Determination of diagnostic competence in histopathology trainees

Background To be competent at forming diagnoses is an essential component of being a sound consultant pathologist as these diagnoses can directly affect patient care. Currently, trainees in histopathology undertake five years of specialist training before becoming consultants. During this time, they must complete eighteen workplace-based assessments (WBAs) per year and pass two major exams. However, there is no research which clearly describes the knowledge, skills and attitudes which are relevant to the competence of forming diagnoses. Further, there is little evidence to suggest WBAs are able to determine if trainees are diagnostically competent, even though they are used in part to evidence this. Understanding how consultants determine diagnostic competence in trainees may help to ensure the current assessment methods measure what is most important and ensure trainees are fit to practice at the end of training. It may also reveal the judgmental process so that expectations underpinning competence are made explicit to trainees. This should improve the quality of training. Aim This research aimed to understand how consultant pathologists determine diagnostic competence in trainees. Materials and Methods The work was conducted in three stages: 1. A questionnaire study to determine the current perception of workplace-based assessments 2. A qualitative interview study to explore and understand how consultants judge diagnostic competence in trainees 3. A Delphi study to triangulate findings from the interviews Results Several perceived issues were identified with the current WBAs, particularly their inability to determine diagnostic competence, struggling trainees and accurately reflect trainee progress. Diagnostic competence was conceptualized as a complex construct which should be assessed longitudinally. Both process and person qualities are required, with increasing expectations as trainees progress through training. Diagnostic competence is manifested in trust developing between trainee and consultant, but must be maintained following qualification. A Delphi study triangulated and validated findings from the qualitative interviews with the majority of items reaching “consensus in”. Conclusions There are problems with the current WBAs as they do not test those qualities which are most relevant to diagnostic competence nor reflect the true judgement ecology. This is problematic given the current emphasis placed on WBAs in training to evidence competence. This research has demystified how consultants determine diagnostic competence and should help to inform future assessment strategies in histopathology. In particular, a longitudinal approach to assessing competence is recommended rather than the current approach of assessing competence on individual cases.