Student-identified barriers to histology learning and the perceived value of coloring as a multimodal educational...

Histology is a visually complex and cognitively demanding subject often perceived as abstract, memorization-heavy, and disconnected from clinical practice. Despite its foundational importance, histology is frequently under-emphasized relative to gross anatomy and lacks interactive, multimodal resources tailored to its unique challenges. This study explored student-identified barriers to learning histology and evaluated the perceived value of coloring as a supplemental learning strategy. An online mixed-methods survey was distributed to individuals with histology learning experience. Respondents answered questions about educational level, learning challenges and strategies, and prior use of coloring books. Quantitative data were analyzed descriptively, and open-ended responses were thematically coded. Findings were interpreted alongside cognitive learning theories and accessibility frameworks. Most participants were enrolled in professional (53.7%) or graduate (26.7%) programs. While 91.7% of respondents found histology enjoyable or somewhat enjoyable. Many respondents reported difficulties distinguishing connective, nervous, and epithelial tissues. Common challenges included abstract content, inconsistent staining, and poor structure-function integration. Some respondents had previously used educational coloring books in other disciplines and reported the act of coloring as moderately to extremely effective for their learning. Respondents valued labeled diagrams, repetition, and guided prompts, and suggested including quiz-style activities with closer alignment to course content. Survey results support coloring as an engaging, multimodal teaching strategy that accommodates diverse learning needs. At the time of this study, a histology coloring book was in the process of development. Future work will evaluate its effectiveness in improving comprehension, accessibility, and learner performance in histology education.