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A human factor event-based learning assessment tool for assessment of errors and diagnostic accuracy in histopathology and cytopathology
  1. David Nigel Poller1,
  2. Massimo Bongiovanni2,
  3. Beatrix Cochand-Priollet3,
  4. Sarah J Johnson4,
  5. Miguel Perez-Machado5
  1. 1 Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK
  2. 2 Department of Pathology, Synlab Suisse SA Lausanne, Lausanne, Switzerland
  3. 3 Department of Pathology, Cochin Hospital, University of Paris, Paris, Île-de-France, France
  4. 4 Department of Cellular Pathology, Royal Victoria Hospital, Newcastle upon Tyne, UK
  5. 5 Department of Pathology & Cytology, Royal Free Hospital, London, UK
  1. Correspondence to Dr David Nigel Poller, Queen Alexandra Hospital, Portsmouth, UK; mail{at}


This review article summarises systems for categorisation of diagnostic errors in pathology and cytology with regard to diagnostic accuracy and the published information on human factors (HFs) in pathology to date. A 12-point event-based checklist for errors of diagnostic accuracy in histopathology and cytopathology is proposed derived from Dupont’s ‘Dirty Dozen’ HF checklist, as used in the aerospace industry for aircraft maintenance. This HF checklist comprises 12 HFs; (1) Failure of communication. (2) Complacency. (3) Lack of knowledge. (4) Distractions. (5) Lack of teamwork. (6) Fatigue. (7) Lack of resources. (8) Pressure. (9) Lack of assertiveness. (10) Stress. (11) Norms. (12) Lack of awareness. The accompanying article explains practical examples of how each of these 12 HFs may cause errors in diagnostic accuracy in pathology. This checklist could be used as a template for analysis of accuracy and risk of diagnostic error in pathology either retrospectively ‘after the event’ or prospectively at the time of diagnosis. There is a need for further evaluation and validation of this proposed 12-point HF checklist and similar systems for categorisation of diagnostic errors and diagnostic accuracy in pathology based on HF principles.

  • histopathology
  • diagnostics
  • cytopathology
  • laboratory tests

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  • Handling editor Dhirendra Govender.

  • Contributors DNP: Conception and principal major contribution to the design and conduct of study MB, BC-P, SJJ, MP-M: Assisted with the design and conduct of study. DNP is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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