Evaluation of Resident Education and Quality Practice in Gross Examination Services
MS Ryan, SS Raab. University of Colorado, Denver, CO
Background: At our institution, residents perform the gross examination of all large specimens and learn gross examination techniques through apprenticeship with senior residents and faculty and reading a protocol manual. The effect of this practice on resident education and patient care quality is unknown.
Design: We performed a two-year retrospective review of all gross examination reports of uteri removed for non-malignant causes (n=78). For each case, we recorded the number and anatomic regions of histologic sections, case turn around time (TAT) from accession to sign-out, the number of sections submitted and the number of bucket dives (BD) or returns to obtain more sections after initially sectioned tissues were processed. These metrics were correlated with resident PGY year (PGY1-4), specific attending pathologist (n=12), and month (e.g., first or second) of resident rotation.
Results: The mean case TAT of specimens grossed by first and fourth year residents was 3.1 and 2.5 days, retrospectively. If a resident performed a BD (n=7), the mean case TAT was 5 days (versus 2.5 days average TAT if no BD performed) and 71% of BDs were performed by PGY1 residents, while the other 29% were performed by PGY3 residents. Individual pathologists had an average TAT from 1.25 to 4.8 days (mean=2.6 days), and only 5 pathologists requested a BD. A resident on the first and second month of his/her surgical pathology rotation had a mean TAT of 3.2 days and 2.3 days, respectively. The number of sections per case varied from an average of 9.5 for PGY1 residents to 7.3 for PGY4 residents. The individual pathologists had an average number of sections per case ranging from 6.3-13.6 (mean= 8.8). When all basic sections (anterior and posterior cervix and anterior and posterior endomyometrium) were submitted initially, the TAT was 2.64 days, whereas those cases in which these sections were not included had an average TAT of 3.35 days.
Conclusions: Our current practice of gross specimen examination is non-standardized and has resulted in less than optimal resident education and patient care quality. Although our data demonstrate resident performance improvement over time, our data also shows a lack of safety focus for beginning residents. We currently are standardizing practice by creating a unified code and number of sections for basic gross techniques to improve TAT and grossing efficiency.
Category: Quality Assurance
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 248, Monday Morning