Enhancing histology education through a multimodal approach: Integrating digital annotation, manual drawing, and histological batik design

Histology often challenges medical students due to its complex terminology and abstract visualization demands. Although various instructional innovations exist, multimodal frameworks that integrate technology with culturally relevant artistic expression remain underexplored, particularly in non-Western settings. This study evaluates a multimodal curriculum combining digital annotation, manual drawing, and culturally grounded batik-motif creation to enhance histology learning. A quasi-experimental mixed-methods study compared two medical student cohorts: a 2019/2020 conventional cohort (n = 232) receiving standard microscopy-based instruction and a 2022/2023 multimodal cohort (n = 248) engaging in digital annotation, manual drawing, and batik-motif design. Data sources included computer-based exam scores, survey responses (n = 169), content analysis of open-ended feedback, and faculty evaluations of student-produced batik designs. Students in the multimodal cohort achieved significantly higher exam scores (89.4 ± 8.7) than those in the conventional cohort (64.2 ± 11.8; p < 0.001; Cohen's d = 2.43). Digital annotation was rated as the most motivating component (91%), while batik design-despite being the most challenging-was valued by 60% of students for deepening histological understanding. Content analysis indicated that the batik task enhanced visual-spatial understanding (78%) and creative engagement (72%). Integrating batik-motif design within a multimodal histology curriculum was associated with improved performance, engagement, and pattern-recognition skills. This culturally informed approach provided complementary learning pathways that supported diverse learners and fostered creative-analytical integration. The model is adaptable to other cultural contexts through locally meaningful artistic traditions.