Pathology residents' use of a Web-based tutorial to improve Gleason grading of prostate carcinoma on needle biopsies

Little is known about pathology residents' ability to Gleason grade or thei r ability to learn surgical pathology using Internet-based technology. A fr ee Web-based program (available at www.pathology. jhu.edu/prostate) was dev eloped that consisted of 20 pretutorial images for grading, 24 tutorial ima ges, and the same 20 posttutorial images for Gleason grading. The grading i mages were selected from cases that had a consensus Gleason grade from 10 u ropathology experts. In 2.5 months, 255 residents visited the website, and 151 (59%) completed it. Of those who completed the website, their year in t raining 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 l earned 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 rc ere not related to the reside nts' 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 n oted in 1 of one Gleason score 4; 2 of 7 Gleason score 5 to 6; 2 of 6 Gleas on score 7; and 6 of 6 Gleason score above 7 tumors. In summary, a Web-base d tutorial improved Gleason grading accuracy by pathology residents to an e qual extent regardless of their year hi training. It is more difficult to t each residents to grade Gleason scores 5 to 7 tumors, and additional traini ng should be concentrated in this area. Cop)right (C) 2000 by W.B. Saunders Company.