Table 3.
Areas of Practice Change Toward Improving Clinical Performance According to Whether they Over, Under, or Closely Estimated Their Performance (n=22)
| Perceived Interpretive Performance | Thematic Area of Practice Change | Exemplars in Response to the Question: Is there anything you would change in your practice as a result of what you have learned? |
|---|---|---|
| Under-estimated | ||
| Threshold Setting | • I think I am under-diagnosing atypia. Any under-diagnosis of Ductal Carcinoma In Situ bothers me a bit less, as I m likely to show it to colleagues and atypia should trigger the appropriate clinical response at our institution. However, lowering my threshold for atypia is very useful to know. | |
| Information Seeking | • Continue breast focused continuing medical education | |
| Threshold Setting | • Refine thresholds. I do not agree with how this course handled FEA (perhaps there will be chance for additional comments subsequently) | |
| Information Seeking | • Better understanding of breast atypia diagnostic terminology | |
| Closely Estimated | ||
| Consultation | • Take greater care to call benign lesions with variable proliferative changes and show to colleague to r/o | |
| More Careful Review | • More alert for atypical changes and Ductal Carcinoma In Situ. | |
| More Careful Review | • Pay more attention to details in mildly atypical cases | |
| Threshold Setting | • Consider shifting threshold lower for calling atypical lesions | |
| Consultation | • Share more borderline cases with colleagues | |
| Threshold Setting | • I will adjust my level of calling atypia and Ductal Carcinoma In Situ | |
| Threshold Setting | • Back off some of my Ductal Carcinoma In Situ diagnoses. | |
| Threshold Setting | • I may need to adjust my threshold for Ductal Carcinoma In Situ diagnosis. | |
| Consultation/Confidence | • Continue use of breast consultation. Better comfort with atypical hyperplasia. | |
| Consultation | • Although I show all atypical cases in my practice to another colleague, I feel that even though I am in line with many other pathologist in practice I would show more of my benign cases to check that I am not missing any atypical cases. | |
| Confidence | • Better comfort level with columnar cell changes | |
| Overestimated | ||
| More Careful Review | • Interpretation of atypical proliferation. | |
| More Careful Review | • I would apply the criteria/new information I have learned to my practice. | |
| More Careful Review | • To review more information in the atypia category, since compared with current experts I seem to be less aggressive in calling atypia | |
| Consultation | • Review more cases with my staff. | |
| Consultation | • I have more understanding of the differentiation of Ductal Carcinoma In Situ and atypical ductal hyperplasia. I over called atypia compared to experts and have never had much confidence in this area. I rely on associates who are considered breast experts in my practice and will continue to do so. This course reinforces my current practice. | |
| Threshold Setting | • Change my threshold for atypia | |
| More Careful Review | • I would be a little stronger of atypias, and I would think about them more. | |