The Organiser of this Scheme changed in the summer of 2008. The new Organiser is Dr Ian Roberts, Department of Cellular Pathology, Level 1, John Radcliffe Hospital, Headley Way, Headington, Oxford.
Tel 01865 220 490 Email ian.roberts@orh.nhs.uk
The previous Organiser was Professor P. N. Furness , Department of Histoathology, Leicester Royal Infirmary, Leicester LE1 5WW.
Tel. (+44)116 2586594 Fax (+44)116 2584573 Email pnf1@le.ac.uk
Is not allowed. Consulting colleagues is good practice in routine diagnostic work, but when EQA schemes in histopathology were first established in the UK it was agreed by the RCPath Working Group that EQA responses should represent the work of undividual pathologists, working unaided. Consultation would make the personal feedback system meaningless.
This question was raised again at the Renal EQA Scheme participants' meeting in July 2006, and the original view was reaffirmed. A question was raised as to whether a department could submit a 'team response' if the department was registered with the EQA scheme as a single participant. An overwhelming majority of participants present voted against allowing this. Renal EQA participants are individual pathologists, assessing their own skills.
Participants are invited to comment on the quality of the material circulated, so that feedback on technical matters can be provided to the laboratories which provided the cases.
Delay in passing on the slides is the most likely cause for breakdown of the system. There are four techniques to prevent this:
To make the cases representative of a typical diagnostic workload, the Organiser writes to individual participants and asks for material from one case to be selected from a defined diagnostic category and within a defined number of biopsies following the receipt of the letter; for example, 'a renal biopsy from the next ten you personally report'. The number can be adjusted to achieve cases with an appropriate mix of `difficulty'. A small number will provide cases representative of a routine workload whereas a larger number will introduce more 'difficult' cases with a greater educational element.
A single case representing a 'splendid example' for educational purposes, or a particularly bizarre case for consultation, is usually included with each circulation. These cases will be clearly identified as such and will not be used for personal analysis (see below).
Given the circulation system described above, one set of slides will be seen by six pathologists within 12 weeks. Two concurrent circulations allow the same set of sections to be seen by twelve pathologists within six months. Six duplicate sets permit at least 72 pathologists to see the same cases within six months. It should be possible in most cases to provide six sets of H&E with two conventional special stains; with sectioning at 3 microns or less this would take less than 60 microns of tissue, which is not an unreasonable request. Wherever possible further material should be provided in the form of other sections, photographs or e.m. grids, but where this is not possible all available information and material should be described.
The original diagnosis of the submitting pathologist will not be requested until after the circulation (otherwise the organiser would be unable to participate).
A certificate of participation will be issued annually, using the confidential code system. This will identify the recent circulations, the circulations in which a participant returned diagnoses, and any areas of diagnostic practice from which the participant has claimed exemption (e.g. transplant, perinatal).
The certificate will not bear any performance related information; it will merely confirm participation. It can be used to claim CPD points and may be shown to laboratory accreditation inspectors.
There will be a meeting, at least annually, at which cases can be presented (preferably by the submitting Pathologist) and discussed. Personal scores will not be calculated until the appropriateness of each case for EQA purposes has been discussed at such a meeting.
After the meeting, those participants who identified their responses by the code number receive personal analyses indicating the degree of correlation between their diagnoses and the consensus of the group. This is done by the computer and does not involve 'marking' by the Organiser. A histogram giving the distribution of the accumulated 'scores' of each participant is also sent, permitting the participant to see in private how his/her performance compares with his/her peers. The computer program which runs this system is described in the Journal of Clinical Pathology 1993; 46: 357-363. Reprints are available on request. A summary on-line is available by clicking here. The software package is available for other EQA schemes which wish to use it; contact the author on: pnf1@le.ac.uk
The GMC requirement that any doctor who suspects that a colleague's performance might put patient care at risk means that the scheme must have a definition of sub-standard performance, and remedial procedures. The current procedure is as follows.
The annual subscription rate from April 2008 has been set at 90 pounds sterling per participant per year.
As pathologists often have to cover annual leave for the local renal pathologist, colleagues working at the same address as each full participant may be offered a lower rate; 35 pounds sterling.
Participants from outside the U.K. please add 5 pounds sterling to the above prices.
Participants will also have to bear the cost of postage and the cost of occasionally preparing material for the contribution of a case; currently this is running at less than once every two years. If a request for a case is outstanding at the time the annual invoices are posted (April) then a surcharge of £60 is added to the invoice.