Systematic Prediagnostic Review of Endoscopy Reports Significantly Enhances Resident Performance during Slide Preview.
Luisa YA Watts, Mariam Alexander, Hao Wu, Stephen Hammond, Katherine Downey, Yanelba Toribio, Michael Roehrl. Boston Medical Center, MA
Background: Gastric biopsy specimens are frequently diagnostically challenging, particularly for pathologists-in-training. However, an advantage of GI pathology is the routine availability of a detailed gross impression provided by the concomitant endoscopy report. We hypothesized that systematic combined review of the endoscopy report together with the glass slide will improve diagnostic accuracy of residents.
Design: Classic biopsy cases of gastric pathology were selected, including normal, gastritis, polyps, and neoplasia. 50% of our resident population diagnosed this study set, once without any knowledge of the endoscopic findings and then again at least 2 weeks later together with the full text of the endoscopic reports. The accuracy of each resident's diagnoses was compared with the staff diagnosis and scored as acceptable, partially acceptable or unacceptable. The unacceptable category was in particular used when either the biopsy was completely negative and the resident had assigned any pathology or the biopsy showed pathology but was called within normal limits by the resident.
Results: Overall diagnostic accuracy was excellent with 80-85% of diagnoses falling into acceptable or partially acceptable categories, whether or not an endoscopy report was available. Importantly however, when considering the critical distinction between resident diagnoses that were unacceptable after preview and those that were at least partially acceptable, 60% of residents showed improvement after having read the endoscopy report and thus did not make a critical mistake. Resident performance improved most significantly with cases that exhibited subtle pathologic changes that would have been missed, but were diagnosed correctly when an endoscopy report describing a mild abnormality was available. >90% of residents enjoyed the preview experience and felt more confident when an endoscopy report was available compared to a glass slide with limited or no clinical information.
Conclusions: GI pathology demands that the pathologist be able to incorporate all endoscopic and other clinical findings related to the patient's biopsy to render optimal diagnoses. Routine incorporation of endoscopy reports into pathology resident education and independent slide preview enhanced diagnostic accuracy and boosted individual confidence for making diagnoses. Our results support the notion that residency education will be improved by routinely making endoscopy reports available during preview of GI biopsies in addition to the standard limited information provided on the requisition sheets.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 135, Tuesday Morning