Time Required for Gross Examination of Routine Second and Third Trimester Singleton Placentas by Pathologists' Assistants.

INTRODUCTION: In both Canada and the United States, workload measurement for anatomic pathology is mainly based on complexity and clinical significance of specimens, with gross examination being a considerable contributor. While Pathologists' Assistants (PAs) play an increasing role in gross examination, there is little known regarding the time required for PAs to complete grossing tasks. This information is essential for effective staffing and workload management in pathology laboratories. The objective of our study was to determine the time required for PAs to gross second and third trimester singleton placentas in a large tertiary hospital with a significant perinatal pathology service. MATERIALS AND METHODS: For our study, 7 certified PAs each grossed a minimum of 10 second and third trimester singleton placentas using a standard placental grossing protocol, an electronic laboratory information system, and voice recognition dictation software. Placental specimens requiring photography, sampling for ancillary studies, or immediate pathologist's consultation were excluded. We calculated average and standard deviation of grossing times for each PA, overall average grossing time, and 95% confidence interval using a mixed linear regression model. We analyzed the impact of PA job experience, degree obtained, and number of blocks prepared on overall average in a multivariate analysis. RESULTS: The mean grossing times for each PA ranged from 11.0 (standard deviation [sd] = 2.0) to 17.8 (sd = 4.5) minutes. The overall average grossing time was 14.5 minutes, with a 95% confidence interval of 11.7 to 17.3 minutes. In multivariate analysis, an increase in the number of blocks prepared was significantly associated with longer overall average grossing time. If 4 blocks were prepared consistently, the model predicted a slightly lower overall average of 13.3 minutes, with a 95% confidence interval of 10.9 to 15.7 minutes. DISCUSSION: To our knowledge, our study is the first to objectively report time required for PAs to perform gross examinations of routine second and third trimester singleton placentas. The methodology of our study is replicable and can be applied to other specimen types and laboratory settings. Previously, estimated grossing times for specimens were primarily based on retrospective surveys, which were susceptible to recall errors and subjectivity. However, our study demonstrates objective data collection is achievable. Furthermore, the data collected from this study offer valuable insights into the accuracy of previous and current pathology workload models for second and third trimester singleton placentas.

The utility of a gross dissection anatomical model for simulation-based learning in pathology.

INTRODUCTION: The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators. METHODS: Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3). RESULTS: The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1-5) (range 3.4-4.7, σ0.89). The categories 'knowledge of resection margins' and 'macroscopic diagnosis' received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by 'understanding of handling and gross examination of the surgical specimen' (4.5, σ0.49), 'prognosis' (4.3, σ0.67) and 'understanding of a tumor resection' (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15'39″ (σ2'12″), 16'50″ (σ3'45″), and 17'52″ (σ2'12″), respectively (p<0.05). Gross dissection marks (0-5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8). CONCLUSIONS: This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.

The utility of a gross dissection anatomical model for simulation-based learning in pathology

Introduction: The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators. Methods: Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3). Results: The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1–5) (range 3.4–4.7, σ0.89). The categories ‘knowledge of resection margins’ and ‘macroscopic diagnosis’ received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by ‘understanding of handling and gross examination of the surgical specimen’ (4.5, σ0.49), ‘prognosis’ (4.3, σ0.67) and ‘understanding of a tumor resection’ (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15′39″ (σ2′12″), 16′50″ (σ3′45″), and 17′52″ (σ2′12″), respectively (p<0.05). Gross dissection marks (0–5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8). Conclusions: This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.(AU)

Introducción: En Anatomía Patológica el examen macroscópico y la disección resultan fundamentales para alcanzar un diagnóstico correcto. Los métodos tradicionales de enseñanza de esta habilidad presentan limitaciones, como el riesgo de enfermedad transmisible, la exposición al formol y la disponibilidad de especímenes. Describimos aquí un método de enseñanza en disección utilizando simuladores anatómicos. Material y métodos: Se usaron modelos anatómicos neoplásicos artesanales que utilizan silicona líquida. Ochenta y cinco estudiantes de medicina participaron en una experiencia de examen macroscópico y disección y cumplimentaron un cuestionario sobre su percepción de aprendizaje adquirido. Además, se organizó un taller para comparar 3 metodologías distintas: imágenes estáticas (Grupo 1), vídeo (Grupo 2) y observación directa de un patólogo tallando (Grupo 3). Resultados: El cuestionario de conocimientos adquiridos mostró una valoración media de 4,4 sobre 5 (1-5) (rango 3,4-4,7, σ=0,89). Las categorías de «conocimiento sobre márgenes quirúrgicos» y «diagnóstico macroscópico» obtuvieron las mejores valoraciones (4,8, σ=0,11 y 4,7, σ=0,32, respectivamente), seguidas del «manejo de una pieza quirúrgica y su disección» (4,5, σ=0,49), el «pronóstico» (4,3, σ=0,67) y la «comprensión de una cirugía tumoral» (3,9, σ=0,96) (p<0,05). En relación con el método de enseñanza, el Grupo 3 realizó la disección en menos tiempo que el Grupo 2 y el Grupo 1, con unos tiempos medios de 15′39″ (σ=2′12″), 16′50″ (σ=3′45″), y 17′52″ (σ=2′12″), respectivamente (p<0,05). Por otra parte, se encontraron resultados estadísticamente significativos en función de la metodología utilizada (0-5) (p<0,05). El Grupo 2 obtuvo mejores resultados (3,7; σ=0,54) comparado con el Grupo 3 (3,4; σ=0,94) y el Grupo 1 (3,1; σ=0,8). Conclusiones: Este estudio preliminar demuestra que es posible implementar un módulo de simulación en disección en el Grado en Medicina, permitiendo esta metodología adquirir la habilidad en un entorno seguro.(AU)

Gross Dissection Time Values of Pathologists' Assistants Using Standardized Metrics.

OBJECTIVES: A validated and objective method to quantify the gross dissection time of pathologists' assistants (PAs) does not exist. We propose a method to calculate standardized work units (dissection time values [DTVs]) to monitor PA productivity. METHODS: The Current Procedural Terminology system specifies six levels of specimen complexity encompassing 176 unique specimen types. Using our institutional dictionary, we designated all specimen types into a priori five levels of complexity based on expected dissection time. We hypothesized that expected time could be matched prospectively with the actual measured dissection time for all specimens. Dissection time data were collected prospectively for 12,775 specimens at two tertiary academic medical centers, and work effort was converted to a numeric DTV equivalent (number of minutes to dissect single specimen/420 minutes in a working day). RESULTS: For 44 of 155 specimen types, measured dissection time for the five "levels" was lower than expected dissection (P < .0001). Accordingly, those 44 specimen types were reclassified to a lower level. CONCLUSIONS: A numeric standard of the work effort for dissection time for 155 specimen types was developed, validated, and then used prospectively to monitor grossing efficiency of PA workforce.