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Resident education and quality of gross tissue examination practices of benign uteri
  1. Margaret S Ryan1,
  2. Maxwell L Smith1,
  3. Dana M Grzybicki2,
  4. Stephen S Raab3
  1. 1Department of Pathology, University of Colorado, Aurora, Colorado, USA
  2. 2Department of Specialty Medicine, Rocky Vista University, Parker, Colorado, USA
  3. 3Laboratory Medicine, Memorial University of Newfoundland and Eastern Heath Authority, St. John's, Newfoundland, Canada
  1. Correspondence to Stephen S Raab, Department of Laboratory Medicine, Memorial University of Newfoundland, Eastern Health Authority, Room 1J445, 300 Prince Philip Drive, St. John's, NL, Canada A1B 3V6; raabss{at}


Introduction In the USA, most anatomical pathology residency training is based on an apprenticeship model in which residents learn directly by watching more senior personnel and then performing the examination. The level and the effect of the standardisation of resident trainee gross tissue examination practices have not been extensively evaluated.

Methods In this apprenticeship-based training programme, a retrospective report review was performed to measure the level of standardisation of gross description (for 11 mandatory descriptors) and tissue submission (for four mandatory sections) practices for uterine specimens removed for benign conditions (n=78). Practices were examined for significant relationships with error, turnaround time (TAT), resource utilisation and postgraduate year of resident (n=25) training.

Results Residents provided mandatory descriptors from 23.1% to 93.6% of the time and submitted mandatory sections from 82.1% to 96.2% of the time. Cases submitted by less experienced residents had a longer TAT and were associated with more errors, measured by the necessity to submit additional tissues. Less experienced residents used greater resources (submitting 9.5 tissue cassettes per case) compared with more experienced residents (7.3 cassettes per case), and a statistically significant correlation was found between the number of cassettes submitted and TAT.

Conclusions In this training programme, the model of apprenticeship training leads to less than optimal standardisation of gross examination practices, inefficiency, active errors and a high frequency of latent conditions leading to error.

  • Gross tissue examination
  • pathology
  • uterus
  • medical error
  • quality improvement
  • quality assurance
  • quality control
  • gynaecological pathology
  • surgical pathology
  • audit
  • clinical audit

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  • Competing interests None.

  • Ethics approval University of Colorado Denver Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.