Diagnostic Skills Research Articles

Diagnostic Logic and Forensic Reading: The Case ofWieland

AbstractAt the end of the eighteenth century, professional and lay audiences alike negotiated the lines between mental health and disorder, questioning whether criminal behavior, for example, laid within medicine’s jurisdiction. This essay examines the role of literature in developing a “diagnostic logic” that trained readers in evolving forms of mental surveillance. First, it shows how physicians like Benjamin Rush relied on popular and literary sources to create new diagnostic categories, citing newspaper crime reports and Shakespearean plays as medical evidence and encouraging readers to interpret familiar behavior through the lens of pathology. Next, I turn to Charles Brockden Brown’s Wieland (1798) to demonstrate how the novel’s suspicion of empiricism could paradoxically heighten readers’ desire to sort and predict behavior. Soliciting readers’ interest through scenes of gothic horror, the novel concludes by urging readers to apply their diagnostic skills in more mundane social settings. Moreover, unlike Rush’s straightforward assessment of pathology’s mitigating impact on accountability, Brown’s novel invites readers to reach their own conclusions on the ethical implications of diagnosis. Ultimately, I argue, texts like Wieland did not simply work alongside medical tracts to authorize the surveillance of an increasing number of pathologized behaviors, but deepened readers’ engagement in doing so.

Review of “Conflicted Care: Doctors Navigating Patient Welfare, Finances, and Legal Risk”

There is a quote in Hyeyoung Oh Nelson’s Conflicted Care: Doctors Navigating Patient Welfare, Finances, and Legal Risk, which captures the book’s substance beautifully. In an interview excerpt with the director of residency training at the hospital Nelson studied, the doctor explains the “single biggest dilemma” physicians face in an academic medical institution. He addresses an imaginary trainee to illustrate the problem: “Look, this is the time when you are learning to be a doctor: we want you to be cost-effective but we also want you to be thorough and humanistic and use physical diagnostic skills that you have learned appropriately, and not overorder tests. And you have to do all that within two and a half days…” (p. 37). Abundant research by medical and organizational sociologists has underscored the inescapable tension of the healthcare system in the United States: caught between the “do no harm” oath, which directs physicians to put patients’ wellbeing above everything else, and the financial and bureaucratic structuring of healthcare provision, which has introduced the principle of efficiency in every healthcare institution. In an ideal world, these mandates would align: providing the best care would also be cost-efficient (and such is the promise of managed care policies). In the real world, unsurprisingly, health logics and financial logics tend to clash.

High and low-fidelity simulation for respiratory diseases pediatric training: a prospective and randomized study

ObjectiveTo compare high and low-fidelity simulations for the recognition of respiratory distress and failure in urgency and emergency pediatric scenarios. Methods70 fourth-year medical students were randomly distributed in high and low-fidelity groups and simulated different types of respiratory problems. Theory tests, performance checklists, and satisfaction and self-confidence questionnaires were used in the assessment. Face-to-face simulation and memory retention was applied. The statistics were evaluated by averages and quartiles, Kappa, and generalized estimating equations. The p-value was considered 0.05. ResultsIn the theory test there was an increase in scores in both methodologies (p < 0.001); in memory retention (p = 0.043) and at the end of the process the high-fidelity group had better results. The performance in the practical checklists was better after the second simulation (p > 0,05). The high-fidelity group felt more challenged in both phases (p = 0.042; p = 0.018) and showed greater self-confidence to recognize changes in clinical conditions and in memory retention (p = 0.050). The same group, in relation to the hypothetical real patient to be treated in the future, felt better confident to recognize respiratory distress and failure (p = 0.008; p = 0.004), and better prepared to make a systematic clinical evaluation of the patient in memory retention (p = 0.016). ConclusionThe two levels of simulations enhance diagnostic skills. High fidelity improves knowledge, leads the student to feel more challenged and more self-confident in recognizing the severity of the clinical case, including memory retention, and showed benefits regarding self-confidence in recognizing respiratory distress and failure in pediatric cases.

