Digital slides and ACGME resident competencies in anatomic pathology: An altered paradigm for acquisition and assessment

Abstract

Whole slide digital imaging technology has matured considerably over the past decade. Applications in pathology education are widespread and are rapidly transforming the manner in which medical students learn pathology and histology, and they have a novel and significant impact on postgraduate continuing medical education. Whole slide digital images for use in pathology graduate education have been slower in adoption and remain much less widespread. Emphasis on professional competency by the Accreditation Council on Graduate Medical Education (ACGME) and credentialing organizations, however, appear poised to significantly increase. The convergence of these two forces is propitious for pathology training. This article examines the opportunities for the use of whole slide images (WSI) in pathology residency training along with the developing potential uses in each of the areas of competency, as categorized by the ACGME. Barriers to WSI adoption in the pathology community are identified along with potentially significant promoters for adoption in training and practice. Current literature and recent presentations are reviewed. Digital pathology coupled with emphasis on competency is a shift of tremendous magnitude that can dramatically improve our abilities to help trainees acquire, demonstrate, and maintain the skills to practice pathology in the generation ahead.

An Assessment of Pathology Resident Access to and Use of Technology: A Nationwide Survey

“…32 Further, WSI is increasingly used for assessment on the American Board of Pathology certification examination. 23,24,26,28,33 Thus, access to and specific instruction in telepathology and digital pathology are becoming progressively necessary. 31 Implementation of these technologies is costly and this can be prohibitive.…”

“…Telepathology is the practice of pathology at a distance, using technology to directly view a specimen, rather than a microscope. 20 Whole slide imaging uses digital slide scanners to scan glass slides, creating digital slides, 21 and can be used for education, 4,5,[22][23][24][25][26][27][28][29][30][31] consultations, and clinical diagnostics. 32 Further, WSI is increasingly used for assessment on the American Board of Pathology certification examination.…”

Whole slide imaging for educational purposes

“…[1819] Centralizing WSI resources (scanning and storage) and providing easy, secure web access to digitized slides makes it possible to standardize training (e.g., grading of tumors), offer self-paced virtual rotations, manage and archive conference materials (e.g., unknown cases), and assess competency. [20–22] Digital slide teaching sets have become popular at several institutions. [2324] For example, at the University of Pittsburgh Medical Center over 4000 WSI have been created to date for pathology educational purposes, which encompasses most anatomical pathology subspecialties.…”

“…[25] Tracking tools, incorporated into WSI, also have the ability to provide quantitative metrics to help evaluate resident competency at evaluating slides. [22] Exposing pathology trainees is important to avoid technophobia, as they are the future pathologists who are most likely to use WSI technology when they graduate. Also, it will provide them with the preparatory skills necessary to better navigate digital slides which are increasingly being used on formal tests (e.g., board examinations in the USA and Europe).…”

Educational Value of Digital Whole Slides Accompanying Published Online Pathology Journal Articles: A Multi-Institutional Study

“…But in some respects, the pace of adoption or penetration into certain niches has lagged expectations. 1 Although digital slides are now routinely used in most educational settings for pathology and histology courses, [2][3][4][5][6] and most current texts include access to an enriched array of fixed magnification digital images, user-controlled, manipulatable whole slide images are still vanishingly rare as components of published pathology scientific studies or textbooks. Almost every pathology meeting featuring case studies includes user-accessible digital slides, acknowledging the added convenience of digital slides and the added value of whole slide examination over fixed, selected images, yet these very same sponsoring organizations have not included digital slides routinely or ever in their publications.…”