Effectiveness of Training in Gross Image Disease Recognition and Technical Skills Using Simulation Based Medical Education (SBME)
Andrea Simmonds, Steve Rath, Sheila Mehri, Suzanne M Dintzis, Stephen S Raab. Eastern Health and Memorial University, St. John's, NL, Canada; University of Washington, Seattle, WA
Background: Knowledge of gross tissue disease and proper technical gross examination skill is important for patient safety. Current residency training in gross tissue examination generally is dependent on daily practice volume and case type and learning gross skills on unusual diseases or atypical patterns of presentation is challenging. We developed and tested the effectiveness of a gross tissue disease SBME system.
Design: From institutional image files and from internet images, we developed an intestinal and an ovarian database of gross tissue cases consisting of 250 cases each. Cases represented a spectrum of common to rare disease types and of common to unusual presentations (graded on a 1(easy)-4(difficult) Likert scale). Multiple images of all major diseases were included (e.g., 32 cases of Crohn's disease). We also developed a gross tissue examination question bank that queried gross technique skills based on institutional protocols (e.g., how many sections would you take of this lesion?). We tested the gross disease identification and technique skills components on 10 and 5 residents, respectively. We used a skills-checklist to determine the number of images required to reach successful mastery of gross diagnosis (2 consecutive scores of Likert-4 cases provided randomly) and the number of images required for successful mastery of gross technique (based on all correct responses per case type).
Results: For gross technique, residents reached mastery of reporting the appropriate grossing protocol after a mean of 2.2 challenges, range 1-5, depending on experience level. For gross tissue diagnosis, residents rapidly improved in their correct identification of common diseases. PGY1 and PGY2 residents generally examined 1-2 (mean 1.5) images at Likert difficulty 1 and 2, prior to diagnosing the disease accurately. More experienced residents correctly diagnosed most diseases without prior challenges at Likert difficulty 3. All residents were challenged on rarer diseases for even Likert difficulty 1 or 2 cases.
Conclusions: In our SBME training, residents quickly and accurately learned to report grossing protocols for all case types. All residents also quickly established accuracy for diagnosing moderately difficult cases (Likert 3) of common diseases and many reached mastery level. We hypothesize that SBME training is a highly useful training tool that augments traditional training methods.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 77, Monday Morning