Background: Global health is less about geography than it is about equity. Tremendous disparities exist in access to care and in the conditions that make good health possible throughout the world. Investigators at Rutgers Global Health Institute, Rutgers Cancer Institute of New Jersey and the University of Botswana School of Medicine have entered into a productive collaboration to implement and adopt a low-cost, high-fidelity digital pathology technology; design, develop and deploy point-of-contact computer-assisted diagnostic tools; and deploy a cloud-based dynamic database of “gold-standard” cases to provide asynchronous, clinical decision support and training to pathologists and students at each participating global sites.

Design: A portable software is tailored for users to transform text, images and video into web-ready, interactive tutorials and examinations. A dynamic quiz bank (DQB) module is developed for educational and training objectives of the project. The DQB features whole slide images (WSI) and radiological images of growing database of pathology and oncology cases. The Google cloud-based platform features WSI serving back ends (OMERO and SmartInMedia) and an educational web front end that provides detailed instructions for operating the WSI component of dynamic quizzes. The pathology question databases are being developed through a collaborative effort among faculty members at participating sites using de-identified cases exhibiting a range of morphological presentations and disease states. The quizzes target different levels of difficulty and provide hints/feedback to the end-user during training sessions.

Results: Faculty and students from the US, Botswana and Kenya with different levels of computer proficiency have tested the DQB platform to date. During the preliminary performance studies, the cloud service showed no significant latency or degradation of quality while viewing the WSI and using the educational material. A new digital pathology system was just recently installed in the Botswana site to facilitate expansion of the DQB.

Conclusions: The DQB software program facilitates access and authoring and maintenance of Web-based medical educational materials. The modular, cloud-based design of the System maximizes flexibility of the exercises and allows for continued optimization of workflows and content. Through the implementation of the DQB on Google cloud the speed and efficiency of content is facilitated for delivery to other sites throughout the globe.

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