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Remote teaching of techniques in medical mycology, can it replace benchwork?


Paweł Krzyściak1, Katarzyna Talaga-Ćwiertnia1, Zuzanna Bębenek1, Piotr Kochan2, Magdalena Skóra1


Introduction

Fungal infections are a serious socioeconomic problem. According to Global Action Fund for Fungal Infections (GAFFI) estimates, fungi are responsible for: "killing over 1.5 million and affecting over a billion people worldwide, fungal diseases have been the most neglected topic by public health authorities" [1].

Facing such a large problem, it is very important to teach mycology to medical and biology students and have access to qualified Medical Laboratory Scientists (MLS)/Medical Laboratory Technicians (MLT) trained in medical mycology. Courses and training in the techniques used in the diagnosis of mycoses and the selection of appropriate therapy are an important element of education and self-education of this personnel. Medical mycology is usually taught as part of the broadly understood microbiology subject, however, disproportionately less time is spent on fungi than on other pathogens (bacteria, viruses and parasites).

Many authorities raise the problem of the lack or too little attention given to fungi in their study programs. Quoting the statement of Prof. Chełkowski from the pages of the Monthly Courier of the Polish Mycological Society (pol. Kurier Miesięczny Polskiego Towarzystwa Mykologicznego): "There is definitely a lack of the subject of mycology in the curricula that is needed for this important group of organisms" [2].

The SARS-CoV-2 pandemic, which has affected over 43 million people so far while authorizing this text for publication, causing over one million deaths [3], has resulted in numerous restrictions for mass gatherings and mobility of the public and thus on the possibility to conduct classes. Many universities, including the Jagiellonian University Medical College, have switched from face-to-face to remote or hybrid teaching techniques. This has caused great difficulties in the implementing contact activities. An indispensable part of teaching microbiology, including mycology, are practical exercises at the laboratory bench. This is reflected in the number of hours of practical classes in the courses organized, among others by Institute Pasteur or Centraalbureau voor Schimmelcultures (CBS).

In our opinion, an important aspect of conducting classes is respect for intellectual property of the authors of the shared content, as well as the conviction that self-prepared materials should be used throughout classes. In this article, we want to present a proposal of our team's films presenting examples of basic techniques used in medical mycology, which can serve as aids during practical classes, as well as substitutes for laboratory classes in online teaching.


Materials and methods

In this global pandemic situation, full of restrictions, as academic teachers we faced the challenge of teaching students basic laboratory techniques for diagnosing infections caused by pathogenic fungi. One solution we came up with was to present the laboratory activities in the form of short videos, which could be available either publically or to a limited number of persons, depending on the applicability.

The high-definition films were made using DSLR Nikon, 50 mm f1.8 lens with macrolinks, 400W halogen lamp (FAMED 1, Fabryka Aparatury Elektromedycznej, Łódź, Poland), and edited using Olive Video Editor with Manjaro Linux on MSI GL65 Leopard Intel Core i5 9th Gen, 32 GB RAM, GeForce GTX 1650. The films were prepared with no soundtrack with Polish or English subtitles for the Polish or English-speaking medical and dentistry students at our university to understand, respectively. Production and editing took about 2 weeks. The films were then uploaded to the cloud for the students to access during class and at any chosen time for review (Figures 1-2).

figure1
Figure 1. Backstage photo showing the laboratory filming set, with Nikon DSLR camera visible.
[please click on the image to enlarge]


figure2
Figure 2. Backstage photo with the halogen lamp visible in the foreground.
[please click on the image to enlarge]


We have prepared the following films:
1) Fast nigrosin staining (Figure 3),
2) Preparing a specimen of nail fragments
in KOH solution (Figure 4),
3) Inoculating nail fragments on fungal isolation
substrate (Figure 5),
4) Microculture of filamentous fungi and preparations from microculture (Figure 6),
5) Simple scotch tape slide (Figure 7),
6) Yeast culture on starvation medium - Dalmau plate technique (Figure 8).

