1
|
Rozario SY, Sarkar M, Farlie MK, Lazarus MD. Responding to the healthcare workforce shortage: A scoping review exploring anatomical pathologists' professional identities over time. ANATOMICAL SCIENCES EDUCATION 2024; 17:351-365. [PMID: 36748328 DOI: 10.1002/ase.2260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/16/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Anatomical pathology (AP) is an anatomy-centric medical specialty devoted to tissue-based diagnosis of disease. The field faces a current and predicted workforce shortage, likely increasing diagnostic wait times and delaying patient access to urgent treatment. A lack of AP exposure is proposed to preclude recruitment to the field, as medical students are afforded only a limited understanding of who a pathologist is and what they do (their professional identity/PI and role). Anatomical sciences educators may be well placed to increase student understanding of anatomical pathologists' PI features, but until features of anatomical pathologists' PI are understood, recommendations for anatomy educators are premature. Thus, this scoping review asked: "What are the professional identity features of anatomical pathologists reported in the literature, and how have these changed over time?" A six-stage scoping review was performed. Medline and PubMed, Global Health, and Embase were used to identify relevant studies (n = 74). Team-based framework analysis identified that features of anatomical pathologists' professional identity encompass five overarching themes: professional practice, views about the role, training and education, personal implications, and technology. Technology was identified as an important theme of anatomical pathologists' PI, as it intersected with many other PI feature themes, including diagnosis and collaboration. This review found that pathologists may sometimes perceive professional competition with technology, such as artificial intelligence. These findings suggest unique opportunities for integrating AP-specific PI features into anatomy teaching, which may foster student interest in AP, and potentially increase recruitment into the field.
Collapse
Affiliation(s)
- Shemona Y Rozario
- Centre for Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Melanie K Farlie
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
2
|
Mremi A, Bentzer NK, Mchome B, Mlay J, Blaakær J, Rasch V, Schledermann D. The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. PLoS One 2022; 17:e0266649. [PMID: 35421156 PMCID: PMC9009664 DOI: 10.1371/journal.pone.0266649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/25/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction Adequate and timely access to pathology services is a key to scale up cancer control, however, there is an extremely shortage of pathologists in Tanzania. Telepathology (scanned images microscopy) has the potential to increase access to pathology services and it is increasingly being employed for primary diagnosis and consultation services. However, the experience with the use of telepathology in Tanzania is limited. We aimed to investigate the feasibility of using scanned images for primary diagnosis of pre-malignant and malignant cervical lesions by assessing its equivalency to conventional (glass slide) microscopy in Tanzania. Methods In this laboratory-based study, assessment of hematoxylin and eosin stained glass slides of 175 cervical biopsies were initially performed conventionally by three pathologists independently. The slides were scanned at x 40 and one to three months later, the scanned images were reviewed by the pathologists in blinded fashion. The agreement between initial and review diagnoses across participating pathologists was described and measured using Cohen’s kappa coefficient (κ). Results The overall concordance of diagnoses established on conventional microscopy compared to scanned images across three pathologists was 87.7%; κ = 0.54; CI (0.49–0.57).The overall agreement of diagnoses established by local pathologist on conventional microscopy compared to scanned images was 87.4%; κ = 0.73; CI (0.65–0.79). The concordance of diagnoses established by senior pathologist compared to local pathologist on conventional microscopy and scanned images was 96% and 97.7% respectively. The inter-observer agreement (κ) value were 0.93, CI (0.87–1.00) and 0.94, CI (0.88–1.00) for conventional microscopy and scanned images respectively. Conclusions All κ coefficients expressed good intra- and inter-observer agreement, suggesting that telepathology is sufficiently accurate for primary diagnosis in surgical pathology. The discrepancies in interpretation of pre-malignant lesions highlights the importance of p16 immunohistochemistry in definitive diagnosis in these lesions. Sustainability factors including hardware and internet connectivity are essential components to be considered before telepathology may be deemed suitable for widely use in Tanzania.
