BACKGROUND Acquisition of visual interpretation skills in cytopathology may involve 2 strategies. Analytic strategies require trainees to base their interpretive decisions on carefully considered and often exhaustive cytomorphologic feature lists, a process that can be time‐consuming and inefficient. In contrast, nonanalytic pattern recognition strategies are rarely encouraged during training, even though this approach is characteristic of expert diagnostic behavior. This study evaluated the potential role of nonanalytic learning in cytopathology as an efficient alternative to analytic training. METHODS Forty‐nine cytology novice participants undertook an initial image interpretation test to obtain baseline diagnostic accuracy (test 1). Twenty‐four participants subsequently received training in basic cervical cytomorphology and were given a list of cell features for future reference (the “analytic” group). The remaining 25 participants were simply shown 20 nonannotated paired images of normal and abnormal cervical cells (the “nonanalytic” group). Following a practice phase, both groups were retested (test 2). Prior to a final test (test 3), participants in both groups were instructed to adopt a combined analytic/nonanalytic diagnostic strategy. Diagnostic accuracy and response times were measured in each test. RESULTS Diagnostic accuracy in both groups improved significantly between tests 1 and 2 (P<.001) but decreased between tests 2 and 3 (P<.05). Speed of response to test images was generally faster under nonanalytic than under analytic conditions. CONCLUSIONS Nonanalytic reasoning in cytopathology image interpretation can be as accurate as traditional feature‐based reasoning. Encouraging trainees to adopt pattern recognition strategies may help to expedite the acquisition of visual interpretation skills in cytopathology training programs, yet combining analytic and nonanalytic reasoning do not appear to be effective. Cancer (Cancer Cytopathol) 2013;121:329–38. © 2013 American Cancer Society.

BACKGROUND: Cytologists must learn how to discriminate cells that might be visually very similar but have different neoplastic potential. The mechanism by which trainees learn this task is poorly researched and is the focus of the current investigation. Cognitive science offers a theoretical platform from which to design meaningful experiments that could lead to novel training strategies. METHODS: The interpretation of a cell image is a category-discrimination task, and the process by which discrimination improves with practice is called perceptual learning. The study authors operationalized this concept by training 150 naive observers on paired cell images without providing explicit tuition, employing cervical cytology as a model system. Six strategies were tested, which differed according to the diagnostic category and level of interpretive difficulty of each image. Participants were tested before and after training to determine the extent to which visual learning had occurred. RESULTS: Diagnostic accuracy improved for participants who were trained on normal/ abnormal image pairs in which at least one member of the pair was "easy" to interpret (P <.05). Training was not effective when image pairs were drawn from the same diagnostic category or when both members of the pair were "difficult" to interpret (P >.05). CONCLUSIONS: Training on paired cell images without explicit tuition can be an efficient and effective means of visual learning in cytopathology, but only if care is taken to avoid image pairs from category boundaries. Training on same-category image pairs is ineffective. This study is a step toward the development of perceptual learning modules for cytopathology.

STEVE GILL is a product designer with 15 years experience in industry and academia. He is a Principal Lecturer at the University of Wales Institute Cardiff and Director of the Programme for Advanced Interactive Prototype Research (PAIPR) within The National Centre for Product Design & Development Research (PDR). He has designed or product managed around 50 products to market and has published 20 academic journal and conference papers. Steve has a range of research interests related to product design and development including the rapid design development of information appliances, the role of physicality in the design process and the role of Cradle to Cradle theories in product design & development.He works closely with academic partners, particularly Lancaster University and those in blue chip industry such as SonyEricsson and Samsung. He is currently engaged in a major project with partners at Lancaster University investigating the nature of physical interaction and its effects on design with the help of an Arts and Humanities Research Council grant. Darren Walker

To the extent that the results from cytology novices extend to experienced practitioners, visual distraction is an unlikely source of error in virtual microscopy. Efficient visual selection and spatial attention, coupled with the high perceptual load of target images and the peripheral location of distractors, provide plausible explanations for the observed results.

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