X-pose: A Dermatopathology Teaching and Conferencing Program at Montefiore Medical Center

Context: A university dermatopathology laboratory with teaching units at 2 US medical schools with dermatology residencies. Objective: To study and determine whether digital images captured during microscopic sign-out could be exported to a teaching program for dermatology residents. Design: Via an intranet, resident trainees could access the dermatopathology database for report lookup and printing or to view the images in a quiz format, entering their diagnosis before seeing the report. The congruency of resident diagnoses and those of the dermatopathologist were recorded and trended. The dermatology residents were provided with digital cameras and encouraged to image or photograph their cases. Using a Web-based format, the residents could log on at specifically designated workstations and upload their clinical images to the dermatopathology database server. Dermatology residents could access their cases (with the pathology image once acquired). Upcoming conference cases, recent interesting cases, and recent conferences were also available. For the weekly conferences, residents were asked to assess and prepare to discuss the cases based on the images. They were also able to return to the case at a later date and add additional information (eg, clinical response to therapy at a subsequent clinic visit or a new image). Having reviewed a case, a resident collected his or her own image library. Residents at selected outside institutions could participate in the conferences using teleconferencing, with a question-and-answer session available at the end for the other residents. These sessions were recorded and available on the intranet with their respective conferences. Residents (primarily dermatology and pathology residents) were able to review teaching image sets linked to histopathologic criteria. The sets include topics such as inflammatory diseases, neoplasms and hamartomas, cysts, and deposits. Results: The program was popular among both dermatology and pathology residents. However, preparing the image sets for the teaching sets required considerable time on the part of the attending physician staff. Conclusions: This adjunctive program proved valuable in expanding dermatopathology teaching, by increasing resident access to the images. The feedback of additional clinical patient data from conferences and additional clinical images obtained at follow-up visits improved the accuracy of diagnosis in some cases.