Building low-cost simulators for invasive ultrasound-guided procedures using the V-model

The use of medical simulators for training technical and diagnostic skills has rapidly increased over the past decade. Yet, most available medical simulators have not been developed based on a structured evaluation of their intended uses but rather out of expected commercial value. Moreover, educators often struggle to access simulators because of cost or because no simulators have been developed for a particular procedure. In this report, we introduce “the V-model” as a conceptual framework to illustrate how simulator development can be guided by the intended uses in an iterative fashion. Applying a needs-based conceptual framework when developing simulators is important to increase the accessibility and sustainability of simulation-based medical education. It will minimize the developmental barriers and costs, while at the same time improving educational outcomes. Two new simulators for invasive ultrasound-guided procedures are used as examples, the chorionic villus sampling model and the ultrasound-guided aspiration trainer. Our conceptual framework and the use cases can serve as a template for future simulator development and documentation hereof.

Can antidepressant use be associated with emotional blunting in a subset of patients with depression? A scoping review of available literature.

Despite frequent recognition of emotional blunting in the published literature, either as a primary symptom of depression or as an adverse effect of antidepressants, there is no systematic synthesis on this topic to our knowledge. We undertook this scoping review to assess the prevalence, clinical features, implicated causes and management of emotional blunting, outlining the phenomenological and clinical gaps in research. A systematic search was done until March 15, 2022, to include all original studies (i.e., interventional trials, cohort & cross-sectional studies, case reports, and case series). All reviewed data were delineated to answer pertinent clinical, phenomenological, and management questions related to the phenomenon of emotional blunting. A total of 25 original studies were included in our scoping review. Emotional blunting was described as a persistent diminution in both positive and negative feelings in depressed patients, who could subjectively differentiate it from their acute symptoms. However, the literature lacked the distinction between emotional blunting as a primary symptom of depression or an adverse effect of antidepressants. Common clinical strategies to manage antidepressant-induced emotional blunting included dose reduction or switching to a different antidepressant. Emotional blunting was a significant patient-reported concern with antidepressants. Future research should clarify phenomenological and neurobiological constructs underlying emotional blunting to improve diagnostic and management skills.

Minimising Prescribing Errors: A Phenomenological Exploration of the Views and Experiences of Independent Prescribing Pharmacists.

This study aims to explore the views and experiences of pharmacist independent prescribing (IPs) regarding prescribing errors and strategies to mitigate errors in practice. One-to-one online semi-structured interviews were conducted with IP pharmacists across the UK. Verbatim transcripts of the interview were generated and coded using NVivo® 12 software for thematic analysis. A mixed inductive and deductive approach was used to generate themes and sub-themes which were then mapped onto the framework of factors that influence clinical practice proposed by Vincent et. al. A total of 14 interviews were conducted. Participants linked the risk-averse nature of a pharmacist, self-perception of their roles as medicines experts, and previous experience of keeping checks on doctor's prescriptions as a dispenser often made them feel confident in prescribing. However, lacking adequate diagnostic skills, inadequate prescribing training programmes, and dealing with complex patients often made them feel vulnerable to committing errors. Organisational and system-related factors such as work interruptions and increased workload were identified as other factors linked to prescribing errors. Independent prescribing pharmacists use a variety of strategies to reduce the risk of prescribing errors. Promoting diagnostic competency in their area of practice, strengthening undergraduate and prescribing curricula, and addressing known organisational and system-related factors linked to prescribing errors can minimise errors and promote patient safety.

Shakespeare as a vehicle for empathy and diagnostic skills training in undergraduate medical students in their psychiatry posting

Psychiatry undergraduate training has been significantly curtailed by the advent of the COVID-19 pandemic. This article examines the use of Shakespeare’s Hamlet, especially via the characters of Hamlet and Ophelia, to impart two core skills in psychiatry, namely diagnostic abilities and empathy. Medical students undergoing the psychiatry posting watched Kenneth Branagh’s Hamlet online, focusing on identifying psychopathology, forming diagnoses, identifying countertransferences, and developing empathy through acting out close passages. Students were able to identify the features of bipolar disorder in Hamlet, correlating his behavior with separate depressive and manic episodes. They were also able to appreciate the unique quality of dissociation in Ophelia, especially in Act 4 of Hamlet, and recognize it as a manifestation of post-traumatic stress disorder. Through acting out closed passages, students were also able to feel empathy by putting themselves into the shoes of Hamlet and Ophelia. Such a pedagogical approach has additional unexpected utility in view of the COVID-19 pandemic, which has significantly curtailed face-to-face medical education, leading to alternative online methods such as movies and Shakespearean plays in psychiatry education. In conclusion, though online methods cannot fully supplant face-to-face patient contact, they can be crucial tools in times of necessity and allow students to engage in interdisciplinary education, marrying the arts and the humanities.

