Abstracts from USCAP 2021: Education (271-295)
Bibliographic record
Abstract
Background: Increasing resident and fellow independence as they progress through training is a cornerstone of medical education.However, this is particularly challenging in pathology training programs, due to the stringent regulatory environment and high stakes of generating a final pathology report.Regardless, conditional independence is an ACGME accreditation requirement, and therefore pathology training programs must seek ways of providing graduated responsibility in safe and deliberate fashion.Design: For a 1-week pilot period, board-certified surgical pathology fellows (Anatomic Pathology, American Board of Pathology) were allowed to independently manage cases sent from outside institutions for confirmatory review before additional treatment was undertaken at our facility.Preliminary reports were released at their discretion, then visible in the electronic medical record.Safety measures included a coded comment in each report, conversion to final report by an attending (goal <48 hours), and an 8 case limit for pending preliminary reports.Results: Participating fellows (n=4) released 59 preliminary reports out of 101 total cases reviewed (58%), and elected to show the remaining cases to an attending pathologist without releasing a preliminary report.The fellows shared cases with a subspecialty pathologist before releasing a preliminary report in 32% of cases.In 5 cases (8%), the attending pathologist chose to show a subspecialty pathologist after the preliminary was released by the fellow.55 preliminary reports (93%) were finalized in <48 hours.The median time from accessioning to preliminary report was 0.22 days (range 0.07-4.04).For cases with a preliminary report, the median time from accessioning to final report was 0.96 days (range 0.14-10.1),compared to a median of 1.05 days (range 0.06-25.9)for cases where no preliminary report was released.There was only 1 case with a difference in diagnosis between the preliminary and final report that was deemed potentially significant, but this did not adversely impact patient care.The pilot was endorsed by all 4 fellows (100%) as a positive experience, greatly increasing their independence and responsibility.Faculty and allied health staff feedback was also very positive.Conclusions: Preliminary report release is an effective way to increase surgical pathology fellow autonomy in a safe learning environment, and will be adopted as our standard practice with additional data collection over the first 6 months of implementation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.912 | 0.863 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".