MEDICAL SCIENCE EDUCATOR

The Journal of the International Association of Medical Science Educators ORIGINAL RESEARCH
Med Sci Educ 2013; 23(4): 607-619

Preference of Interactive Electronic Versus

Traditional Learning Resources by University of
Michigan Medical Students during the First Year
Histology Component
Louisa Holaday, Daniel Selvig, Joel Purkiss & Michael Hortsch
University of Michigan Medical School, Ann Arbor, MI, USA

Abstract
Histology or microanatomy is an integral component of most first year medical curricula. As histology is heavily
based on the review and analysis of images, modern educational resources are increasingly used for teaching this
subject. These novel didactic approaches often supplement more traditional offerings of the material, such as
lectures and laboratory sessions. After completion of their M1 histology component, University of Michigan
medical students participated in a voluntary survey about their study habits and their use of various histology
learning resources and how this usage changed over time. The data presented in this analysis demonstrate a
strong preference of these students for studying histology with electronic rather than traditional learning
resources. In particular, students’ use of scheduled didactic opportunities decreased over the progression of the
course. Students also exhibited a strong inclination to study histology individually rather than in study groups.
These reported insights in students’ preferences suggest a need to develop and update educational tools for
teaching this very visual subject.

Introduction offered to them, and why students make the choices

Due to the development of new electronic teaching
tools and an emphasis on interactive learning
models, methods for teaching histology or
microanatomy to medical and dental students have
been changing considerably in the last few years.1
New didactic approaches include the use of virtual
microscopy, recorded lecture videos that allow
students to watch on their own time, as well as
online learning modules, which incorporate and
promote active learning.2-10 This abundance of new
teaching models is slowly supplanting traditional
modes of teaching histology, such as classroom
lectures, laboratories using light microscopes, and
textbooks or histological atlases.11 Such traditional
teaching methods are often more reliant on passive
absorption of information and knowledge. However,
there is a paucity of research into the choices
students make between traditional and novel
learning methods for histology, when both are
Corresponding authors: Michael Hortsch, PhD, Department of
Cell and Developmental Biology, University of Michigan Medical
School, 109 Zina Pitcher Place, Ann Arbor, Michigan 48109 USA;
Tel: +1 734 6472720; Fax: +1 734 6158191;
Email: hortsch@umich.edu
they do. Although some published reports suggest
that faculty and students welcome and embrace new
didactic offerings for teaching and learning
histology, a comprehensive analysis of medical
students’ acceptance of traditional versus electronic
and passive versus interactive teaching resources
has not been published.8,12-15 To this end, we sought
to address this question by surveying a group of 168
M1 students on their use of traditional and
electronic resources during their M1 year histology
component. In recent years the number of electronic
resources available for studying histology at the
University of Michigan Medical School has grown
quickly, while most traditional resources remain
available to students. In our curriculum, students
are free to choose from a multitude of available
histology learning resources. They may attend
lectures in person, watch lecture videos that they are
able to speed up, or a combination of both. The
attendance of laboratory sessions, where students
can use traditional light microscopes or virtual
microscopy is also optional. In addition, there are
multiple online resources that can be used from a

