This Article Full Text Full Text (PDF) All Versions of this Article: M1123v1 10/1/39    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Crowley, R. S. Articles by Friedman, C. P. Search for Related Content PubMed PubMed Citation Articles by Crowley, R. S. Articles by Friedman, C. P.

Development of Visual Diagnostic Expertise in Pathology - An Information-processing Study

Affiliations of the authors: Center for Pathology Informatics, Center for Biomedical Informatics, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (RSC); Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh Pennsylvania (GJN); Center for Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh Pennsylvania (CPF); Department of Pathology and Laboratory Medicine, University of Kentucky Medical Center, Lexington, Kentucky (JS).

Correspondence and reprints: Rebecca S. Crowley, MD, MS, Center for Pathology Informatics, UPMC Shadyside Cancer Pavilion–307, 5230 Centre Avenue, Pittsburgh, PA 15232; e-mail: <crowleyrs{at}msx.upmc.edu>.

Received for publication: 03/14/02; accepted for publication: 08/28/02.

Objective: To identify key features contributing to trainees’ development of expertise in microscopic pathology diagnosis, a complex visual task, and to provide new insights to help create computer-based training systems in pathology.

Design: Standard methods of information-processing and cognitive science were used to study diagnostic processes (search, perception, reasoning) of 28 novices, intermediates, and experts. Participants examined cases in breast pathology; each case had a previously established gold standard diagnosis. Videotapes correlated the actual visual data examined by participants with their verbal "think-aloud" protocols.

Measurements: Investigators measured accuracy, difficulty, certainty, protocol process frequencies, error frequencies, and times to key diagnostic events for each case and subject. Analyses of variance, chi-square tests and post-hoc comparisons were performed with subject as the unit of analysis.

Results: Level of expertise corresponded with differences in search, perception, and reasoning components of the tasks. Several discrete steps occur on the path to competence, including development of adequate search strategies, rapid and accurate recognition of anatomic location, acquisition of visual data interpretation skills, and transitory reliance on explicit feature identification.

Conclusion: Results provide the basis for an empirical cognitive model of competence for the complex tasks of microscopic pathology diagnosis. Results will inform the development of computer-based pedagogy tools in this domain

This article has been cited by other articles:

				D Galvani What are the features of an expert haematological microscopist? J. Clin. Pathol., October 1, 2008; 61(10): 1108 - 1111. [Abstract] [Full Text] [PDF]

				R. S. Crowley, E. Legowski, O. Medvedeva, E. Tseytlin, E. Roh, and D. Jukic Evaluation of an Intelligent Tutoring System in Pathology: Effects of External Representation on Performance Gains, Metacognition, and Acceptance J. Am. Med. Inform. Assoc., March 1, 2007; 14(2): 182 - 190. [Abstract] [Full Text] [PDF]

				C. L. Scudamore and S. H. Smith Future Directions in Training Veterinarians for Careers in Toxicological Pathology in the United Kingdom J Vet Med Educ, January 1, 2007; 34(4): 450 - 457. [Abstract] [Full Text] [PDF]

				E S M Tiersma, A A W Peters, H A Mooij, and G J Fleuren Visualising scanning patterns of pathologists in the grading of cervical intraepithelial neoplasia J. Clin. Pathol., September 1, 2003; 56(9): 677 - 680. [Abstract] [Full Text] [PDF]