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J Cutan Pathol. 2018 Jul;45(7):478-490. doi: 10.1111/cup.13147. Epub 2018 Apr 26.

Complexities of perceived and actual performance in pathology interpretation: A comparison of cutaneous melanocytic skin and breast interpretations.

Author information

1
Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
2
Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
3
Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
4
Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
5
Norris Cotton Cancer Center, Lebanon, New Hampshire.
6
Pathology Associates, Clovis, California.
7
Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
8
Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
9
Dermatopathology Northwest, Bellevue, Washington.
10
Department of Pathology, Institut Curie, University of Paris Descartes, Paris, France.
11
Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania.
12
Department of Pathology, University of Vermont, Burlington, Vermont.
13
Department of Internal Medicine, University of Washington, Seattle, Washington.

Abstract

BACKGROUND:

Little is known about how pathologists process differences between actual and perceived interpretations.

OBJECTIVE:

To compare perceived and actual diagnostic agreement before and after educational interventions.

METHODS:

Pathologists interpreted test sets of skin and/or breast specimens that included benign, atypical, in situ and invasive lesions. Interventions involved self-directed learning, one skin and one breast, that showed pathologists how their interpretations compared to a reference diagnoses. Prior to the educational intervention, participants estimated how their interpretations would compare to the reference diagnoses. After the intervention, participants estimated their overall agreement with the reference diagnoses. Perceived and actual agreements were compared.

RESULTS:

For pathologists interpreting skin, mean actual agreement was 52.4% and overall pre- and postinterventional mean perceived agreement was 72.9% vs 54.2%, an overestimated mean difference of 20.5% (95% confidence interval [CI] 17.2% to 24.0%) and 1.8% (95% CI -0.5% to 4.1%), respectively. For pathologists interpreting breast, mean actual agreement was 75.9% and overall pre- and postinterventional mean perceived agreement was 81.4% vs 76.9%, an overestimation of 5.5% (95% CI 3.0% to 8.0%) and 1.0% (95% CI 0.0% to 2.0%), respectively.

CONCLUSIONS:

Pathologists interpreting breast tissue had improved comprehension of their performance after the intervention compared to pathologists interpreting skin lesions.

KEYWORDS:

breast pathology; continuing medical education; dermatopathology

PMID:
29603324
PMCID:
PMC6013368
[Available on 2019-07-01]
DOI:
10.1111/cup.13147
[Indexed for MEDLINE]

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