Patient and care partner assessments of diagnostic excellence in the emergency department: A cognitive interview study

BackgroundDiagnostic excellence encompasses both receiving an accurate and timely explanation of a health problem that was communicated well, and the process it took to get to the correct diagnosis. Directly eliciting patients’ perceptions of their diagnostic experience and outcomes after emergency visits is a promising method of assessing diagnostic excellence. However, little is known about how patients interpret and respond to questions about their diagnostic experiences and outcomes. ObjectiveTo analyze patient and care partners’ interpretation of questions capturing patient-reported diagnostic excellence in emergency settings. DesignCognitive interviews using think-aloud and probing methods. Setting(s)Interviews were conducted virtually and via phone calls. Participants were patients or care partners of patients recently discharged from three emergency departments within a single academic health system in the Mid-Atlantic region of the US. Participants15 patients and care partners, 18 years or older, with recent emergency department experiences. MethodsQualitative analysis using a deductive approach was used to code transcripts and analyze participant responses to Patient-Report to Improve Diagnostic Excellence in Emergency Department (PRIME-ED) questionnaire items. Themes of patient and care partners’ questionnaire interpretations are presented descriptively. Results80% of participants were female, 47% were between the ages of 18–24 years, 47% of participants were White, and 7% were Hispanic/Latino. Participants shared their interpretations of diagnostic excellence following PRIME-ED domains: diagnostic accuracy and care team skills, their comprehension of the diagnosis, provider communication of uncertainty, and quality of diagnostic communication, including whether they felt the care team communicated well, adapted communication to their needs, listened and took concerns seriously, treated them as an equal, and provided clear, sufficient, and functional communication about follow-up steps. Responses indicated that patients and care partners can identify diagnostic errors, rationalize why their diagnosis was inaccurate, and assess whether diagnostic excellence was achieved. Respondents identified factors that contributed to their assessments of diagnostic accuracy and the quality of diagnostic communication. The quality of diagnostic communication contributed to patient perception of diagnostic accuracy and understanding of the diagnosis. ConclusionsPatient report is a useful tool for assessing diagnostic excellence in emergency settings. Our patient and care partners describe how they assess diagnostic excellence in the emergency department.Registration: N/A.Tweetable abstract: Patients and care partners provide accessible and useful information to assess diagnostic practices and diagnostic excellence in emergency departments.

Development of an anatomical breast phantom from polyvinyl chloride plastisol with lesions of various shape, elasticity and echogenicity for teaching ultrasound examination.

The WHO reported an increasing trend in the number of new cases of breast cancer, making it the most prevalent cancer in the world. This fact necessitates the availability of highly qualified ultrasonographers, which can be achieved by the widespread implementation of training phantoms. The goal of the present work is to develop and test an inexpensive, accessible, and reproducible technology for creating an anatomical breast phantom for practicing ultrasound diagnostic skills in grayscale and elastography imaging, as well as ultrasound-guided biopsy sampling. We used FDM 3D printer and PLA plastic for printing an anatomical breast mold. We made a phantom using a mixture of polyvinyl chloride plastisol, graphite powder, and metallic glitter to simulate soft tissues and lesions. Various degrees of elasticity were imparted using plastisols of stiffness ranging from 3 to 17 on the Shore scale. The lesions were shaped by hand. The materials and methods used are easily accessible and reproducible. Using the proposed technology, we have developed and tested a basic, differential, and elastographic versions of the breast phantom. The three versions of the phantom are anatomical and intended for use in medical education: the basic version is for practicing primary hand-eye coordination skills; the differential one is for practicing the differential diagnosis skills; the elastographic version helps developing the skills needed for assessing the stiffness of tissues. The proposed technology allows the creation of breast phantoms for practicing hand-eye coordination and develop the critical skills for navigation and assessment of the shape, margins, and size of the lesion, as well as performing an ultrasound-guided biopsy. It is cost-effective, reproducible, and easily implementable, and could be instrumental in generating ultrasonographers with crucial skills for accurate diagnosis of breast cancer, especially in low-resource settings.