Medical Science Educator © IAMSE 2013 Volume 23(4) 607

course website (http://histology.med.umich.edu/
schedule/medical), including a comprehensive
library of virtual histology slides and several series
of supplemental PowerPoint and PDF files, some of
which are interactive. The goal of our analysis was
to evaluate students’ use of these options and
learning resources for histology, including any
changes over the course of the academic year. We
also surveyed students’ choices regarding preference
of passive versus active learning tools and
traditional scheduled versus self-directed resources.
The results of our analysis strongly suggest that
students generally prefer interactive and self-
scheduled resources that are offered in an electronic
format.
Methods
M1 Histology Curriculum at the University
of Michigan.
The University of Michigan Medical School
curriculum is designed to complete the academic
work for an M.D. degree within a 4 year time period.
The M1 year is organized in multi-week organ-
system-based sequences and histology is taught in 8
of these units, which are offered from September
through March of each academic year. Each of the
organ-system-based units contains one to five
traditional-style histology lectures which are
followed by three-hour-long faculty-attended
laboratory sessions. At the University of Michigan
Medical School, pathology is taught independently
of histology and follows after completion of the first
year histology component. The entire M1 histology
component offers 26 hours of lectures and 21 three-
hour-long laboratory sessions. Attendance of
histology lectures and laboratory sessions is not
compulsory or documented. Alternatively, students
have the choice to view lectures by video and to
perform laboratory assignments at their own chosen
schedule. Each laboratory session begins with a
PowerPoint introduction to the virtual slide material
(approximately 30 minutes) that is presented by a
faculty member. Subsequently, students have the
opportunity to work on their laboratory
assignments in the presence of histology teaching
faculty members, who are available to answer their
questions. Unless students contact them by email,
faculty members are not available outside of
laboratory hours. Students are expected to bring
their laptops or computer tablets to the laboratory
sessions for viewing the virtual slides and for
performing the assigned laboratory tasks as
outlined on the Michigan Histology webpage
(http://histology.med.umich.edu/schedule/medical
). During laboratory sessions, they also have the
option of viewing histological glass slides with real
Medical Science Educator © IAMSE 2013
microscopes, which are set up in one of the
laboratory rooms. These glass slides offer the same
or similar views as provided by the virtual slide
collection. Poster-size, labeled electron micrographs
are displayed in the hallways outside the laboratory
rooms and remain available to students throughout
each organ-system unit. PowerPoint files of the
lectures and laboratory introductions can be
downloaded by students from the M1 histology
website. Paper copies of lecture handouts and the
laboratory manual are made available to all students
prior to lectures and the beginning of the laboratory
sessions. The spiral bound laboratory manual
provides the same instructions and information as
the Michigan Histology webpage, but does not
include the multiple-choice practice questions
available online.
Learning success and competency in histology are
evaluated by weekly quizzes and a final examination
for each organ-system-based units. All are
administered online and consist of multiple-choice
questions with associated images. Histology is only
one of several subjects (gross anatomy, physiology,
biochemistry etc.) that are tested in these quizzes
and exams. Over the M1 year, students have to
answer about 180 histology questions and a
cumulative 75% correct answer rate is considered
passing.
Histology Resources Available to M1
Students at the University of Michigan.
The purchase of a histology textbook or atlas is
strongly recommended to all students at the
beginning of the M1 histology component, but is not
a requirement. All of the electronic histology
learning tools are available to students and faculty
at the University of Michigan Medical Histology
website (http://histology.med.umich.edu/schedule
/medical). The website not only allows downloading
of password-protected histology resources (lecture
handouts and various series of PowerPoint files),
but also contains learning objectives, laboratory
instructions and links to the University of Michigan
virtual slide collection, which are openly accessible
to non-University users under a Creative Commons
license. The end of each organ-based web section
contains a number of review problems and
multiple-choice practice questions. As students are
able to access the virtual histology slides outside of
scheduled laboratory hours, they can complete
laboratory assignments without faculty assistance.
The multiple supplemental PowerPoint series,
