Patient Safety Curriculum for Anatomic Pathology Trainees: Recommendations Based on Institutional Experience

From sampling to cellblock: The fully automated journey of cytological specimens

In recent years, technological innovation have emerged to standardize pathology laboratory processes and reduce the handling of diagnostic samples. Among them is an automatic tissue embedding system that eliminates the need for manual activity in tissue paraffin embedding, thereby improving sample preservation. Unfortunately, this system cannot be used for cytological specimens due to the lack of an effective holder to support the procedure steps. In this study, we evaluated the performance of a commercial polymer matrix to enable and standardize the automatic paraffin embedding of cytological material from different organs and sources. Cytological samples from 40 patients were collected on the matrices and submitted for fully automatic workflow preparation, from formalin fixation until paraffin block, using the Sakura embedding system. Our results demonstrated the feasibility of the automated procedure, from loading cytological sample onto the matrix to obtaining the paraffin cellblock, thereby avoiding manual manipulation of cellular material. All samples resulted adequately processed and paraffin-embedded showing satisfactory tissue permeation by processing reagents, optimal preservation of cytoplasmic and nuclear details, and good quality of staining results on paraffin sections. Automated embedding of cytological samples eliminates the risk of lost specimens, reduces laboratory burden, standardizes procedures, increases diagnostic yield, and ultimately improves patients' management.

Errors encountered in the diagnostic pathway: A prospective single-institution study

BACKGROUND

Biopsy specimens go through a diagnostic pathway before a pathology report is rendered for the clinician. Errors can occur at any step in this pathway.

METHODS

A 1-year prospective study was conducted at a single academic institution to identify and characterize errors that occurred in the diagnostic pathway from the clinic to the dermatopathology lab.

RESULTS

A total of 25 662 specimens were processed and 190 errors were recorded (an error rate of 0.7%). The most common errors were an incorrect biopsy site (n = 65), incorrect data entry of a correct diagnosis (n = 25), and specimen mix-up (n = 23). There were 17 diagnostic errors. Errors most often occurred in the pre-analytical phase (n = 128). The clinician was responsible for 34.2% of errors, the dermatopathologist for 23.7%, and the histotechnician for 18.9%. Slips were the most common type of human error (n = 156).

CONCLUSION

The most common error involved an incorrect biopsy site at the clinical stage. Over two-thirds of errors occurred before the slide reached the dermatopathologist. Diagnostic errors (analytical phase) rarely occurred, and when they did occur, the clinician was most likely to discover the error. Examining and addressing common laboratory errors help to reduce their incidence and lead to quality improvement in dermatopathology.

Supporting a culture of patient safety: Resident-led patient safety event reviews in a pathology residency training program

Patient safety is a critical component of quality patient care at any healthcare institution. In order to support a culture of patient safety, and in the context of a hospital-wide patient safety initiative at our institution, we have created and implemented a new patient safety curriculum within our training program. The curriculum is embedded in an introductory course for first-year residents, in which residents gain an understanding of the multifaceted role of the pathologist in patient care. The patient safety curriculum is a resident-centered event review process and includes 1) identification and reporting of a patient safety event, 2) event investigation and review, and 3) presentation of findings to the residency program including core faculty and safety champions for the consideration of implementation of the identified systems solution. Here we discuss the development of our patient safety curriculum, which was trialed over a series of seven event reviews conducted between January 2021 and June 2022. Resident involvement in patient safety event reporting and patient safety event review outcomes were measured. All event reviews conducted thus far have resulted in the implementation of the solutions discussed during event review presentations based on cause analysis and identification of strong action items. Ultimately this pilot will serve as the basis by which we implement a sustainable curriculum in our pathology residency training program centered on supporting a culture of patient safety, and in line with ACGME requirements.

