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Updated: Feb 26, 2026
DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020
Parker J Magin1, Amanda Tapley2, Simon Morgan3
1University of Newcastle, Newcastle, NSW parker.magin@newcastle.edu.au.
This study looked at how general practice trainees in Australia ordered pathology tests during their first two years of clinical work. Using data from 876 trainees and over 100,000 consultations, the researchers found that trainees ordered more tests with each training term. The increase was about 11% per term and was statistically significant. This finding was unexpected since more experienced doctors typically order fewer tests. The study suggests that diagnostic behavior patterns develop during early practice and that trainees may need additional support to avoid overtesting. The results highlight the importance of monitoring and guiding trainees during this critical period of their careers.
Area of Science:
Background:
Little is known about how pathology test ordering evolves during early medical training. Prior research has shown that experienced physicians tend to order fewer diagnostic tests than trainees. However, no prior work had resolved whether this pattern holds for general practice registrars in their first years of clinical work. The ReCEnT study provides a unique dataset tracking registrars across multiple training terms. This gap motivated the current analysis of test ordering trends over the first 18-24 months of practice. No prior work had resolved the relationship between training duration and diagnostic test frequency in this specific population. The study focused on registrars in Australian general practice settings. The dataset spans ten rounds of data collection from 2010 to 2014. The findings aim to address uncertainties about diagnostic behavior patterns in early career physicians.
Purpose Of The Study:
The study aimed to analyze changes in pathology test ordering by general practice registrars during their initial clinical training period. Researchers sought to determine whether diagnostic test frequency increased or decreased over time. The motivation stemmed from concerns about potential overtesting by trainees. The analysis focused on registrars in their first 18-24 months of practice. The study used longitudinal data from the ReCEnT program. The goal was to identify patterns in diagnostic behavior across training terms. The dataset included ten rounds of data collection between 2010 and 2014. The study aimed to inform strategies for supporting registrars in developing appropriate diagnostic practices.
Main Methods:
The study employed a longitudinal design using data from the ReCEnT program. Researchers analyzed ten rounds of data collected between 2010 and 2014. The dataset included consultations from general practice registrars in five Australian states. The analysis focused on pathology test requests per consultation. A negative binomial regression model was used for statistical analysis. The framework accounted for repeated measures on individual registrars. The time unit was defined as a 6-month training term. The analysis included data from up to four training terms per registrar.
Main Results:
Pathology test ordering increased by 11% per training term (95% CI, 8-15%; P < 0.001). The analysis included data from 876 registrars and 114,584 consultations. The increase was statistically significant across all training terms. The pattern contradicted expectations of decreasing test use with experience. Registrars ordered more tests in later training terms. The trend was consistent across all five participating states. The study found no evidence of a plateau in test ordering frequency. The results suggest a need for targeted support during early career development.
Conclusions:
The study found that pathology test ordering increased significantly during the first two years of clinical practice. This finding contradicts expectations of decreasing diagnostic intensity with experience. The authors suggest that test ordering may peak during late vocational training. The increase raises concerns about potential overtesting by early career physicians. The results highlight the need for support during this critical period. The study does not claim that all registrars overtest, but the trend is notable. The findings suggest that diagnostic behavior patterns develop during early practice. The authors propose that training programs should address this trend directly.
The study found an 11% increase in pathology test requests per training term (95% CI, 8-15%; P < 0.001) over 18-24 months of clinical practice.
The researchers used negative binomial regression within a generalized estimating equations framework to account for repeated measures on registrars.
The increase contradicts expectations that diagnostic intensity decreases with experience and raises concerns about potential overtesting by early career physicians.
The study included data from 876 registrars and 114,584 consultations across five Australian states.
The analysis used a 6-month training term as the time unit, with registrars contributing data for up to four terms.
The authors propose that training programs should provide targeted support to address the observed increase in pathology test ordering during early career practice.