which have been created by histology teaching
faculty members, include Dr. Christensen’s white
board Histological Drawings, which summarize
histology terminology and structures; Dr. Velkey’s
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labeled still shots of Michigan Virtual Histology
Micrographs; Dr. Kim’s “Review and Look-Alike”
images that specifically address similar-looking
histological structures and tissues and Dr. Hortsch’s
“SecondLook” series that provides students with a
self-evaluation tool to test their preparedness before
quizzes and examinations (http://
www.med.umich.edu/lrc/secondlook/).
Structure of the Survey and Data Collection.
The results presented in this paper are derived from
an online survey that was administered to the
University of Michigan Medical School Class of 2014
following the final histology module of their first
year histology component. Participation was
entirely voluntary, but was encouraged by the
random drawing of four $70 cash prizes from
among participating students. A total of 146, out of
168, M1 students completed the survey, yielding an
87% response rate. Not all participating students
answered all questions, resulting in some N<146.
The survey was constructed using the Qualtrics
online survey service and consisted of 18 question-
sets. Each question-set addressed from one to 17
different points or resources with ranges of two to
five possible answers. For example, students
responded to questions regarding their histology
study habits and their use of fourteen different
histology education resources. For each resource,
students were asked to describe on a five-point
Likert scale (“Always”, “Frequently”, “Moderately”,
“Rarely”, or “Never) how often they used each
resource and whether their use of that resource
increased, decreased, or remained the same over the
course of the academic year. Four questions allowed
participating students to enter text-based, open-
ended responses. Demographic characteristics and
past educational experiences were also assessed.
Survey questions established personal background,
including college majors, time since graduation,
previous relevant coursework and laboratory
experiences. Additional questions focused on
histology study habits, specifically individual versus
group study, and study time spent per lecture topic.
Prior to the data analysis, all survey responses were
rendered anonymous by a study contributor, who
was not personally involved in teaching the M1
histology component. Before the administration of
the survey, the project received an IRB exemption
from the University of Michigan IRBMED panel
(application number HUM00048823).
Statistical analysis of data.
IBM SPSS Statistics Version 19 was used for the
statistical analysis. We calculated descriptive
statistics including percentages, means and
standard deviations to summarize student response
Medical Science Educator © IAMSE 2013
patterns for the various survey items. We also used
paired-sample t-tests, to evaluate statistical
significance of self-reported changes in use of
different types of study resources over the course of
the academic year. We used α=0.05 as our threshold
for statistical significance.
Other Materials.
A commercial use license for the icons used in
Figures 3 and 4 was purchased from psdGraphics,
Columbus, Ohio.
Results
Student Study Habits
Students were asked how much time they spent
studying histology per laboratory topic (excluding
time spent in the classroom), and whether they
study histology alone or with others. For time spent
studying, students were allowed to enter a number
in a free text box, and answers were later grouped
into categories 0-1 hours, >1-3 hours, >3-5 hours,
and >5 hours. Findings from this process indicate
that beyond the time in lecture and laboratory, a
majority of students (58.9%) reported spending an
additional 1-3 hours of study per laboratory topic
(Figure 1). Students chose responses from a Likert
scale to describe how often they studied alone as
well as how often they studied in a group with other
classmates (options were “Never,” “Rarely,”
“Moderately,” “Frequently,” and “Always”). Most
students (>67%) reported always studying alone.
Students also indicated whether there was a
decrease, increase, or no change in the frequency
with which they studied alone or with others. There
was a trend for students to study alone more
frequently over the course of the year, with 17.8%
reporting an increase in studying alone versus 6.2%
of students reporting a decrease in studying alone
(Figure 2).
Electronic vs. Traditional Histology
Learning Resources
Of the fourteen resources available to students of
the Medical Class of 2014, nine involve computer
use, while five are more traditional (textbook,
lectures, EM micrograph posters and light
microscopes with glass microscope slides). Figure 3
and Table 1 show students’ self-reported use of each
histology learning resource, as well as how their use
of that resource changed over the course of the
academic year. Of the nine electronic resources, five
