Integration of digital microscopy into histology and pathology education: Opportunities for the future

We read with great interest the scoping review by Nava et al., “Blended and digital approaches in histology and pathology teaching,” published in Anatomical Sciences Education.1 At this juncture, we wish to express our opinion on the published article. This topic has become more important in the post-pandemic era. The pandemic has compelled medical schools worldwide to rethink teaching models while preserving quality, sustainability, and interaction. The authors are to be commended for conducting a rigorous and transparent scoping review following JBI methodology and PRISMA-SCR guidelines. The authors have mapped teaching methods, digital learning tools, assessment strategies, and student–educator interactions extensively, which offers a valuable synthesis. These elements reflect more than a decade of educational transformation in histology and pathology. Particularly noteworthy is the rigorous categorization of digital microscopy-integrated platforms, complemented by a critical and balanced evaluation of the respective strengths and limitations of fully digital and blended approaches. This work will undoubtedly serve as a key reference for educators engaged in instructional redesign and curriculum review. From the perspective of an anatomy educator working within an integrated, systems-based medical curriculum, several points merit further reflection. While the review effectively catalogs pedagogical approaches and technologies, the analysis remains predominantly descriptive. A more robust critical comparison of educational effectiveness, explicitly linking specific tools and blended strategies to learning outcomes, skill acquisition, and knowledge retention, would substantially strengthen the review's value for curricular decision-making. Moreover, although assessment methods are well enumerated, limited attention is given to issues of assessment validity, standard setting, and alignment with competency-based medical education. As histology and pathology assessments in integrated curricula are often embedded within multidisciplinary evaluations, guidance on aligning digital microscopy-based assessments with outcomes frameworks is relevant. Within a competency-based education model, such alignment is crucial. It is important to ensure that assessment data demonstrate learners' attainment of defined competencies with high validity. It is necessary to inform transparent and defensible progression decisions. It has been reported earlier that histology teaching with digital aids is advantageous with regard to manpower, access to the laboratory, and maintenance of slide collections.2, 3 Institutions in low- and middle-income regions are underrepresented in this review. This gap in the geographical distribution of included studies is crucial as these institutions often face the greatest challenges related to infrastructure, licensing costs, and faculty development. For such contexts, the transition to digital microscopy is frequently incremental rather than transformative. In my view, explicit discussion of scalable, cost-effective, or hybrid implementation models would strengthen the global applicability of the review findings. The authors have highlighted the importance of the flipped classroom. According to earlier reports, the flipped classroom was found to be most effective when used to teach higher order skills or processing, that is, knowledge analysis or application, when compared to usual memorizing.4 The team-based learning (TBL) activities were adequately highlighted. It is pertinent to mention that TBL enhances better problem-solving skills in students. Finally, we think that further exploration of how to optimize the balance between digital efficiency and meaningful mentorship would be valuable. Despite advances in digital platforms, anatomy and histology education continue to depend on guided interpretation, tacit knowledge transfer, and professional identity formation as essential learning outcomes that remain challenging to replicate in exclusively digital contexts. In summary, Nava et al. provide a timely and well-executed overview of blended and digital approaches in histology and pathology education. Building on the foundation made by this review, future research could make a meaningful contribution to the field. The integration of outcome-based analyses with contextual considerations would better support a sustainable approach to curriculum innovation. Finally, we thank the authors and the editors for publishing such an interesting article. Halima Albalushi: Writing – original draft; writing – review and editing; formal analysis. Srijit Das: Formal analysis; resources; writing – original draft; writing – review and editing. Dr. Halima Albalushi is an accomplished associate professor at Sultan Qaboos University, Muscat, Oman, specializing in stem cell research, regenerative medicine, and oncofertility. With a strong commitment to advancing research and education, Dr. Albalushi has made significant contributions to her field through innovative studies and publications. Her research focuses on stem cell culture and differentiation, regenerative medicine, oncofertility and fertility preservation, digital health, and medical education. Dr. Albalushi is dedicated to fostering academic excellence and mentoring the next generation of scholars. She actively collaborates with local and international institutions, enhancing the impact of her work on both a regional and global scale. Through her leadership and expertise, she continues to inspire students and peers alike, contributing to the growth of knowledge and innovation at Sultan Qaboos University and beyond. Dr. Srijit Das is an anatomist with a medical background. He has served earlier at UKM Medical Centre, Malaysia, until 2021, and then joined the Department of Human & Clinical Anatomy, SQU, Muscat, Oman. He has 29 years of teaching experience after his post-graduation in anatomy. His research areas include antioxidants, complementary medicine, drug design, clinical anatomy, and morphology. He has 592 indexed publications with an H index of 42. He has won the ‘Best International Young Scientist Award’ given by the Phytochemical Society of Europe in 2017. He received the Fellowship of the Royal College of Surgeons of Edinburgh in 2019. He is the examiner for the MRCS Part-B OSCE and a surgical trainer for the Faculty of Surgeons, Royal College of Surgeons. Dr. Das received his fellowship from the Anatomical Society of India in 2024. He has written chapters in books published by Springer Nature, Elsevier, Taylor & Francis, and UKM Press, Malaysia. Dr. Das has featured in the top 2% researchers of the world for the last five consecutive years according to a list published by Stanford University & Elsevier publishers. He is a source person for publication-related workshops worldwide.