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治疗的基石 研究。诊断过程需要复杂的视觉感知任务与认知交互作用 过程，然而，几乎没有做过什么研究来理解和潜在地改进所需的技能 以获得准确的诊断。关于解释性的数据尤其缺乏。 病理学领域的进程。我们之前的工作确定了一个令人担忧的诊断水平 与癌症筛查和乳房活检相关的乳房活检的不一致和错误的解释 每年都有数百万例乳房活检。拟议的研究将有助于改善 病理学家诊断乳房疾病和癌症的准确性。 我们将检查住院医生和有经验的病理学家对乳腺病理的解释，同时 他们解释医学图像以了解整个诊断过程中的专业知识是如何发展的 从初步诊断到第二次诊断的过程。首先，我们将考察一下 美国十所医学院病理住院医师在这两个领域的专业知识 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，我们将研究认知和认知的起源 有经验的病理学家在解读图像时的诊断准确性和错误 初步诊断(目标2)。来自Aim 2的病理学家将被要求提供“第二意见”。 在以下情况下，描述初步诊断知识如何影响解释过程的案例 提供诊断第二意见(目标3)。使用来自AIMS 1-3的数据，我们将开发和测试 试点教育计划(目标4)，旨在促进病理学专业知识的发展。 拟议的工作在使用尖端数字整体幻灯片图像和 记录眼睛跟踪和高分辨率图像导航行为，并在我们的计划中遵循 在三年多的培训中，纵向上是相同的住院医师。使用以下工具提供诊断 最近得到FDA批准的数字成像技术是病理学的未来；我们的工作都将得到改进 当前执业病理学家的诊断准确性，并指导培训下一代。 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 多站点R01资助的研究；2)利用现有访问权限的高效数据收集计划 特征明确的乳房活组织检查病例，全面开发的图像查看和跟踪工具，以及 AIMS之间的协同作用；3)无与伦比地获得来自全球10个临床地点的200名病理学家 国家；以及4)成功招募医生参加类似研究的历史。

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.