were used “always” or “frequently” by a majority of
students (laboratory introduction PowerPoint files
and virtual slides that were viewed outside
laboratory hours, “Reviews and Look-Alike”
PowerPoint files, “SecondLook” PowerPoint files
Volume 23(4) 609
and usage of online practice questions). Of the five
traditional (non-electronic) learning resources, only
one, lectures, was used “always” or “frequently” by a
majority (69.9%) of students. Of the four resources
that students reported using most frequently, three
are electronic (“Reviews and Look-Alike”
PowerPoint files, “SecondLook” PowerPoint files
and practice questions in the online laboratory
guide), while one (histology lectures that were
attended in person) is traditional. The three
resources that students reported using least
frequently were traditional (histology textbook or
atlas, histological slides with a real microscope and
electron micrograph posters). Students reported a
net increase in use of eight out of nine electronic
resources over the course of the year, while
reporting a net decrease in use of each of the six
traditional resources. Overall, students tended to
use electronic resources more frequently than
traditional resources and this trend increased over
the course of the academic year. This preference was
statistically highly significant (Table 2).
Scheduled vs. Time-Independent Didactic
Resources
Many of the new resources available to students of
histology can be used on the students’ own time
rather than in a scheduled setting. Therefore, we
analyzed the extent to which students tended to use
scheduled versus unscheduled resources. Of the
fourteen resources in our study, four were
scheduled at fixed times (histology lectures attended
in person, laboratory introduction attended in
person, laboratory assignments during laboratory
hours and histological glass slides with real
microscopes) (Figure 3 and Table 1). Only one of the
four scheduled resources was used “always” or
“frequently” (69.9%) by a majority of students
(histology lectures attended in person). Five of the
ten non-scheduled resources were used “always” or
“frequently” by a majority of students. Of the four
most popular resources, three were unscheduled
(Reviews and Look-Alike” PowerPoint files,
“SecondLook” PowerPoint files and the online
practice questions), while only one (histology
lectures attended in person) was scheduled. Of the
three least popular resources, one was scheduled
(histological glass slides with real microscopes).
Each of the four resources that required a fixed time
commitment had a net decrease in student use over
the course of the academic year, whereas students
reported a net increase in use of eight out of eleven
resources that were unscheduled. In summary,
students reported higher use of resources that are
available at any time compared to scheduled
didactic opportunities and this trend increased over
the course of the academic year. Again, a statistical
Medical Science Educator © IAMSE 2013
analysis indicates that these results are highly
significant (Table 2).
Interactive vs. Non-Interactive Resources
The educational resources available to Michigan
histology students vary in the degree to which they
require active participation. We analyzed whether
students preferred resources that provide active
questioning and immediate feedback to those that
do not. Four of the resources in our study involve
active participation and immediate feedback (lab
assignments during laboratory hours, “Reviews and
Look-Alike” PowerPoint files, “SecondLook”
PowerPoint files and practice questions from the
online laboratory guide) (Figure 3 and Table 1).
Each of the four resources requires the student to
identify a structure and/or to answer a question and
subsequently provides immediate feedback with the
correct answer. The other ten resources are
primarily passive. Students read or listen to
information without directed questioning or
feedback (as the opportunity of asking questions
during the lecture is limited, we counted lectures in
this category of learning opportunities). Lab
assignments, when worked on outside of laboratory
hours, are considered a non-interactive resource,
since immediate feedback from faculty was not
available. Three of the four interactive resources
were used “always” or “frequently” by a majority of
students, while three of the ten non-interactive
resources were used “always” or “frequently” by a
majority of students (Figure 3). Of the four most
popular resources, three are interactive (“Review
and Look-Alike” PowerPoint files, “SecondLook”
PowerPoint files and the practice questions from the
online laboratory guide), while one (histology
lectures attended in person) is non-interactive. All
three of the least popular resources are non-
interactive. Students reported a net increase in
three of the four interactive resources over the
academic year, compared with a net increase in five
of the ten non-interactive resources. As shown in
Table 2 a statistical analysis indicates a high
