title: Diagnostic performance on briefly presented digital pathology images.
abstract: BACKGROUND
  Identifying new and more robust assessments of proficiency/expertise (finding new "biomarkers of expertise") in histopathology is desirable for many reasons. Advances in digital pathology permit new and innovative tests such as flash viewing tests and eye tracking and slide navigation analyses that would not be possible with a traditional microscope. The main purpose of this study was to examine the usefulness of time-restricted testing of expertise in histopathology using digital images.
  
  
  METHODS
  19 novices (undergraduate medical students), 18 intermediates (trainees), and 19 experts (consultants) were invited to give their opinion on 20 general histopathology cases after 1 s and 10 s viewing times. Differences in performance between groups were measured and the internal reliability of the test was calculated.
  
  
  RESULTS
  There were highly significant differences in performance between the groups using the Fisher's least significant difference method for multiple comparisons. Differences between groups were consistently greater in the 10-s than the 1-s test. The Kuder-Richardson 20 internal reliability coefficients were very high for both tests: 0.905 for the 1-s test and 0.926 for the 10-s test. Consultants had levels of diagnostic accuracy of 72% at 1 s and 83% at 10 s.
  
  
  CONCLUSIONS
  Time-restricted tests using digital images have the potential to be extremely reliable tests of diagnostic proficiency in histopathology. A 10-s viewing test may be more reliable than a 1-s test. Over-reliance on "at a glance" diagnoses in histopathology is a potential source of medical error due to over-confidence bias and premature closure.
authors.affiliation: Centre for Medical Education, Queen's University Belfast, Belfast BT9 7BL, Ireland.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Houghton
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Smoller
authors.affiliation: Department of Histopathology, St. James's Hospital, James's Street, Dublin 8, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Leonard
authors.affiliation: Centre for Medical Education, Queen's University Belfast, Belfast BT9 7BL, Ireland.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Stevenson
authors.affiliation: Centre for Medical Education, Queen's University Belfast, Belfast BT9 7BL, Ireland.
authors.forename: Tim
authors.initials: T
authors.lastname: Dornan
keywords: Digital pathology; expertise; overconfidence bias; premature closure; time-restricted test