Implementation of a Quality and Patient Safety Curriculum for Pathology Residency Training

Quality and Patient Safety education for resident physicians is necessary to prepare them for independent practice and to meet accreditation requirements. Integrating such education into the residents’ routine work can provide them with valuable practical experience, while advancing the institution’s quality priorities. We committed to Quality and Patient Safety education for our pathology residents but found no published program that met their specific needs. To fill this gap in pathology residency education, we designed and implemented a new curriculum that spans the 4-year duration of residency training. Curriculum content was drawn from the pathology milestones, and educational strategies were based on the principles of adult learning. The curriculum was implemented in the 2018 to 19 academic year, and residents were assessed before and after their participation. The residents engaged in several Quality and Patient Safety activities and projects under faculty supervision, and improved their scores on objective assessments (Quality and Patient Safety quiz and in-service examination). Implementation was facilitated by a Quality and Patient Safety chief resident, and the recruitment of faculty with demonstrated Quality and Patient Safety interest. Our comprehensive Quality and Patient Safety curriculum is feasible to implement and can help pathology residents develop the knowledge and skills needed to lead quality initiatives. We believe that the curriculum framework is readily adaptable to other residency programs.

Developing an interactive and illustrative laboratory management curriculum for cytopathology trainees

Laboratory management is a critically important but often overlooked portion of cytopathology training. Indeed, recent surveys of new-in-practice pathologists have consistently shown this to be an area of deficiency. Fortunately, there are a multitude of resources available to fill this need.^1-6 These resources, such as government websites and publications by professional organizations, are often freely accessible to everyone; however, the information they provide is scattered across the vast expanse of cyberspace. We offer this educational module to bridge those gaps and string together a web of resources. The curriculum content includes a pretest to assess the trainee's knowledge and a tree of clickable subject headings covering basic laboratory management topics that a graduating cytopathology fellow should be familiar with. Each subject heading is linked to a summary of the subject using tables and visual diagrams with hyperlinks to specific online resources and additional detailed information. A posttest is included to provide instant feedback. Although by no means comprehensive, we hope this will provide a stepping stone for our readers to build a sound laboratory management foundation that may guide their practice.

[Learning pathologic anatomy during medical formation: Understanding the contribution of the motivation]

INTRODUCTION

The motivations of medical students for Pathologic Anatomy are little known although they can strongly influence their academic performance. Our work focused on the analysis of the relationship between performance and motivation for Pathologic Anatomy.

MATERIALS AND METHODS

Second-year students (n=268) from the University of Nantes were contacted to complete a motivation questionnaire and to provide indicators of performance and attendance. The responses were analyzed in order to establish the psychometric reliability and the factorial structure of the questionnaire. The relationship between motivation and performance was explored by correlation and by linear regression studies. A cluster analysis was performed to specify the distribution of the two variables in our sample.

RESULTS

The sample corresponded to 168 respondents with a F/M ratio similar to that of our population. Our data demonstrated the reliability of the questionnaire and a structure described by 5 motivation factors (self-determination, self-efficacy, career, grade and intrinsic motivation). The academic performance was not significantly correlated with the overall motivation or with student attendance. However, it was predicted by self-determination and self-efficacy. Our work revealed gender differences as well as the existence of two distinct clusters defined by the motivation and performance of the students.

DISCUSSION/CONCLUSION

This work constitutes the first study of the motivations of French medical students for cyto-pathology. It validates a quantitative assessment tool for motivation. Finally, it explores the heterogeneity of the distribution of motivation and academic performance within a population of learners.

Assessment of Quality and Risks Exposure in Histopathology Department

The role of histopathology department in establishing a correct and final diagnosis is essential, this leading to an effective treatment for the patient so its healing to be complete. In order to achieve this goal, it is necessary that all complex steps belonging to this department to be properly carried out because any mistakes in a pathology report may adversely affect the patient outcome. Therefore, it is mandatory the quality assessment of all procedures from the laboratory to be constantly done so that the report to be reliable and accuracy. All three main categories of activities specific to a pathological laboratory (pre-analytic, analytic and post-analytic phases) must undergo quality control. During the progress of these phases, it also must be identified the risks and safety problems regarding the personal staff. These may be different for each activity or procedure which is performed by the laboratory workers. All the physical, chemical or biological hazards must be identified to assess, appreciate the possible risks and to implement preventive measures. The aim of this study is to highlight the importance of quality management for all phases included in a surgical pathological laboratory based on the pathological errors observed, identify emerging risks exposure and necessary measures to prevent them.