significance for these results. Among all histology
learning tools that were offered to the class, three of
the four most popular resources are electronic,
interactive and quiz-type. Besides lectures attended
in person (36% of responding students),
“SecondLook” PowerPoint files (95% of responding
students), the Michigan Histology webpage with
online practice questions (32% of responding
students), and “Review and Look Alike” PowerPoint
files (30% of responding students) were most often
selected as one of the three most valuable histology
study resources. These three resources are unique in
that they allow the student to test their knowledge
and receive immediate feedback. Self-testing has
Volume 23(4) 610
been shown to be an especially effective learning
tool and our study shows that when interactive
resources are available, histology students gravitate
towards them.16,17
Online vs. Paper Handouts for Histology
Lectures and Laboratory Sessions
Students participating in the M1 histology
component during the 2010-11 academic year had a
choice between different formats for two histology
learning resources offered in an electronically
online format or as paper handouts. Students had
the option to either use one or a combination of
both formats. Both formats contained the same
information. Lecture handouts were either offered
as downloadable PowerPoint files or as black/white
paper copies. The laboratory assignments were
accessible on the course website (http://
histology.med.umich.edu/schedule/medical) or as a
spiral-bound paper booklet. For the lecture
handouts, a majority of students used the paper
copy (83%), either alone or in combination with an
online version of the handout. For the laboratory
assignments, only a small percentage of students
made exclusive use of the paper booklet (3%),
whereas a majority of students (97%) used the
course website, either alone or in combination with
the paper version (Figure 4).
Discussion
It is a well-known fact, which has been widely
discussed in the literature, that modern didactic
technologies are increasingly used for teaching
histology and other basic sciences.18-20 Several
publications report that students prefer specific new
technological advances, such as virtual microscopy,
recorded lectures or computer-administered
examinations, over their traditional counterparts
light microcopy, live lecture presentations, and
paper examinations.4,5,8,15,21 However, a more
general analysis of students’ learning preferences,
when they have the choice between alternative
learning resources, has not been published. The M1
histology component at the University of Michigan
offers an opportunity to investigate this question,
because students are free to select from a variety of
learning resources and use those that fit their
individual learning style. As the student population,
the medical school curriculum, the associated
educational content, and the desired learning
outcome at the University of Michigan is similar to
many other schools, we expect that our results will
apply equally to other learning environments.
Medical Science Educator © IAMSE 2013
Computer-assisted learning has become
increasingly popular in many educational settings,
including medical schools.10,18,19 The results
presented here confirm that across all aspects of the
M1 histology component, electronic learning tools
are very popular with the student cohort and their
reported use increases with time during the M1
histology component. This also complements and
extends an earlier report by Ogilvie et al. that
students highly value computer-administered
examinations.15 Other published surveys indicate
that for learning histology virtual microscopy is
strongly preferred by dental and medical students
over traditional light microscopes.8,21,22 These
observations and our findings reported here should
not come as a surprise, as this generation of
students was raised having computers available to
them. However, it raises the question whether
electronic study tools are better and more effective
in facilitating a positive learning outcome. For most
resources that are being offered to students learning
histology, this has not yet been definitively
answered in the literature. One exception is the
impact of traditional versus virtual microscopy on
students’ learning outcome. Most published
analyses found an improvement of learning success
after the introduction of virtual microscopy
technology.8,12-14,23,24 Only two publications report
no difference when comparing the use of traditional
versus virtual microscopy.22,25 It should be noted
that in the analysis published by Swan and
O’Donnell virtual microscopy was only offered to
students as a supplementary resource.25 However,
all studies conclude that the use of virtual
microscopy is extremely popular with students and
increases learning efficiency resulting in time-
savings for both students and teaching faculty.
Other reports indicate that e-learning resources are
equally popular with students learning other
biomedical subjects, such as biochemistry,
