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Mirham L, Naugler C, Hayes M, Ismiil N, Belisle A, Sade S, Streutker C, MacMillan C, Rasty G, Popovic S, Joseph M, Gabril M, Barnes P, Hegele RG, Carter B, Yousef GM. Performance of residents using digital images versus glass slides on certification examination in anatomical pathology: a mixed methods pilot study. CMAJ Open 2016; 4:E88-94. [PMID: 27280119 PMCID: PMC4866926 DOI: 10.9778/cmajo.20140075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND It is anticipated that many licensing examination centres for pathology will begin fully digitizing the certification examinations. The objective of our study was to test the feasibility of a fully digital examination and to assess the needs, concerns and expectations of pathology residents in moving from a glass slide-based examination to a fully digital examination. METHODS We conducted a mixed methods study that compared, after randomization, the performance of senior residents (postgraduate years 4 and 5) in 7 accredited anatomical pathology training programs across Canada on a pathology examination using either glass slides or digital whole-slide scanned images of the slides. The pilot examination was followed by a post-test survey. In addition, pathology residents from all levels of training were invited to participate in an online survey. RESULTS A total of 100 residents participated in the pilot examination; 49 were given glass slides instead of digital images. We found no significant difference in examination results between the 2 groups of residents (estimated marginal mean 8.23/12, 95% confidence interval [CI] 7.72-8.87, for glass slides; 7.84/12, 95% CI 7.28-8.41, for digital slides). In the post-test survey, most of the respondents expressed concerns with the digital examination, including slowly functioning software, blurring and poor detail of images, particularly nuclear features. All of the respondents of the general survey (n = 179) agreed that additional training was required if the examination were to become fully digital. INTERPRETATION Although the performance of residents completing pathology examinations with glass slides was comparable to that of residents using digital images, our study showed that residents were not comfortable with the digital technology, especially given their current level of exposure to it. Additional training may be needed before implementing a fully digital examination, with consideration for a gradual transition.
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Affiliation(s)
- Lorna Mirham
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Christopher Naugler
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Malcolm Hayes
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Nadia Ismiil
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Annie Belisle
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Shachar Sade
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Catherine Streutker
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Christina MacMillan
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Golnar Rasty
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Snezana Popovic
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Mariamma Joseph
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Manal Gabril
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Penny Barnes
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Richard G Hegele
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - Beverley Carter
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
| | - George M Yousef
- Department of Laboratory Medicine and Pathobiology (Mirham, Ismiil, Sade, Streutker, MacMillan, Rasty, Hegele, Yousef), University of Toronto, Toronto, Ont.; Department of Pathology and Laboratory Medicine (Naugler), University of Calgary, Calgary, Alta.; Department of Pathology and Laboratory Medicine (Hayes), University of British Columbia, Vancouver, BC; Department of Pathology and Cellular Biology (Belisle), Université de Montréal, Montréal, Que.; Department of Pathology and Molecular Medicine (Popovic), McMaster University, Hamilton, Ont.; Department of Pathology (Joseph, Gabril), Western University, London, Ont.; Department of Pathology and Laboratory Medicine (Barnes), Dalhousie University, Halifax, NS; Department of Pathology (Carter), Memorial University of Newfoundland, St. John's, NL; Department of Laboratory Medicine (Yousef), St. Michael's Hospital, Toronto, Ont
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