Are Pathologists Self-Aware of Their Diagnostic Accuracy? Metacognition and the Diagnostic Process in Pathology.
Are Pathologists Self-Aware of Their Diagnostic Accuracy? Metacognition and the Diagnostic Process in Pathology.
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DOI：
10.1177/0272989x221126528
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发表时间：
2023-02
影响因子：
3.6
通讯作者：
Elmore, Joann G.
中科院分区：
文献类型：
--
作者：
Clayton, Dayna A.;Eguchi, Megan M.;Kerr, Kathleen F.;Miyoshi, Kiyofumi;Brunye, Tad T.;Drew, Trafton;Weaver, Donald L.;Elmore, Joann G.
关键词：
元认知是一个涉及思维、理解和表现的自我意识的认知过程。本研究通过检查病理学家在解释皮肤和乳房活检时诊断准确性和自我报告的置信水平之间的关联来评估病理学家的元认知。我们研究了来自黑色素瘤病理学研究（M-Path）的187名病理学家和来自乳腺病理学研究（B-Path）的115名病理学家。我们通过检查AUC来测量病理学家的元认知能力，AUC是每个病理学家的受试者工作特征（ROC）曲线下的面积，总结了置信度和诊断准确性之间的关系。我们研究了AUC测量值（称为元认知敏感性）与病理学家属性之间的可能关系。我们还评估了较高的元认知敏感性是否会影响诊断准确性和第二诊断行为（如请求第二意见）之间的关联。我们发现病理学家的临床属性和后皮质醇AUC之间没有显著相关性。然而，我们发现，与具有较低AUC的病理学家相比，具有较高AUC的病理学家表现出更强的趋势，要求对不准确的诊断采取二次诊断行动，而不是对准确的诊断采取二次诊断行动。病理学家报告了对特定诊断术语的信心，而不是诊断术语后来被分组以确定准确性的更广泛类别。此外，虽然没有正确诊断的“金标准”来确定病理学家解释的准确性，但我们的研究通过使用三位经验丰富的病理学家的一致诊断实现了高质量的参考诊断。元认知可以影响临床决策。如果病理学家有自我意识，他们的诊断可能是不准确的，他们可以要求额外的测试或第二意见，提供机会，以纠正不准确的诊断。
Metacognition is a cognitive process that involves self-awareness of thinking, understanding, and performance. This study assesses pathologists’ metacognition by examining the association between their diagnostic accuracy and self-reported confidence levels while interpreting skin and breast biopsies. We studied 187 pathologists from the Melanoma Pathology Study (M-Path) and 115 pathologists from the Breast Pathology Study (B-Path). We measured pathologists’ metacognitive ability by examining the AUC, the area under each pathologist’s receiver operating characteristic (ROC) curve summarizing the association between confidence and diagnostic accuracy. We investigated possible relationships between this AUC measure, referred to as metacognitive sensitivity, and pathologist attributes. We also assessed whether higher metacognitive sensitivity affected the association between diagnostic accuracy and a secondary diagnostic action such as requesting a second opinion. We found no significant associations between pathologist clinical attributes and metacognitive AUC. However, we found that pathologists with higher AUC showed a stronger trend to request secondary diagnostic action for inaccurate diagnoses and not for accurate diagnoses compared to pathologists with lower AUC. Pathologists reported confidence in specific diagnostic terms, rather than the broader classes into which the diagnostic terms were later grouped to determine accuracy. Additionally, while there is no “gold standard” for the correct diagnosis to determine accuracy of pathologists’ interpretations, our studies achieved a high-quality reference diagnosis by using the consensus diagnosis of three experienced pathologists. Metacognition can affect clinical decisions. If pathologists have self-awareness that their diagnosis may be inaccurate, they can request additional tests or second opinions, providing the opportunity to correct inaccurate diagnoses.