Improving Resident Education through Large Volume Surgical Pathology Case Rapid Review
SB Sams, ML Smith, MS Lucia, SS Raab. University of Colorado Denver, Aurora, CO
Background: Pathology residency training programs lack standardization in the methods by which residents are trained to examine and interpret slides. Historically, residents in our program preview a limited number of slides and are mainly observers in case sign-out. We implemented a process whereby senior level residents performed rapid review of large numbers of surgical pathology cases and evaluated the effect on learning and diagnostic accuracy.
Design: A senior level resident rapidly previewed all surgical pathology cases (i.e., < 2 minutes per biopsy and < 15 minutes per large case) and made an interpretation prior to passing the case to the pathologist-junior resident team. We correlated the pathologist-senior resident diagnosis and classified discrepancies as major and minor, based on a subjective assessment of the effect on patient care. We compared performance at the beginning and end of a 3 month rotation and determined anatomical site diagnostic weaknesses. We evaluated how pathologist variation in the use of standardized diagnostic categories (e.g., cervical intraepithelial lesion system) affects resident performance.
Results: In a 3 month rotation, a senior resident previewed, on average, 1950 cases with 2630 case parts. The proportion of resident correct diagnoses and major and minor discrepancies at the beginning and the end of the rotation was 66.5%, 14.3%, and 19.2% and 87.4%, 5.9%, and 6.7%, respectively (P < 0.05). Greatest levels of improvement were observed in gastrointestinal pathology (decrease of total case error proportion from 36.3% to 11.6%) and prostate pathology (decrease of total case error proportion from 25.0% to 4.7%). Senior residents had considerably higher levels of discrepancy with some pathologists than others even taking into account the overall improvement over time (e.g., variation from 11% to 17% major discrepancy). The root cause of this variation arose from the lack of pathologist standardization in diagnostic areas with the senior resident adopting criteria from some faculty and exposing differences in criteria use among faculty.
Conclusions: We conclude that large volume surgical pathology rapid review rotations markedly improve the quality of senior level resident diagnostic accuracy and identify specific organ system diagnostic weaknesses. Our study also illustrates that the lack of pathologist diagnostic standardization undermines residency education and exposes unaddressed errors in pathology services.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 84, Monday Morning