title: Expertise under the microscope: processing histopathological slides.
abstract: OBJECTIVE
  Although the obvious goal of training in clinical pathology is to bring forth capable diagnosticians, developmental stages and their characteristics are unknown. This study therefore aims to find expertise-related differences in the processing of histopathological slides using a combination of eye tracking data and verbal data.
  
  
  METHODS
  Participants in this study were 13 clinical pathologists (experts), 12 pathology residents (intermediates) and 13 medical students (novices). They diagnosed 10 microscopic images of colon tissue for 2 seconds. Eye movements, the given diagnoses, and the vocabulary used in post hoc verbal explanations were registered. Eye movements were analysed according to changes over trial time and the processing of diagnostically relevant areas. The content analysis of verbal data was based on a categorisation system developed from the literature.
  
  
  RESULTS
  Although experts and intermediates showed equal levels of diagnostic accuracy, their visual and cognitive processing differed. Whereas experts relied on their first findings and checked the image further for other abnormalities, intermediates tended to double-check their first findings. In their explanations, experts focused on the typicality of the tissue, whereas intermediates mainly mentioned many specific pathologies. Novices looked less often at the relevant areas and were incomplete, incorrect and inconclusive in their explanations. Their diagnostic accuracy was correspondingly poor.
  
  
  CONCLUSIONS
  This study indicates that in the case of intermediates and experts, different visual and cognitive strategies can result in equal levels of diagnostic accuracy. Lessons for training underline the relevance of the distinction between normal and abnormal tissue for novices, especially when the mental rotation of 2-D images is required. Intermediates need to be trained to see deviations in abnormalities. Feedback and an educational design that is specific to these developmental stages might improve training.
authors: Centre for Learning Sciences and Technologies (CELSTEC), Open Universiteit in The Netherlands, Heerlen, The Netherlands.
authors: Thomas
authors: T
authors: Jaarsma
authors: Halszka
authors: H
authors: Jarodzka
authors: Marius
authors: M
authors: Nap
authors: Jeroen J G
authors: JJ
authors: van Merrienboer
authors: Henny P A
authors: HP
authors: Boshuizen
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003071:Cognition / Q000502:physiology*; D003110:Colonic Neoplasms / Q000473:pathology; D003937:Diagnosis, Differential; D004192:Discrimination, Psychological; D053483:Eye Movement Measurements; D005260:Female; D005403:Fixation, Ocular / Q000502:physiology; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D010338:Pathology, Clinical / Q000193:education* / Q000592:standards; D013337:Students, Medical / Q000523:psychology; D013997:Time Factors; D014705:Verbal Behavior; D014796:Visual Perception / Q000502:physiology*