Simulation Based Medical Education (SBME) in Breast Fine Needle Aspiration (FNA) Cytopathology as a Means of Quality Improvement.
Heather N Mack, Maxwell L Smith, Philippe Vielh, Sharon B Sams, Gregory Kotnis. Univeristy of Colorado, Aurora; Institut Gustave Roussy, Villejuif, France
Background: Traditionally, pathology residents are trained using an apprenticeship model in real practice settings. The effectiveness of high fidelity simulation education on the improvement and maintenance of resident diagnostic interpretation skills has not been measured in pathology training programs.
Design: For the interpretation of breast fine needle aspiration cytopathology, we developed a SBME composed of 550 modules of various case complexities, based on difficulty level and preparation quality. Following an assessment of baseline skills, we initiated daily tailored-by-skill training sessions for 10 residents using 5-set case modules. Based on previous resident performance, the individualized modules reflected real practice, focused on rapid diagnostic skill accrual and maintenance, and involved immediate feedback with self-assessed root cause analysis of cytologic criteria (n=21 criterion). We assessed competency and mastery (i.e., top 1% of practitioners) as 80% and 90% agreement, respectively, with expert performance. We tracked weekly performance using statistical process control charts and interval performance testing.
Results: In a 1 month rotation, all residents had achieved diagnostic competency with 50% of residents achieving a master level of performance. Most residents (90%), including residents with no prior FNA experience, had achieved competence at two weeks. Initial resident errors exclusively involved cases of fibroadenoma, well differentiated ductal carcinoma, lobular carcinoma, and bloody, scirrhous, or low cellular specimens. Immediate feedback and root cause analysis involving assessment of cytologic features showed that residents misinterpreted small cellular groups (10% of errors), stripped nuclei (7% of errors), necrosis (5% of errors), and minimal nuclear atypia (5% of errors). Achieving mastery level required dedicated practice involving increased numbers of specimens demonstrating these criteria and poor quality specimens.
Conclusions: We conclude that resident competence in diagnostic interpretation of breast FNA may be achieved using SBME in less than one month with a resident spending approximately one hour per day in a practice of concetrated work and feedback. Mastery level may be achieved with dedicated practice and self assessment. We determined that tailored skill-based programs assist residents in mastering weaknesses in diagnostic interpretation.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 76, Monday Morning