physiology, gross anatomy, radiology and
embryology.18,19,26,27
At first sight, the variation in acceptance and use
levels of resources that were offered both in an
electronic and paper format at times may seem
inconsistent. However, a closer look at how
Michigan medical students use these two alternative
formats quickly uncovers significant differences.
Despite the fact that paper lecture handouts are
printed in black and white and lack color-based
informational content, students like to bring them
to class and to add handwritten notes to individual
slides during the lecture. The reason for the
overwhelming preference of using the online
Michigan Histology webpage (http://
histology.med.umich.edu/schedule/medical) over
Volume 23(4) 611
the paper laboratory guide can be easily explained.
The Michigan Histology webpage contains live URL
links to a number of histological sample images and
to the collection of virtual histology slides. Students
can access any light or electron microscope image
with a simple point and click of their computer
cursor. This advantage clearly outweighs the benefit
of adding handwritten notes to a spiral bound paper
laboratory guide. As a result of this study, spiral
bound laboratory manuals are no longer provided to
M1 students. In summary, the context in which
information is offered in either a paper or an
electronic format and the tasks involved are of
central importance for the media choices made by
students. A traditional paper handout is still valued
and used by many students, even though one might
speculate that this will change gradually over time
as more and more students become accustomed to
taking notes on their personal computer or
electronic tablets.
The overriding criteria for students to choose a
certain learning modality or specific resources
appear to be efficiency and time management, and
these pressures may drive the reported changes in
study habits over the academic year. Several studies
report that some electronic learning tools, like
lecture recordings, are highly valued by students as
they are viewed to enhance learning efficiency, even
when actual examination scores are not improved.4,5
The didactic offering that is, or is perceived to be,
most helpful for learning the required material and
preparing for quizzes and examinations in a timely
manner will generally be selected by a majority of
students. In their free answers to the question
“What characteristics make a histology study
resource valuable”, many students used the words
“succinct” and “concise”. One student in the survey
summarized it by writing: “Time efficiency... which
resources allow me to learn the most in the least
amount of time”. This may not be surprising
considering the workload students are facing today
at any level of the educational hierarchy. Today’s
students feel that electronic interactive resources
that can be accessed independently of any fixed
schedule best fulfill this demand for efficient use of
time.
Conclusion
This study looks at preferences for and the use of
different didactic tools for learning histology during
the first year of Medical School at the University of
Michigan. A voluntary survey of first year medical
students indicates a strong preference for learning
histology by working alone rather than in study
groups. In addition, students report that they
Medical Science Educator © IAMSE 2013
gravitate to using electronic study tools over most
traditional didactic offerings. However, how specific
tools are accepted and used by students often
depends on the context in which these tools are
being offered. In addition, students report a strong
preference for learning opportunities that are not
scheduled and restricted to specific times. Histology
resources that provide immediate and efficient
feedback are also highly valued by most students
who participated in the survey.
Acknowledgements
We would like to thank Drs. Mary Wright (Center
for Research on Learning and Teaching, University
of Michigan), Patricia Mullan and Larry Gruppen
(both Department of Medical Education, University
of Michigan) for their continuous support and
advice over the progression of our study. This
material is based upon work supported by a
Michigan Center for Research on Learning and
Teaching's Investigating Student Learning Grant,
2011-12.
Notes on Contributors
MICHAEL HORTSCH, PhD, is an associate
professor in the Department of Cell and
Developmental Biology at the University of
Michigan Medical School in Ann Arbor, Michigan,
USA.
LOUISA HOLADAY, BGS, and DANIEL SELVIG,
B.Sc., are medical students in the class of 2014 at
the University of Michigan Medical School, Ann
Arbor, Michigan, USA.
JOEL PURKISS, PhD, is the Director of Evaluation
and Assessment in the Office of Medical Student
Education and a member of the Department of
Medical Education at the University of Michigan
Medical School, Ann Arbor, Michigan, USA.
Key words
Histology, microanatomy, virtual microscopy,
electronic learning resources
Volume 23(4) 612
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Appendix

