 5. In some cases the student had only to click on the correct image and an incorrect click would lead to a detailed web page of explanation about the error. In other cases the student had to choose from a number of alternatives by clicking on "radio buttons".

Figure 4

Figure 4: Multiple choice-like question

Figure 5

Figure 5: Response to incorrect selection

Drag-and-drop questions (Java applet)

The feature recognition questions comprised a JAVA applet which presented a simple graphical interface to the student (see Figure 6). The applet displayed a colour image (usually a photomicrograph of human tissue) and also some "markers" for features of the image. The interface allowed the student to "drag" the markers onto the image and then to press a button to indicate that the problem was "Done".

Figure 6
Figure 6: Applet prior to student interaction. A predetermined number of markers for each feature must be placed onto the photomicrograph. They cannot be placed on top of one another.
The applet would then "assess" the student's work and provide specific, diagnostic feedback for any incorrectly placed markers. The software was set up so that the same Java applet was used many times for different problems. The image and diagnostic information specific to each problem was stored in configuration files. For example, each problem of this type had a text file containing diagnostic messages for the errors the student was likely to make.

Figure 7
Figure 7: Applet following marker placement and "Done" click. Once the student has placed all the markers, the "Done" button is clicked and the applet compares the position of the markers with a mask (not seen) and places a tick or a cross next to the marker.
The applet provided feedback for incorrect answers by placing a red cross next to the marker. If the student then moved the mouse near the marker a detailed text message was shown (visible in Figure 6). Students were allowed to reposition the markers and re-submit the answer any number of times without penalty. However there is no reason that a numerical mark could not be given based on the accuracy of each attempt or the total number of attempts; this approach may be used for assessment in future years.

Figure 8
Figure 8: Applet feedback from another marker. As the student moves the mouse over the markers, specific feedback is displayed in a text box. Wrongly placed markers can then be moved to another location and then the question marked again via the "Done" button.


Student interaction

Within 2 weeks of the delivery of the lecture 33 students had logged in and completed some part of the tutorial. At this time, just prior to another lecture, the students were asked en masse for feedback about their interaction with UWA MedTut, particularly why only 33 had logged in. The response was very enthusiastic about the potential of the system, and in explanation of the limited number of logins, students said they had other course commitments that, for the time being, must come first, and there had been some difficulty getting access to computer terminals.

Just prior to the exams a total of 55 students had accessed the system indicating its use as revision for exams.

A total of 15 email communications was received from 10 students in the trial period. These concerned difficulties of access, mistakes in the assessment of the marker placement, and general enthusiasm for such a system and asking for more.


The information intense nature of the medical course is being addressed in the major curriculum review underway at UWA. The new curriculum aims to have a reduction in contact hours, horizontal and vertical integration of subject material and an increased emphasis on problem-solving, self-directed learning and flexible learning. A web-based instruction component will facilitate these goals.

The trial of the new tutorial system, UWA MedTut, has shown that expert guidance can be coupled with self-directed learning using a few simple software tools. The value added by the diagnostic feedback far outweighs the limited effort required on the part of the teacher to master the UDB file format. A knowledge of HTML is desirable but no programming is required. Students need only a JAVA enabled web browser and, at present, the internet to use the system. The experienced teacher can anticipate common misconceptions and redirect unfocussed mental effort so that students make more efficient use of their learning time.

The documentation of student performance is a prominent feature of the JellyFish course server environment. When used for official assessment, i.e. 100% of students log in, it enables the teacher to track poor performers for remedial support and also to direct the better students to other resources to further promote their performance.

This type of tutorial system provides a non-threatening interface between the student and a remote teacher and facilitates self-directed, asynchronous learning. Although UWA MedTut is in its infancy, the path is now open for a rapid progression toward the integrated teaching of medical disciplines using the web resource as a consistent interface for students. The same approach could be taken to postgraduate training which is often done by remote access.


The authors would like to acknowledge the contribution of Dr Dianne Barrington, Curriculum Development Officer in the Faculty of Medicine to the initial development of this project. We are grateful to Mr Phillip Williams for his professional photographic skills.

Please cite as: Maley, M., Harvey, J., Yu, L. and Scott, N. (1999). Drag & Drop Pathology: First experiences with a new computer-based tutorial system in the Faculty of Medicine. In K. Martin, N. Stanley and N. Davison (Eds), Teaching in the Disciplines/ Learning in Context, 243-250. Proceedings of the 8th Annual Teaching Learning Forum, The University of Western Australia, February 1999. Perth: UWA.http://lsn.curtin.edu.au/tlf/tlf1999/maley.html

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