title: Perceptual analysis of the reading of dermatopathology virtual slides by pathology residents.
abstract: BACKGROUND
  The process by which pathologists arrive at a given diagnosis-a combination of their slide exploration strategy, perceptual information gathering, and cognitive decision making-has not been thoroughly explored, and many questions remain unanswered.
  
  
  OBJECTIVE
  To determine how pathology residents learn to diagnose inflammatory skin dermatoses, we contrasted the slide exploration strategy, perceptual capture of relevant histopathologic findings, and cognitive integration of identified features between 2 groups of residents, those who had and those who had not undergone their dermatopathology rotation.
  
  
  METHODS
  Residents read a case set of 20 virtual slides (10 depicting nodular and diffuse dermatitis and 10 depicting subepidermal vesicular dermatitis), using an in-house-developed interface. We recorded residents' reports of diagnostic findings, conjectured diagnostic hypotheses, and final (or differential) diagnosis for each case, and time stamped each interaction with the interface. We created search maps of residents' slide exploration strategy.
  
  
  RESULTS
  No statistically significant differences were observed between the resident groups in the number of correctly or incorrectly reported diagnostic findings, but residents with dermatopathology training generated significantly more correct hypotheses (mean improvement of 88.5%) and correct diagnoses (70% of all correct diagnoses).
  
  
  CONCLUSIONS
  Two types of slide exploration strategy were identified for both groups: (1) a focused and efficient search, observed when the final diagnosis was correct; and (2) a more dispersed, time-consuming strategy, observed when the final diagnosis was incorrect. This difference was statistically significant, and it suggests that initial interpretation of a slide may bias further slide exploration.
authors.affiliation: Department of Biomedical Informatics, University of Pittsburgh, UPMC Shadyside Hospital, Cancer Pavilion, 5150 Centre Avenue, Pittsburgh, PA 15232, USA. mellothomsc@upmc.edu
authors.forename: Claudia
authors.initials: C
authors.lastname: Mello-Thoms
authors.forename: Carlos A B
authors.initials: CA
authors.lastname: Mello
authors.forename: Olga
authors.initials: O
authors.lastname: Medvedeva
authors.forename: Melissa
authors.initials: M
authors.lastname: Castine
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Legowski
authors.forename: Gregory
authors.initials: G
authors.lastname: Gardner
authors.forename: Eugene
authors.initials: E
authors.lastname: Tseytlin
authors.forename: Rebecca
authors.initials: R
authors.lastname: Crowley
mesh_terms: D003657:Decision Making; D006801:Humans; D007396:Internship and Residency; D010338:Pathology, Clinical / Q000193:education; D010820:Physicians / Q000523:psychology*; D012871:Skin Diseases / Q000175:diagnosis*; D014584:User-Computer Interface