These films are available on the official WJOMI YouTube channel clicking on the link: https://www.youtube.com/channel/UCv78AAmi2wvjdg1HVHwIXog

The reagents and laboratory equipment necessary for the performance of individual procedures are provided as a supplementary file, as per request from WJOMI Editorial Office.

figure3
Figure 3. Still shot from the film showing fast nigrosin staining of cryptococcal capsules. Direct link to the film: https://youtu.be/NklGaftICdM
[please click on the image to enlarge]




















































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figure4
Figure 4. Still shot from the film on dermatophyte isolatiom and potassium hydroxide mount showing arthroconidia from a nail sample in 10% KOH / CalcoFluor White mount. Direct link to the film: https://youtu.be/z3JvVMBlOKU
[please click on the image to enlarge]


figure5
Figure 5. Still shot from the film showing inoculation of nail fragments on fungal isolation substrate. Direct link to the film: https://youtu.be/z3JvVMBlOKU
[please click on the image to enlarge]


figure6
Figure 6. Still shot from the film on microculture of filamentous fungi showing a preparation. Direct link to the film: https://youtu.be/y1Fc-5OxGl0
[please click on the image to enlarge]


figure7
Figure 7. Still shot from the film showing simple scotch tape slide. Direct link to the film: https://youtu.be/gCm39jFWWk0
[please click on the image to enlarge]


figure8
Figure 8. Still shot from the film showing yeast cultures on starvation medium (Dalmau plate technique). Direct link to the film: https://youtu.be/O7sBhRQFuWg
[please click on the image to enlarge]


Discussion

After the microbiology course, a student should acquire practical skills that are crucial elements of the diagnostic process in detecting fungal infections. This is possible if he/she has the opportunity to practice these skills during practical classes. In the remote learning mode, in which we currently teach students, videos can help convey the set content and partially replace practical classes. The quality of the films, both in terms of content and technology, is extremely important in transferring knowledge and skills, especially in case of people who come in contact with mycological diagnostics for the first time. On YouTube one may find a lot of videos, but some of them are of unsatisfactory quality or unacceptable, e.g. due to failure to comply with safety rules, such as lack of gloves on - which may result in teaching students bad habits.

Furthermore, what else is important for good quality, educational films showing practical lab procedures? We think that the following criteria should be applied for best results:
  • Prepare the recording equipment, laboratory aids and enough batteries ahead of filming,
  • Use fresh cultures and new slides,
  • Set the equipment in comfortable, ergonomic and quiet settings,
  • Make sure good lighting and exposure are available,
  • Teamwork can facilitate recording (one person films, the other person performs the experiments),
  • When recording, speak loudly, slowly and clearly.

Conclusions

What may come as a surprise, when making good quality educational films - the whole process may take much longer than preparing for a stationary lab class. But the definite advantage is that the films may be recorded once, and may be used over and over again without the need for repeating the procedures in a lab every time. Also for teachers with stage fright - this technique virtually eliminates this unpleasant social experience. The disadvantage is that videos of the procedures performed in the mycology laboratory will not allow students to acquire exactly the same knowledge and skills as in the course of practical classes. The degree of obtaining individual learning outcomes in terms of skills with the use of remote teaching methods would require direct verification - in a laboratory with access to the necessary equipment and materials. Undoubtedly, however, depicting the entire procedure in the form of a film creates better conditions for learning than education based only on diagrams or text.

References

[1] Global Action Fund for Fungal Infections. The Global Action Fund For Fungal Infections (GAFFI) will #fightfungus with global awareness campaign. Posted September 20, 2019. Access valid on 23 October 2020: https://www.gaffi.org/the-global-action-fund-for-fungal-infections-gaffi-will-fightfungus-with-global-awareness-campaign/
[2] Chełkowski J. Nauczanie mykologii w Polsce. Grzyby – znacząca część biosfery i gospodarki. Kurier Miesięczny Polskiego Towarzystwa Mykologicznego 2013; 6:4-7. Access valid on 23 October 2020: http://www.ptmyk.pl/wp-content/uploads/2013/02/kurier_miesieczny_6.13.pdf
[3] John Hopkins University of Medicine. Coronavirus Resource Center. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Access valid on 27 October 2020: https://coronavirus.jhu.edu/map.html

Conflict of interest: PK is the Editor-in-Chief of WJOMI.

Authors’ affiliations:
1 Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Infection Control and Mycology, Cracow, Poland.
2 Jagiellonian University Medical College, Faculty of Medicine, Chair of Microbiology, Department of Bacteriology, Microbial Ecology and Parasitology, Cracow, Poland.

Corresponding author:
Magdalena Skóra, PhD
18 Czysta Str.
31-121 Cracow
Poland
Phone: +48 12 633 25 67
e-mail: magdalena.skora@uj.edu.pl

To cite this article: Krzyściak P, Talaga-Ćwiertnia K, Bębenek Z, Kochan P, Skóra M. Remote teaching of techniques in medical mycology, can it replace benchwork? World J Med Images Videos Cases 2020; 6:e37-43.

Submitted for publication: 28 September 2020
Accepted for publication: 26 October 2020
Published on: 31 October 2020







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