Collapse
Affiliation(s)
- Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- * E-mail:
| | | | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joseph Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Jan Blaakær
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Vibeke Rasch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | | |
Collapse
|
3
|
Girolami I, Neri S, Eccher A, Brunelli M, Hanna M, Pantanowitz L, Hanspeter E, Mazzoleni G. Frozen section telepathology service: Efficiency and benefits of an e-health policy in South Tyrol. Digit Health 2022; 8:20552076221116776. [PMID: 35923756 PMCID: PMC9340333 DOI: 10.1177/20552076221116776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objective/Background Telepathology has been widely adopted to allow intraoperative pathology
examinations to be performed remotely and for obtaining second opinion
teleconsultation. In the Italian northern region of South Tyrol, the
widespread geographical distances and consequent cost for the health system
of having a travelling pathologist cover intraoperative consultations in
peripheral hospitals was a key driver for the implementation of a
telepathology system. Methods In 2010, four Menarini D-Sight whole slide scanners to digitize entire
pathology slides were placed in the peripheral hospitals of Merano,
Bressanone, Brunico, and in the hub hospital of Bolzano. Digital
workstations were also installed to allow pathologists to remotely perform
intraoperative consultations with digital slides. This study reviews the
outcome after 12 years of telepathology for this intended clinical use. Results After an initial validation phase with 100 cases which yielded a sensitivity
of 65% (CI 43–84%) and specificity of 100% (CI 95–100%), there were 2058
intraoperative consultations handled by telepathology. The cases evaluated
were mainly breast sentinel lymph nodes, followed by urological,
gynecological and general surgical pathology frozen section specimens. There
were no false-positive cases and 165 (8%) false-negative cases, yielding an
overall sensitivity and specificity of 65% (CI 61–69%) and 100% (CI
99–100%), respectively. Conclusion Telepathology is reliable for remote intraoperative diagnosis and, despite
technical issues and initial acquaintance issues, proved beneficial for
patient care in satellite hospitals, improved standardization, promoted
innovation, and resulted in cost savings for the health system.
Collapse
Affiliation(s)
- Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Stefania Neri
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Mattew Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liron Pantanowitz
- Department of Pathology & Clinical Labs, University of Michigan, Ann Arbor, MI, USA
| | - Esther Hanspeter
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Guido Mazzoleni
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| |
Collapse
|
4
|
Meléndez-Álvarez B, Robayo O, Gil-Guillén V, Carratalá-Munuera M. Design and Validation of a Low-Cost Telepathology System. Telemed J E Health 2017; 23:976-982. [PMID: 28537789 DOI: 10.1089/tmj.2017.0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This work sought to evaluate the precision and repeatability of a telepathology prototype based on open software and hardware. MATERIALS AND METHODS A prototype was designed with application in telepathology and telemicroscopy. Accuracy and prototype precision were evaluated by calculating the mean absolute error and the intraclass and repeatability correlation coefficients for a series of 190 displacements at 10, 25, 50, 75, and 100 μm. RESULTS AND CONCLUSIONS This work developed a low-cost prototype that is accessible, easily reproducible, implementable, and scalable; based on the use of technology created under principles of open software and hardware. A pathologist reviewed the obtained images and found them to be of diagnostic quality. Its excellent repeatability, coupled with its good accuracy, allows for its application in telemicroscopy and static, dynamic, and whole-slide imaging pathology systems.
Collapse
Affiliation(s)
| | - Omar Robayo
- 1 Medical School, Pedagogical and Technological University of Colombia, Tunja, Colombia
| | - Vicente Gil-Guillén
- 2 Clinical Medicine Department, University of Miguel Hernández, Elche, Spain
| | | |
Collapse
|
5
|
A systematic review of the methodologies used to evaluate telemedicine service initiatives in hospital facilities. Int J Med Inform 2016; 97:171-194. [PMID: 27919377 DOI: 10.1016/j.ijmedinf.2016.10.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/30/2016] [Accepted: 10/12/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The adoption of telemedicine into mainstream health services has been slower than expected. Many telemedicine projects tend not to progress beyond the trial phase; there are a large number of pilot or project publications and fewer 'service' publications. This issue has been noted since 1999 and continues to be acknowledged in the literature. While overall telemedicine uptake has been slow, some services have been successful. The reporting and evaluation of these successful services may help to improve future uptake and sustainability. The aim of this literature review was to identify peer-reviewed publications of deployed telemedicine services in hospital facilities; and to report, and appraise, the methodology used to evaluate these services. METHODS Computerised literature searches of bibliographic databases were performed using the MeSH terms for "Telemedicine" and "Hospital Services" or "Hospital", for papers published up to May 2016. RESULTS A total of 164 papers were identified, representing 137 telemedicine services. The majority of reported telemedicine services were based in the United States of America (n=61, 44.5%). Almost two thirds of the services (n=86, 62.7%) were delivered by real time telemedicine. Of the reviewed studies, almost half (n=81, 49.3%) assessed their services from three different evaluation perspectives: clinical outcomes, economics and satisfaction. While the remaining half (n=83, 50.6%) described their service and its activities without reporting any evaluation measures. Only 30 (18.2%) studies indicated a two-step implementation and evaluation process. There was limited information in all reported studies regarding description of a structured planning strategy. CONCLUSION Our systematic review identified only 137 telemedicine services. This suggests either telemedicine service implementation is still not a part of mainstream clinical services, or it is not being reported in the peer-reviewed literature. The depth and the quality of information were variable across studies, reducing the generalisability. The reporting of service implementation and planning strategies should be encouraged. Given the fast paced technology driven environment of telemedicine, this may enable others to learn and understand how to implement sustainable services. The key component of planning was underreported in these studies. Studies applying and reporting more rigorous methodology would contribute greatly to the evidence for telemedicine.
