title: A web-based tutorial improves practicing pathologists' Gleason grading of images of prostate carcinoma specimens obtained by needle biopsy: validation of a new medical education paradigm.
abstract: BACKGROUND
  The Internet, although it is in widespread use in medicine, to the authors' knowledge has not been tested rigorously as an educational tool. The authors investigated, as a model to validate web-based education for physicians, the Gleason grading of images of prostate carcinoma tissue specimens that were obtained by needle biopsy, which provides critical information for patient management.
  
  
  METHODS
  A free, web-based program (available at www. pathology.jhu.edu/prostate) was developed. It consisted of 20 pretutorial quiz images of prostate carcinoma specimens that were obtained by needle biopsy for grading, followed by 24 tutorial images with text describing the Gleason grading system. Subsequently, pathologists took a posttutorial quiz, which consisted of the same 20 images that were used in the pretutorial quiz.
  
  
  RESULTS
  In 16 months, there were 2021 visits with 916 participants completing the entire web site; 643 participants (70.2%) were practicing pathologists and formed the basis of the current study. Only the location of practice within the United States compared with outside the United States (P < 0.0001) and < 5 years in practice (P = 0.003) were correlated independently with a higher pretutorial quiz score. Overall, the web-based tutorial significantly improved grading in 15 of 20 images. Of these, on average, there was an 11.9% increase (range, 6-25.3%) in assigning the correct Gleason score. Improvements were noted in images of tumors with the following grades: Gleason score, 2-4 (0 of 1 images); Gleason score, 5-6 (5 of 7 images); Gleason score, 7 (4 of 6 images); and Gleason score, 8-10 (6 of 6 images). Greater improvement after taking the tutorial was correlated with lower pretutorial scores (P < 0.0001).
  
  
  CONCLUSIONS
  A web-based tutorial improves the accuracy of Gleason grading of practicing pathologists. To the authors' knowledge the current study is the first large scale, international study that has evaluated and validated the use of a web-based program to educate a population of widely dispersed physicians.
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Kronz
authors.forename: M A
authors.initials: MA
authors.lastname: Silberman
authors.forename: W C
authors.initials: WC
authors.lastname: Allsbrook
authors.forename: J I
authors.initials: JI
authors.lastname: Epstein
mesh_terms: D001707:Biopsy, Needle; D003194:Computer-Assisted Instruction; D004502:Education, Medical, Continuing; D005260:Female; D006742:Hospital Bed Capacity; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D020407:Internet; D008297:Male; D010336:Pathology / Q000193:education*; D011471:Prostatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results; D014481:United States; D014584:User-Computer Interface