[1999] Focused Professional Peer Review for Anatomic Pathology Faculty: A Pilot Study

Jordan M Newell, Richard J Zaino. Penn State Hershey, Hershey, PA

Background: Focused and ongoing professional practice evaluations are mandated by the JCAHO and most medical staff bylaws for new and current faculty. Formal recommendations for the method of implementation do not exist in anatomic pathology, and institutional approaches vary. For gynecologic pathology, our practice was to have a member of the section review the first 200 cases prior to sign-out (concurrent review) by a new faculty member. Analysis of the most recent concurrent review showed that the ten most frequent diagnoses accounted for 73% of all cases, for which 9 of the 10 were normal or non-neoplastic. While this reflects daily practice, it provides scant information about diagnostic competency in gynecologic pathology.
Design: The goal of this project was to develop a proficiency exam for faculty members that could assess their knowledge of diagnostic gynecologic pathology. Based on the tables of contents of gynecologic pathology texts, we identified about 120 major diagnostic entities. A slide with characteristic features for each diagnosis was obtained from our archives. A representative subset of thirty cases for which the diagnosis could be made using only an H&E stained slide were selected for the proficiency exam, of which 15 were considered routine, 13 challenging, and 2 difficult. The site, patient age, and a short clinical history were provided for each case. Current faculty in the gynecologic pathology section were given the test, for which they had 2 hours and access to desired written or electronic resources.
Results: Five faculty members with a wide range in past experience and current service frequency took the exam. Scores ranged from 21/30 (70%) to 30/30 (100%) with a mean of 26/30 (87%). The scores did not appear to correlate with experience or frequency of time on service, but the sample was too small for statistical analysis. Based on existing proficiency testing for cytopathology and published discordant rates upon second review of cases, we chose a score of 90% as the threshold below which we would provide at least 22 hours of targeted CME to enhance professional development.
Conclusions: A wide range in test results was identified using this proficiency exam. This test is more efficient than concurrent review and appears to provide more useful data. With our routine case distribution, we estimate that it would require concurrent review of at least 1000 cases to achieve a similar mix of challenging and difficult diagnoses. Validation with a larger sample size using faculty at other institutions and the determination of minimal target scores and methods for remediation are future goals.
Category: Quality Assurance

Monday, March 4, 2013 2:00 PM

Proffered Papers: Section G, Monday Afternoon

 

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