Characterizing Interpretive and Diagnostic Competency Development in Pathology Training

Area of Science:

• Medical Education
• Pathology
• Diagnostic Accuracy

Background:

• Accurate disease diagnosis is crucial for patient care and outcomes.
• Developing diagnostic competence is a primary objective of pathology residency.
• Understanding skill progression during residency is vital for optimizing training.

Purpose of the Study:

• To investigate the association between pathology residency training duration and performance in key diagnostic interpretive phases.
• To analyze how image-viewing behavior, annotation accuracy, and diagnostic decisions evolve with increasing years of training.
• To identify critical skills that predict diagnostic accuracy in pathology trainees.

Main Methods:

• Longitudinal study analyzing data from 155 pathology residents across 10 US academic medical centers.
• Residents reviewed 32 digital whole slide images of breast biopsies over multiple training years.
• Generalized estimating equations assessed the relationship between residency year and performance in critical region detection, relevance recognition, feature description, and diagnosis.

Main Results:

• Residency year was not significantly associated with critical region detection or recognition of their importance.
• Each additional training year correlated with broader image scanning strategies (less time on critical regions, more attentional coverage).
• Each training year significantly increased the odds of accurate annotation (19%) and accurate diagnosis (18%).

Conclusions:

• Diagnostic accuracy and the ability to describe histopathological features improve with pathology residency training.
• Accurate feature annotation is a critical predictor of diagnostic accuracy, underscoring its foundational role.
• Competency-based pathology training should focus on enhancing histopathological feature recognition and description to improve diagnostic performance.