The utility of digital pathology in improving the diagnostic skills of pathology trainees in commonly encountered pigmented cutaneous lesions during the COVID-19 pandemic: A single academic institution experience

Abstract

Digital pathology has become an integral part of pathology education in recent years, particularly during the COVID-19 pandemic, for its potential utility as a teaching tool that augments the traditional 1-to-1 sign-out experience. Herein, we evaluate the utility of whole slide imaging (WSI) in reducing diagnostic errors in pigmented cutaneous lesions by pathology fellows without subspecialty training in dermatopathology. Ten cases of 4 pigmented cutaneous lesions commonly encountered by general pathologists were selected. Corresponding whole slide images were distributed to our fellows, along with two sets of online surveys, each composed of 10 multiple-choice questions with 4 answers. Identical cases were used for both surveys to minimize variability in trainees' scores depending on the perceived level of difficulty, with the second set being distributed after random shuffling. Brief image-based teaching slides as self-assessment tool were provided to trainees between each survey. Pre- and post-self-assessment scores were analyzed. 61% (17/28) and 39% (11/28) of fellows completed the first and second surveys, respectively. The mean score in the first survey was 5.2/10. The mean score in the second survey following self-assessment increased to 7.2/10. 64% (7/11) of trainees showed an improvement in their scores, with 1 trainee improving his/her score by 8 points. No fellow scored less post-self-assessment than on the initial assessment. The difference in individual scores between two surveys was statistically significant (p = 0.003). Our study demonstrates the utility of WSI-based self-assessment learning as a source of improving diagnostic skills of pathology trainees in a short period of time.

Keywords: COVID-19 pandemic; Diagnostic skills; Digital pathology; Pathology trainee education; Self-assessment; Whole slide imaging.

Fig. 1

Representative example of whole slide imaging of a pigmented cutaneous lesion viewed via Aperio ImageScope. The main elements of the ImageScope include the toolbar, filmstrip, zoom slider, thumbnail, scale bar, magnifier, status bar, and label (not shown), all of which can be removed from the viewer's screen by unchecking the corresponding options available under the View menu. The cases included in our study were all scanned at 20× magnification and appropriately deidentified prior to distribution to the participants.

Fig. 2

Overview section of image-based teaching slides. A brief overview highlighting key morphologic differences between keratinocytes and melanocytes on hematoxylin and eosin-stained sections was provided as part of the self-assessment following the completion of the first survey. These images were taken from cases of melanoma in situ, lentigo maligna type (A and B, hematoxylin and eosin, original magnification ×20), one of which showed an area of adnexal extension (B).

Fig. 3

Image-based teaching slides highlighting key histological features of melanoma in situ, lentigo maligna type (A and B, hematoxylin and eosin, original magnification ×10 and ×20, respectively). Abbreviation: DEJ = dermal-epidermal junction.

Fig. 4

Image-based teaching slides highlighting key histological features of lentigo maligna melanoma (A and B, hematoxylin and eosin, original magnification ×10 and ×20, respectively). Abbreviation: DEJ = dermal-epidermal junction.

Fig. 5

Image-based teaching slides highlighting key histological features of macular seborrheic keratosis (A and B, hematoxylin and eosin, original magnification ×10 and ×20, respectively).

Fig. 6

Image-based teaching slides highlighting key histological features of pigmented actinic keratosis (A and B, hematoxylin and eosin, original magnification ×10 and ×20, respectively). Abbreviation: SK = seborrheic keratosis.