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Identifying and processing the gap between perceived and actual agreement in breast pathology interpretation
Patricia A Carney1, Kimberly H Allison2, Natalia V Oster3
1Family Medicine and Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA.
Summary
Pathologists often overestimate their diagnostic accuracy in breast pathology cases, particularly for atypia. However, most found continuing medical education valuable for improving practice.
Area of Science:
- Pathology
- Medical Education
- Diagnostic Accuracy
Background:
- Pathologists interpret breast pathology specimens to diagnose conditions.
- Accurate interpretation is crucial for patient treatment and outcomes.
- Understanding pathologists' self-perception of diagnostic agreement is important for targeted education.
Purpose of the Study:
- To assess how pathologists' perceived agreement with a reference standard aligns with their actual diagnostic performance.
- To evaluate the impact of an individualized continuing medical education (CME) program on this self-assessment.
Main Methods:
- 92 pathologists interpreted 60 breast pathology cases.
- Participants estimated their diagnostic agreement with a consensus reference standard.
- An individualized, self-directed web-based CME program was utilized.
Main Results:
- Pathologists generally overestimated agreement with the reference standard (81.4% estimated vs. 75.9% actual).
- Overestimation was most pronounced for atypia diagnoses.
- Non-academic pathologists estimated performance more accurately than academic-affiliated pathologists.
Conclusions:
- Pathologists exhibit good, but not perfect, self-assessment of diagnostic agreement in breast pathology.
- Atypia cases represent a challenge for accurate self-perception.
- Individualized CME effectively provided new information and prompted practice changes for many participants.
