Histology is one of those med school subjects that should be taught in an integrated way. There’s really no point in learning microstructures without knowing the macrostructure, so I am of the very strong opinion that Histology and Anatomy should go hand in hand. In fact, I would add Pathology into this group too, but more so for students who have already studied and finished anatomy, as opposed to new students who shouldn’t be bombarded with more subjects than they already have. Let’s be real, anatomy and histology isn’t exactly a piece of cake! One these giants are down though, pathology becomes easier to understand and retain.
I don’t know how histology is taught in other schools, but in my institution, we used to have histology taught through lectures (rarely), sometimes discussion and mostly through lab sessions. It’s the lab sessions which are the most important. Students would be required to draw the histology of the organ or the section we were studying and looking under the microscope for that session. I personally am not a fan of drawing histological drawings. To me, it seemed like the utmost waste of time, drawing out blobs of pinks and blues. Some kids would spend a lot of time making their drawings look really nice and then there was me. My drawing quality dropped significantly once I realized how much I disliked spending my time in this way. Instead, I would go around and look at all the different microscopes, take pictures of the slides and join in on the mini-discussions that the lab assistant would be holding.
That is, in my opinion, one of the most valuable skills that students need to pick up when it comes to content heavy courses like medicine. Yes, it’s important to get assignments and classwork done, but it’s also important to figure out what is working best for you and where you should put in more time. I felt that I didn’t learn much from drawing and that it also stressed me out and put me in a bad mood. So I quickly fixed up my time and decided to convert drawing time into discussion and tutorial time and it helped me a lot more.
Another really important point is that whenever you have a lab session with a microscope, take pictures. I cannot emphasize how important it is to take pictures of what is on the slide. More on that later! Let’s start with this guide to histology and histopathology!
Junqueira’s Basic Histology: Text and Atlas. This was the basic histology book that I purchased for the first two years of med school. Junquiera is a pretty good book. It has good illustrations, lots of histological pictures and also discusses anatomy along with the histology. The text is also really easy to read and understand. It’s not cumbersome, like Guyton or other text and concept-heavy books. There are other books available as well. Another popular option was Di Fiore’s Atlas of Histology with Functional Correlations, however, I don’t like to switch around and use too many books and thus chose to stick with Junqueira.
The main reason why I am including histopathology in this post is that histology is merely the prequel. The ways to study histology and histopathology is different, but without a doubt, histopathology cannot be studied without a base on normal histology. After all, how can you tell that something is wrong with the slide when you don’t know what normal healthy tissue looks like?
Pathoma: Fundamentals of Pathology. Yes, I know this is a review book. Yes, I know I’ve talked way too much about Pathoma already, but it just really is a great book! Due to being a review book, the conditions and pathologies written in it are absolutely important. Not all of these pathologies get graced with a picture in Pathoma however, which is why it’s important to consult other pathology books too.
Robbins and Cotran Pathologic Basis of Disease. There was a point in the third year where I was absolutely freaked out about a practical exam because I had no idea about what and how to study the histopathology. I was really close to breaking down about it too, so my father told me to sit down with Robbins and read out the pathologies and correlate it with pictures. The good thing about Robbins is that there are boxes and summaries purely explaining the histopathology of diseases and it also has plenty of pictures to look at as well.
Last but not least, I suppose Kaplan’s Lecture Notes on Anatomy can also get a mention. There is a section for histology before the anatomy and it really integrates the two together, so it’s good for overall revision. I do not suggest using this as a resource though, but more of a baseline work point that you build up on.
In my opinion, histology and histopathology should be studied with visual aids. These are not text-based subjects! You need to be able to identify cells and structures and pathologies and in order to be able to recognize something, you should be familiar with it. The only way you can make yourself familiar is by gathering images and reviewing them again and again.
Take your own pictures. Please do this. For every lab session and slide that you see in your school, take out your phone and snap a picture. I’ve seen kids in my class use their Snapchat to take pictures of slides and then add text descriptions and drawings on top of the slide to explain what it is that they’re seeing. I think that’s a fantastic way to study on the spot and it also helps build a great study resource right in your phone to access on the go. It’s also tailored particularly to your needs! Just remember to go through the textbooks to make sure you’ve got the important details of a slide down properly.
Use the internet. Sometimes the slides that are set up in histology labs don’t look like the slides described in a textbook, or maybe the faculty admits that these slides are difficult to arrange and are therefore unreliable specimens. In cases like these, just google it. Google the images and read up the descriptions from there. Save the images to your personal library if you can!