Collapse
|
6
|
Abstract
OBJECTIVE Despite telemedicine's potential to improve patients' health outcomes and reduce costs in the ICU, hospitals have been slow to introduce telemedicine in the ICU due to high up-front costs and mixed evidence on effectiveness. This study's first aim was to conduct a cost-effectiveness analysis to estimate the incremental cost-effectiveness ratio of telemedicine in the ICU, compared with ICU without telemedicine, from the healthcare system perspective. The second aim was to examine potential cost saving of telemedicine in the ICU through probabilistic analyses and break-even analyses. DESIGN Simulation analyses performed by standard decision models. SETTING Hypothetical ICU defined by the U.S. literature. PATIENTS Hypothetical adult patients in ICU defined by the U.S. literature. INTERVENTIONS The intervention was the introduction of telemedicine in the ICU, which was assumed to affect per-patient per-hospital-stay ICU cost and hospital mortality. Telemedicine in the ICU operation costs included the telemedicine equipment-installation (start-up) costs with 5-year depreciation, maintenance costs, and clinician staffing costs. Telemedicine in the ICU effectiveness was measured by cumulative quality-adjusted life years for 5 years after ICU discharge. MEASUREMENTS AND MAIN RESULTS The base case cost-effectiveness analysis estimated telemedicine in the ICU to extend 0.011 quality-adjusted life years with an incremental cost of $516 per patient compared with ICU without telemedicine, resulting in an incremental cost-effectiveness ratio of $45,320 per additional quality-adjusted life year (= $516/0.011). The probabilistic cost-effectiveness analysis estimated an incremental cost-effectiveness ratio of $50,265 with a wide 95% CI from a negative value (suggesting cost savings) to $375,870. These probabilistic analyses projected that cost saving is achieved 37% of 1,000 iterations. Cost saving is also feasible if the per-patient per-hospital-stay operational cost and physician cost were less than $422 and less than $155, respectively, based on break-even analyses. CONCLUSIONS Our analyses suggest that telemedicine in the ICU is cost-effective in most cases and cost saving in some cases. The thresholds of cost and effectiveness, estimated by break-even analyses, help hospitals determine the impact of telemedicine in the ICU and potential cost saving.
Collapse
|
7
|
Meyer J, Paré G. Telepathology Impacts and Implementation Challenges: A Scoping Review. Arch Pathol Lab Med 2016; 139:1550-7. [PMID: 26619028 DOI: 10.5858/arpa.2014-0606-ra] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Telepathology is a particular form of telemedicine that fundamentally alters the way pathology services are delivered. Prior reviews in this area have mostly focused on 2 themes, namely technical feasibility issues and diagnosis accuracy. OBJECTIVES To synthesize the literature on telepathology implementation challenges and broader organizational and societal impacts and to propose a research agenda to guide future efforts in this domain. DATA SOURCES Two complementary databases were systematically searched: MEDLINE (PubMed) and ABI/INFORM (ProQuest). Peer-reviewed articles and conference proceedings were considered. The final sample consisted of 159 papers published between 1992 and 2013. CONCLUSIONS This review highlights the diversity of telepathology networks and the importance of considering these distinctions when interpreting research findings. Various network structures are associated with different benefits. Although the dominant rationale in single-site projects is financial, larger centralized and decentralized telepathology networks are targeting a more diverse set of benefits, including extending access to pathology to a whole region, achieving substantial economies of scale in workforce and equipment, and improving quality by standardizing care. Importantly, our synthesis reveals that the nature and scale of encountered implementation challenges also varies depending on the network structure. In smaller telepathology networks, organizational concerns are less prominent, and implementers are more focused on usability issues. As the network scope widens, organizational and legal issues gain prominence.
Collapse
Affiliation(s)
- Julien Meyer
- From the Department of Information Technology, HEC Montréal, Montreal, Quebec, Canada
| | | |
Collapse
|