Kronz J D, Silberman M A, Allsbrook W C, Bastacky S I, Burks R T, Cina S J, Mills S E, Ross J S, Sakr W A, Tomaszewski J E, True L D, Ulbright T M, Weinstein M W, Yantiss R K, Young R H, Epstein J I
The Johns Hopkins Hospital, Baltimore, MD 21287-6417, USA.
Hum Pathol. 2000 Sep;31(9):1044-50. doi: 10.1053/hupa.2000.16278.
Little is known about pathology residents' ability to Gleason grade or their ability to learn surgical pathology using Internet-based technology. A free Web-based program (available at www.pathology. jhu.edu/prostate) was developed that consisted of 20 pretutorial images for grading, 24 tutorial images, and the same 20 posttutorial images for Gleason grading. The grading images were selected from cases that had a consensus Gleason grade from 10 uropathology experts. In 2.5 months, 255 residents visited the website, and 151 (59%) completed it. Of those who completed the website, their year in training was known in 85 (56%): 1st year, 25.8%; 2nd year, 20%; 3rd year, 22.3%; 4th year, 14.1%; 5th year, 15.3%; and 6th year, 2.4%. Eighty percent learned Gleason grading in residency versus being self-taught, and 66% were male. In a multivariate analysis, higher pretutorial scores were associated with both their year in training (P = .001) and their hospital size (P = .003). Improvements in grading posttutorial were not related to the residents' year in training. Overall, the website significantly improved grading in 11 of 20 images and had no effect in 9 of 20 images. Improvements were noted in 1 of 1 Gleason score 4; 2 of 7 Gleason score 5 to 6; 2 of 6 Gleason score 7; and 6 of 6 Gleason score above 7 tumors. In summary, a Web-based tutorial improved Gleason grading accuracy by pathology residents to an equal extent regardless of their year in training. It is more difficult to teach residents to grade Gleason scores 5 to 7 tumors, and additional training should be concentrated in this area.
关于病理学住院医师进行Gleason分级的能力，以及他们使用基于互联网的技术学习外科病理学的能力，我们所知甚少。我们开发了一个免费的基于网络的程序（可在www.pathology.jhu.edu/prostate获取），该程序包括用于分级的20张预习图像、24张教程图像，以及用于Gleason分级的同样20张课后图像。分级图像选自有10位泌尿病理专家达成共识Gleason分级的病例。在2.5个月内，255名住院医师访问了该网站，其中151人（59%）完成了该程序。在完成网站的人中，85人（56%）的培训年份已知：第一年，25.8%；第二年，20%；第三年，22.3%；第四年，14.1%；第五年，15.3%；第六年，2.4%。80%的人是在住院期间学习Gleason分级而非自学，66%为男性。在多变量分析中，预习得分较高与他们的培训年份（P = 0.001）和医院规模（P = 0.003）均相关。课后分级的提高与住院医师的培训年份无关。总体而言，该网站显著提高了20张图像中11张的分级，对20张图像中的9张没有影响。在Gleason评分为4的1张图像中有改进；在Gleason评分为5至6的7张图像中有2张有改进；在Gleason评分为7的6张图像中有2张有改进；在Gleason评分高于7的6张肿瘤图像中有6张有改进。总之，一个基于网络的教程在同等程度上提高了病理学住院医师Gleason分级的准确性，而不论他们的培训年份如何。教授住院医师对Gleason评分为5至7的肿瘤进行分级更困难，额外的培训应集中在这一领域。