Use the internet a little more. There are lots and lots of good histology themed websites that you can visit, for example, http://www.histologyguide.com/ which has brilliant pictures, or http://www.webpathology.com/ which has pathology pictures. However, don’t use these as your only resource. Always consult the textbook that your institution and faculty have recommended for you to use. These are just additional aids that you can use if you are finding things to be deficient or not enough to fully understand the subject.
How to Study Histology
Is drawing worth it? It might be for some students. I am not a part of that group of students who benefitted from drawing. Fun fact: I lost my histology notebook before one of my yearly exams and I freaked out because the last mini-exam had asked for the notebook and added 10 marks to the overall grade just for submission. I was absolutely convinced that I had lost 10 marks on that final exam. Long story short: the notebook had NOT been required and that’s just how it should be.
Read up on the topic beforehand.
We usually got schedules for the entire week before the week would start and that would make planning out a study schedule pretty easy. It’s important to read up on the histology chapter beforehand because looking at a fresh histology slide for the first time is absolutely daunting. Knowing what to look for and what you’re looking at is really important and can really make the upcoming lab sessions a lot easier to bear.
They don’t even have to be precise questions. Just straight up say “I don’t understand what I’m looking at it. Can you explain this to me?”. Trust me, this is the one and only question you need to say in any histology related session. We had a fantastic lab assistant who would patiently explain slides out in detail to every student who came by and asked. Demonstrators would also be nice enough to do that- if they were in a good mood. But if you’re in the mode to learn and people can tell that you’re taking your education very seriously, they will be more than happy to explain the slide to you.
I can’t tell you how important this is. I must have said this a few times already but please! It doesn’t take much time or effort to whip out your phone and snap a few clicks while at the microscope. Yes, it’s a little tricky trying to get the camera to focus and capture the slide but the effort is totally worth it. Make a folder in your phone and steadily save slide pictures throughout the year. They will help immensely in final exams. Trust me.
During these histology sessions, the major focus is mostly on a few core questions and concepts. How do we identify this slide? What are the peculiar features of this slide? What is the importance of these structures? There are always a few core identifying ‘phrases’ for important slides, such as fried egg, starry sky, keratin pearls and you know what I mean. Add these little descriptions to the picture you’ve taken (if you want) or write them down separately. I wrote them separately because I wanted to keep my slides clean for future review purposes.
Correlate what you’re seeing with the anatomy.
The human body doesn’t exist as separate bits and pieces. Everything is linked together so it’s important to study them together too. So the slide of the airway shows pseudostratified columnar epithelium with goblet cells? Why do you think this could be? Why does the epithelium change into simple squamous when we reach the alveoli? Why is there a tracheal ring at some places and not in others? Correlating the microstructure with the macrostructure is what will help you retain both.
Review again and again.
One of the major ways I would review my histology would be by going through my image gallery. I would have a plain, clean slide picture of a specimen, followed by a labeled or explanatory picture. While browsing the gallery, I would try to identify the picture, then turn to the next picture to see if I had gotten it right or wrong. If wrong, the next picture would be explanatory and would help in my learning. I personally liked this system a lot, however, there are ways that I thought up of on how to improve it. One of these days, I would like to compile a histology study guide. The only thing stopping me here is the lack of good histology pictures! Some of the slides at my school weren’t super clear and some of my slide folders have gotten misplaced or deleted- one of the two! There should definitely be an Anki deck out there purely for histology and histopathology!
That’s pretty much it! Histology and histopathology aren’t very tricky subjects. Once you have figured out how to study them and how to understand them, it’s only a question of keeping the information retained. Revise again and again. Don’t be afraid to go back to the books and read up things again. Do whatever it takes. Focus on cue words and special descriptions. Be able to list out identifying features of slides and also be able to identify those identifying features on a slide. It would also help to keep in mind the anatomy and the physiology while you’re studying! It helps to create a cohesive big picture for you to work on. Good luck studying!
Did you try to identify these pictures? Scroll back up and see if you can figure what the pictures are! Before I tell you the answers, I was wondering if you would be interested in helping to create the ultimate study resource for histology and histopathology! As I mentioned earlier, I have lost a big chunk of pictures of histological slides and also have most of my histopathology slides pictures of a very poor quality that can’t be used for a resource for all medical students everywhere. I want it to be a short slideshow/PDF document that shows unlabelled slides followed by identifying points and thoroughly labeled slides so that it may function as a quick flashcard-esque review document. I would consider making an Anki deck but I’m not very well versed in creating those, however, if anyone else wants to take up that project, I would be more than happy to send well-edited histology slides of mine! Back to the answer key: (1) Caseating Granuloma of a Tuberculous Lung (2) Burkitt’s Lymphoma (3) Iron Deficiency Anemia (4) Cervical Intra Epithelial Neoplasia.