College of American Pathologists
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  In so many words, lab reports on the mend


August 2005
Feature Story

Mariann Stephens

The premise sounds a little iffy: combining committee dynamics with game-show technology in a dense, daylong workshop. But the five-star faculty at the CAP ’05 event next month is betting it will deliver a blueprint for clear and complete pathology reports.

The program will have a traditional start. M. Elizabeth H. Hammond, MD, program director, will open the session on Sept. 13 in Chicago by describing reporting habits associated with malpractice risk, drawing on data from The Doctors' Company and the CAP Q-Probes and Q-Tracks programs. Later, she'll present good and bad reports and ask the audience to judge each for effectiveness, utility, and clarity. Ronald Sirota, MD, will focus on how reports can cause clinical error and what can be done about it; Thomas McGowan, MD, MBA, on cancer reports and formatting; Richard Zarbo, MD, DMD, on the correct way to amend and add to a completed report; and Robert Rainer, MD, on CAP efforts to improve tools for interfacing reports and information systems.

"People have strong views about how their reports should be created and they don't like to believe it's important to standardize those reports," Dr. Hammond says. "But we're going to present evidence that standardizing those reports is the best way to get high-quality, good information for patients and doctors, protection from malpractice risk, and documentation of what was done so they can get paid."

What will make this program different is the use of audience participation via "Who Wants To Be a Millionaire" technology. Audience members will be asked to respond to multiple-choice statements about each speaker's session—for example, whether reports have affected billing results, whether they've been used as evidence in malpractice cases, whether some or all of their reports are synoptic, and more. Wireless personal response systems given to each attendee will capture the group's feedback on an overhead screen. As discussion evolves, participants will collaborate, construct new questions, and vote again. The brainstorming should be in near-real time, and at the end of the day, the College should know precisely what its members are seeking in pathology reporting support.

The outcome will become marching orders for a CAP Council on Scientific Affairs task force charged with executing the results of the workshop. "I intend to come up with a PowerPoint and put it on the Web site after the meeting is over," says Dr. Hammond, chair of the CAP's Education Committee. "They're going to have to live with what they say, but so am I, and so is the CAP—and that's good. If they know what they want and they tell us, we're going to do it."

Members of the planning committee for the workshop are the chairs of several committees within the College, as well as House of Delegates speaker Mary Nielsen, MD, who was one of three authors of a resolution adopted last year by the House of Delegates that was the genesis of this activity. The resolution, she says, reflected worries about pathologist vulnerability when reports are inconsistent, unclear, or incomplete.

"Our reports are out there, and they're what most people see of us," Dr. Nielsen says. "Some people have criticized reports and said they could be clearer and we could do much better. We all struggle with how to say something that is difficult to word. We felt the CAP could tackle that."

CAP president Mary E. Kass, MD, expects the workshop to be among the "standout programs" at this year's annual meeting. "One of the first surgical pathologists I studied under told me that the more words you use, the less certain you are of the diagnosis," she says. "When I know what it is, it doesn't take many words to describe it.

"We've got to be direct and to the point. It's very, very important that we get this right. We have to take a leadership role. That's why it's a whole-day course."

The course planners decided to make use of the wireless personal response systems because they believe the anonymity will encourage participants to be candid. "It's exciting as a participant to see how everybody else is responding, and we're hoping that with anonymity people will tell us what they really think," says Elizabeth Gillette, the CAP instructional designer who is helping to plan the program and who says participants should try to stay for the full day. "The more people we have in the room, the better cross-section we have, the more we will know what is really going on in the world of pathology. Then we will discover what we need to create to help them do their jobs."

Anonymity is said to be a key reason for the success of personal response technology when it is used in business and education. "We are going to ask demographic questions at the beginning of the course," Gillette says. "We don't track individuals by name, but we do like to know if the answer to a question came from someone with more than 10 years' experience or who specializes in cytopathology, or someone from a commercial lab, for example." When the demographic data and participant responses have been tallied, they'll be looking for trends and differences among the groups.

Participants will also have access to pre-meeting resources to be posted on the CAP Web site. "We're going to post material on what you should include in a molecular report, in an immunohistochemistry report, a surgical pathology report, and so on," Dr. Hammond says. The resources will eventually be provided to the Council on Scientific Affairs task force that will implement the workshop's educational mandates.

"We need to know what pathologists really need," Dr. Hammond says. At the end, there will be an hourlong session about potential reporting issues that the CAP will address. "We'll get everyone to vote on what they think is the most critical and decide how we should look at those things. We're not going to tell them—we're going to ask them to tell us."

Mariann Stephens is a writer in Chicago.