How can institutions ensure that dermatology residents are competent with both light microscopy and digital pathology?
Clinical Applications
By Kathryn Schwarzenberger, MD, FAAD, May 1, 2025
In this month’s Clinical Applications column, Physician Editor Kathryn Schwarzenberger, MD, FAAD, talks with Carilyn Wieland, MD, FAAD, about her American Journal of Dermatopathology paper, ‘Comparison of digital pathology and light microscopy among dermatology residents: A reappraisal following practice changes.’
DermWorld: Your study compares resident competency with light microscopy versus digital pathology. Why did you and your colleagues choose to study this topic?
DermWorld: For those who haven’t read your paper, how did you go about assessing and comparing resident competencies in these modalities?
Dr. Wieland: A dermatopathology assessment of equivalent case difficulty composed of 32 digital (whole scanned slides) and 32 glass slides was administered to 22 dermatology residents. Participants were surveyed on their prior experience with each modality and preferences.
DermWorld: What were your findings?
Dr. Wieland: Our findings, in contrast to our 2013 study, show that residents achieved a statistically significant higher diagnostic accuracy with digital pathology compared to light microscopy (average 22 correct diagnoses using digital pathology and 18 using light microscopy). Additionally, diagnostic accuracy with digital pathology improved with years of training, while light microscopy did not show a similar trend. Survey data also indicated increased comfort with digital review as compared to use of the microscope.
DermWorld: Did you investigate specific factors that contributed to the residents’ preference for digital pathology (e.g., ease of use, accessibility, or image quality)?
Dr. Wieland: In the current training and learning environment, residents come into resident training with less light microscopy exposure and are exceptionally comfortable in digital spaces. Therefore, they find digital manipulation of whole scanned slides much more accessible and easier to navigate. Interestingly, they also felt that the digital review provided higher image quality, which relates to discomfort with basic manipulation of the light microscope.
DermWorld: What recommendations would you make for institutions transitioning to digital pathology to ensure residents maintain a foundational competency in light microscopy?
Dr. Wieland: We recommend incorporating basic instruction on light microscopy and maintaining access to light microscopes and glass slide study sets so trainees can develop foundational skills in these methods. We recognize that our current trainees are digital natives that quickly adapt to digital and innovative technologies. There are tremendous education advantages with having digital pathology in our practice, including easy access to viewing the whole scanned slide linked directly in the electronic medical record. Our goal is not to necessarily achieve equivalent performance and/or comfort levels as digital pathology, but rather, we want to prevent any deficits in training for as long as light microscopy continues to be widely used in many practice settings.
Carilyn Wieland, MD, FAAD, is an associate professor of dermatology and laboratory medicine and pathology at the Mayo Clinic in Rochester, Minnesota. Her paper appeared in the American Journal of Dermatopathology. Dr. Wieland has no financial or commercial conflicts of interest. She currently serves as a member of the ACGME Dermatology Review Committee and on committees within the American Society of Dermatopathology.
Disclaimer: The views and opinions expressed in this article do not necessarily reflect those of DermWorld.
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