Did I Get It Right?: Implementation of Pathology Trainee Report Feedback System Integrated With Digital Pathology

Effective pathology report feedback is vital for trainee education but is often limited by information technology systems that lack integrated educational support. Most laboratory information systems do not retain resident draft reports after report finalization and lack workflows for structured feedback, hindering self-assessment and progress tracking.

To develop and implement a feedback system that allows pathology trainees to compare their preliminary diagnostic reports with finalized faculty reports and corresponding digital slides.

A custom feedback system was developed, integrating with Cerner Millennium (laboratory information system) and the Paige digital pathology platform. Trainees flagged cases by simulating a report finalization command, which stored their preliminary diagnosis. An automated report compared the resident and faculty diagnoses side by side and included direct links to the relevant digital slides. A total of 3854 cases from 13 trainees were analyzed for diagnostic concordance, categorized as accurate, mostly accurate, partially accurate, or inaccurate.

Overall diagnostic accuracy was 68.8% (2650 of 3854), increasing to 86.1% (3317 of 3854) when "mostly accurate" cases were included. Accuracy varied by trainee (range, 55.5% [238 of 429]-78.3% [553 of 706]) and organ system (highest in neuropathology at 83.8% [31 of 37], lowest in placenta at 46% [46 of 100]). System usage also varied, with some trainees reviewing more than 700 cases and others fewer than 10. Report comparison allowed for assessment of both diagnostic accuracy and report quality.

This integrated feedback system enables scalable, trainee-centered evaluation of diagnostic performance and report writing, fostering reflective learning in daily practice. The database generated through this system further provides opportunities for deeper data exploration, identification of educational trends, and development of competency-based assessment frameworks.