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

病理解释和诊断的读者准确性：感知和认知 (RAPID-PC)

• 批准号: 10388503
• 负责人: JOANN G ELMORE
• 金额: $ 6.47万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-12 至 2021-07-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10388503
• 关键词: Behavior; Breast Diseases; Breast biopsy; Certification; Chemotherapy and/or radiation; Clinical; Cognition; Cognitive; Complex; Consultations; Country; Cross-Sectional Studies; Data; Data Collection; Development; Diagnosis; Diagnostic; Diagnostic Errors; Education; FDA approved; Funding; Future; Glass; Histopathology; Human; Image; Image Analysis; Knowledge; Malignant Neoplasms; Mastectomy; Medical Imaging; Modeling; Operative Surgical Procedures; Pathologic; Pathologist; Pathology; Pathology processes; Patient Care; Patients; Perception; Physicians; Process; Radiation therapy; Reader; Recommendation; Recording of previous events; Research; Research Design; Residencies; Screening for cancer; Second Opinions; Shipping; Site; Slide; Technology; Testing; Time; Training; Training Programs; United States National Institutes of Health; Visual; Visual Perception; Work; accurate diagnosis; anticancer research; apprenticeship; base; breast pathology; cancer diagnosis; clinical practice; clinical research site; cognitive process; design; diagnostic accuracy; digital; digital imaging; experience; high resolution imaging; improved; innovation; longitudinal analysis; malignant breast neoplasm; medical schools; multidisciplinary; next generation; programs; recruit; skills; synergism; tool; visual tracking; whole slide imaging

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.

准确的病理诊断是患者护理和癌症的基石 研究的诊断过程需要复杂的视觉感知任务与认知相互作用。 流程，但很少有研究来了解并可能改进所需的技能 为获得准确的诊断，特别严重缺乏解释性数据。 我们之前的工作确定了病理学领域的相关诊断水平。 与癌症筛查相关的乳腺活检的解释存在分歧和错误 每年都会获得数百万份乳房活检样本。拟议的研究将有助于改善这一现状。 病理学家诊断乳腺疾病和癌症的准确性。 我们将检查住院医生和经验丰富的病理学家对乳腺病理学的解释，同时 他们解读医学图像以了解整个诊断过程中专业知识的发展情况 首先，我们将考察从初步诊断到第二意见的过程。 美国十所医学院的病理学住院实习生在两个领域的专业知识 分析（目标 1a）以及每年收集相同居民数据的纵向分析 三年的培训（目标 1b）同时，我们将研究感知和认知的起源。 经验丰富的病理学家在解释图像时的诊断准确性和错误 初步诊断（目标 2）然后将要求目标 2 的病理学家提供“第二意见”。 案例来描述初始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）。使用目标 1-3 中的数据，我们将开发并测试一个 试点教育计划（目标 4）旨在促进病理学专业知识的发展。 拟议的工作在使用尖端数字全幻灯片图像和 记录眼球追踪和高分辨率图像导航行为，并在我们的计划中遵循 三年来，相同的居民在培训中取得进展，并使用该方法提供诊断。 最近获得 FDA 批准的数字成像是病理学的未来，我们的工作将会得到改善； 当前执业病理学家的诊断准确性并指导下一代培训。 我们申请的优势包括 1) 我们的多学科团队拥有领导类似领域的经验 多地点 R01 资助的研究；2) 利用现有数据收集计划 特征明确的乳腺活检病例、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) 无与伦比地接触来自 10 个临床中心的超过 200 名病理学家 国家；4) 成功招募医生参与类似研究的历史。