Figure 1: Study hours per lecture topic in addition to classroom attendance as reported by participating students (excluding time spent in
the classroom). N = 141.

Figure 2: Self-reported study mode. The left column depicts the self-reported frequency of studying alone, whereas the right column
shows the self-reported frequency of studying histology in a group. The top panel indicates the percentage of students reporting that they
used the respective study mode more (green arrow) or less (red arrows) over the progression of the academic year. N = 144.

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Figure 3: Overall usage of different study resources and reported changes over the progression of the academic year. The monitor icon
indicates electronic histology study tools, such as lecture videos or downloadable PowerPoint files. The clock icon marks educational
offerings that are scheduled and restricted to specific times, such as lectures and laboratory sessions. The red and green arrows in the
middle panel specify the percentages of students, who reported an increase or decrease of the use of the resource over the progression of
the academic year. The bottom panel indicates the reported overall usage frequency of specific educational resources. N = 146.

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Figure 4: Reported usage of paper versus electronic copies of lecture handouts and laboratory manuals by students participating in the
M1 histology component. N = 145 for lecture handout and N = 144 for laboratory handout.

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 How FREQUENTLY did you How did your use of the
Non- use the following histology following resources
Electronic Scheduled Interactive resources, on average, over CHANGE over the
Resource Resource Resource Resource the academic year? A academic year? B
Mean SD N Mean SD N
Attendance at histology lectures in
3.92 1.22 146 -0.25 0.52 146
person
Viewing histology lectures videos
X X 2.75 1.33 146 0.17 0.49 144
online
Attendance at laboratory introduction
2.98 1.51 146 -0.41 0.56 146
presentations in person

Studying the laboratory introduction

PowerPoint files outside of the X X 3.68 1.33 146 0.30 0.63 146
laboratory session
Work on laboratory assignments in
person, during lab hours after the X X 2.66 1.43 146 -0.51 0.54 146
lecture
Work on laboratory assignments
X X 3.45 1.30 146 0.30 0.67 146
outside of laboratory hours

Whiteboard Drawing PowerPoint files

X X 2.95 1.53 146 0.23 0.58 145
(online)

Labeled Micrograph PowerPoint files

X X 2.60 1.59 146 0.13 0.49 145
(online)

"Reviews and Look-Alikes" PowerPoint

X X X 3.73 1.47 146 0.22 0.62 146
files (online)

"SecondLook" PowerPoint files

X X X 4.88 0.51 146 0.45 0.50 146
(online)

Practice questions in the online

X X X 4.18 1.13 146 0.25 0.57 146
laboratory guide

Electron micrograph posters in the

X 2.36 1.09 146 -0.32 0.54 146
hallway near histology laboratories

Real microscope stations in the

1.52 0.86 146 -0.08 0.39 145
histology laboratory
A histology textbook/atlas X 1.50 0.87 146 -0.08 0.43 146

Table 1: Summary statistics for survey items on overall frequency and change in usage of histology learning resources, N=146 U-M medical students. This table provides
descriptive statistics (means of overall resource usage and standard deviations) summarizing student response to the survey items regarding overall frequency of use for the 14
study resources, as well as reported changes in use of the resources over the course of the academic year. (A) The mean in column 5 represents the mean of students’ overall reported
usage of this resources as encoded by 1=Never; 2=Rarely; 3=Moderately; 4=Frequently and 5=Always. Higher means indicate greater reported use of this resource by all survey
respondents, who answered this question. (B) The mean in column 7 represents the mean of students’ reported change of usage over the progression of the academic year as encoded
by -1=Decreased, 0=No Change, and 1=Increased. Positive means indicate increased reported use over the academic year, while negative means indicate declining reported use. As
not all survey participants provided an answer, N varies for the reported change in use of a specific study resource.

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 Averaged results for Averaged results for
nine electronic five non-electronic
resources A resources A
Mean
Mean SD Mean SD Diff. Paired t-test
Electronic versus non-electronic t(145)=12.0
0.17 0.26 -0.23 0.27 0.40
resources p<0.001
Averaged results for Averaged results for
ten non-scheduled four scheduled
resources resources
Mean
Mean SD Mean SD Diff. Paired t-test
Non-scheduled versus scheduled t(145)=11.6
0.11 0.23 -0.31 0.35 0.42
resources p<0.001

Averaged results for Averaged results for

four interactive ten non-interactive
resources resources
Mean
Mean SD Mean SD Diff. Paired t-test
Interactive versus non-interactive t(145)=3.64
0.10 0.33 0.001 0.19 0.10
resources p<0.001

Table 2: Results from paired-sample t-tests comparing students' self-reported change in use over the progression of the academic year of electronic vs. non-electronic and
scheduled vs. non-scheduled histology study resources, N=146 U-M medical students. This table summarizes results from three separate paired-sample t-tests. Means in columns 2
and 4 represent the means of groups of resources as derived from the means in column 8 of Table 1. They reflect the students’ reported change of usage over the progression of the
academic year as encoded by -1=Decreased, 0=No Change, and 1=Increased. The first comparison identifies increasing usage for electronic resources overall (Mean=0.17, SD=0.26)
and declining usage for non-electronic resources overall (Mean=-0.23, SD=0.27), with the difference being statistically significant (t(145)=12.0, p<0.001). The second comparison
identified increasing usage for non-scheduled resources overall (Mean=0.11, SD=0.23) and declining usage for scheduled resources overall (Mean=-0.31, SD=0.35), with this
difference also being statistically significant (t(145)=11.6, p<0.001). The third comparison identifies a strong increase of use for interactive resources (Mean=0.1, SD=0.33) versus
non-interactive resources (Mean=0.0001, SD=0.19). This difference is also statistically significant (t(145)=3.64, p<0.001).

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