Periodic Review of Training Program Teaching Files: A Quality Improvement Study
MA Martin, KC Hallmark, FE Sharkey. University of Texas Health Science Center, San Antonio, TX
Background: Pathology training programs typically retain teaching materials derived from classic and/or difficult diagnostic cases. In many institutions, these files may extend back for decades. However, diagnostic criteria are mutable, and a diagnosis made some years previously may not be considered correct today, or may not use up-to-date terminology. We reviewed a teaching file in order to determine if the archived materials continued to provide a high quality teaching experience.
Design: Each of the reviewed cases was originally reported during the years 2001-2003, and consisted of 1-2 representative H and E slides and a 3x5 card with brief clinical information and the diagnosis; a significant special stain or immunohistochemistry was sometimes included. During the study period, 2-4 cases were reviewed daily at a Faculty Consensus Conference, which was typically attended by 3-5 faculty. Following review, cases were classified into one of three categories: No diagnostic change; diagnosis added; or changed diagnosis. Cases considered less than optimal for interpretation were returned to Conference for final disposition after additional information was obtained.
Results: Of the 112 cases reviewed, 19 had slides missing. Of the remaining 93 cases, 19 cases (20%) required the addition of key clinical information and/or additional slides in order to make an appropriate diagnosis. The final disposition of the 93 reviewed cases was as follows: Diagnosis unchanged - 78 cases (84%); diagnosis added - 9 cases (10%); diagnosis changed - 6 cases (6%). Changed diagnoses are listed in Table 1.
|Organ System||Original Diagnosis||Changed Diagnosis|
|GI, Esophagus||Reflux esophagitis||Eosinophilic esophagitis|
|Testis||Leydig cell tumor||Adrenal rest|
|Prostate gland||Adenocarcinoma, grade 2+2; Epineurial invasion||Adenocarcinoma, grade 3+4; Perineural pseudoinvasion|
|Prostate gland||Prostatic intraepithelial neoplasia, high grade||Adenocarcinoma, small focus|
|Colon||Hyperplastic polyp||Serrated adenoma|
|Colon||Pseudomembranous colitis||Favor ischemic changes|
Conclusions: Pathology teaching files may contain cases with incorrect or incomplete diagnoses, or diagnoses that do not reflect current concepts of pathophysiology or terminology. In addition, critical information may be incomplete or altogether missing, thereby yielding an unsatisfactory teaching experience. Theft of these valuable materials can be a significant problem. Teaching files deserve periodic review if the quality of the educational experience is to be maintained.
Category: Quality Assurance
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 236, Monday Morning