Reader Accuracy in Pathology Interpretation and Diagnosis: Perception and Cognition (RAPID-PC)

准确的病理诊断是病人护理和癌症的基石 research.诊断过程需要复杂的视觉感知任务， 过程，但很少有研究已经做了了解和潜在的改善如何需要的技能 准确的诊断。特别是缺乏关于解释性的数据， 病理学领域的一个过程。我们先前的工作确定了一个有关的诊断水平， 在与癌症筛查相关的乳腺活检解释中存在分歧和错误， 每年进行数百万次乳房活组织检查。拟议的研究将有助于改善 病理学家诊断乳腺疾病和癌症的准确性。 我们将检查住院医师和有经验的病理学家对乳腺病理学的解释， 他们解读医学图像，以了解专业知识在整个诊断过程中的发展情况， 从初步诊断到第二意见。首先，我们将研究 在美国十所医学院的病理学住院实习生中， 分析（目标1a）和纵向分析，每年收集同一居民的数据， 三年培训（目标1b）。同时，我们将研究的知觉和认知的起源， 有经验的病理学家在解释图像时的诊断准确性和错误， 主要诊断（目标2）。Aim 2的病理学家将被要求提供“第二意见” 对病例进行分析，以确定初次诊断的知识如何影响解释过程， 提供诊断性第二意见（目标3）。利用目标1-3的数据，我们将开发和测试一个 试点教育计划（目标4），旨在促进病理学专业知识的发展。 拟议的工作是创新的使用尖端的数字整体幻灯片图像和 记录眼球跟踪和高分辨率图像导航行为，并在我们的计划，以遵循 在三年的培训中，他们纵向地学习相同的住院医生。提供诊断使用 数字成像，最近被FDA批准，是病理学的未来;我们的工作都将改善 当前执业病理学家的诊断准确性，并指导下一代的培训。 我们的应用程序的优势包括1）我们的多学科团队，具有领导类似 多中心R 01资助的研究; 2）有效的数据收集计划，利用现有的 充分表征的乳腺活检病例，完全开发的图像查看和跟踪工具，以及 目标之间的协同作用; 3）无与伦比的访问来自10个临床站点的200多名病理学家 国家;和4）成功的医生招募到类似的研究的历史。

Accurate pathologic diagnoses are the cornerstone of both patient care and cancer research. The diagnostic process requires complex visual perceptual tasks interacting with cognitive processes, yet little research has been done to understand and potentially improve how skills needed for accurate diagnoses are acquired. There is an especially profound lack of data on the interpretative process in the field of pathology. Our prior work identified a concerning level of diagnostic disagreement and errors in the interpretation of breast biopsies related to cancer screening and millions of breast biopsies are obtained each year. The proposed research will help improve the accuracy of pathologists diagnosing breast disease and cancer. We will examine breast pathology interpretation in residents and experienced pathologists while they interpret medical images to understand how expertise develops across the entire diagnosis process from primary diagnoses to second opinions. First, we will examine the development of expertise among pathology resident trainees at ten U.S. medical schools in both cross-sectional analysis (Aim 1a) and in a longitudinal analysis gathering data on the same residents annually over three years of training (Aim 1b). Concurrently, we will study the perceptual and cognitive origins of diagnostic accuracy and errors among experienced pathologists while they interpret images for primary diagnosis (Aim 2). Pathologists from Aim 2 will then be asked to provide “second opinions” on cases to characterize how knowledge of an initial diagnosis impacts the interpretive process when providing diagnostic second opinions (Aim 3). Using data from Aims 1-3, we will develop and test a pilot educational program (Aim 4) designed to facilitate the development of expertise in pathology. The proposed work is innovative in the use of cutting-edge digital whole slide images and recording eye tracking and high-resolution image navigation behavior and in our plan to follow the same residents longitudinally as they progress in training over three years. Providing diagnoses using digital imaging, recently approved by the FDA, is in the future of pathology; our work will both improve the diagnostic accuracy of current practicing pathologists and guide training the next generation. Strengths of our application include 1) our multidisciplinary team with experience leading similar multi-site R01-funded studies; 2) an efficient data collection plan that leverages access to existing well-characterized breast biopsy cases, a fully developed image viewing and tracking tool, and synergy between the Aims; 3) unparalleled access to >200 pathologists from ten clinical sites across the country; and 4) a history of successful physician recruitment into similar studies.