Evaluation of Three Cohorts of the First Neurology Postgraduate Training Program in Zambia (P4-8.001)

<h3>Objective:</h3> Identify strengths, areas for improvement and perceptions of a new neurology training program in Zambia. <h3>Background:</h3> The first Zambian neurology training program commenced in 2018. We report its first programmatic evaluation. <h3>Design/Methods:</h3> All current and former neurology trainees, internal medicine (IM) trainees who rotated with neurology in the past year, all IM faculty, and all international visiting providers from the past four years were sent electronic surveys. Neurology trainees and graduates, IM rotators, international faculty who had visited for at least three months, and one hospital administrator were invited to focus groups or semi-structured interviews. Participants were asked what they perceived as the “most significant change” at the hospital since program implementation. <h3>Results:</h3> 62/78 (80%) completed surveys, 17 contributed to focus groups and interviews. Neurology trainees noted protected didactic time, emphasis on bedside teaching, and one-on-one attending exposure were program strengths and requested more exposure to outpatient subspecialties and electrophysiology training. When asked about the “most significant change”, participants noted providers in other specialties across the hospital also seemed to be learning neurologic examination and diagnostic skills, leading to widely improved neurologic care. Additionally, they noted a stronger research emphasis among trainees, even those outside neurology. <h3>Conclusions:</h3> The Zambian neurology training program has created positive department-wide changes in teaching and research. Other training programs in resource-limited settings may benefit from prioritizing one-on-one bedside teaching and protected didactics. Similarly, trainees in resource-limited settings may benefit from the development of regional collaborations to provide better exposure to subspecialty clinical experiences and mentors that may be limited at single institutions. Our study employed a comprehensive, mixed-methods approach to program evaluation in this resource-limited setting that identified strengths and actionable solutions to areas for improvement. This program evaluation method could provide valuable insights in other training settings, regardless of available resources. <b>Disclosure:</b> Dr. DiBiase has nothing to disclose. Edford Sinkala has nothing to disclose. Dr. Jonathan has nothing to disclose. The institution of Sean Tackett has received research support from NIH. The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from National Multiple Sclerosis Society. The institution of Dr. Saylor has received research support from American Academy of Neurology. The institution of Dr. Saylor has received research support from United States Department of State. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and Educational Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.

Blended Learning Effectiveness: Improving Japanese Medical Laboratory Science Students’ Identification of Parasite Eggs

Parasitic infections are declining in Japan, resulting in fewer hours of parasitology instruction in medical laboratory science and medical schools. However, there are growing concerns that the parasite identification skills of medical laboratory technologists and the diagnostic skills of physicians may be compromised as a result. Effective teaching methods are required to improve the identification of parasites in pre-graduate education. We therefore adopted a new teaching method: the blended learning method, in 2018. This method combined the e-learning and jigsaw methods, which had already been implemented separately in 2017. This study aimed to evaluate the pedagogical effectiveness of this blended learning approach compared to that of 2017 in teaching parasitology practice to students enrolled in the Department of Medical Laboratory Science. The results show that the median score for the practical test was 83.3 points for the blended learning lessons, which was not significantly different from the scores for jigsaw or e-learning lessons. However, blended learning had the lowest percentage of failures on the practical test, at 10.7%. Additionally, the microscopic image test results indicate a significant memory retention effect. From the questionnaire results, 94.7% of the students were satisfied with their practice. In conclusion, the blended learning did not significantly improve parasite identification skills, but it may reduce the number of failures, suggesting a knowledge retention effect and a high level of satisfaction with this practice.

Evaluation of learning outcomes of humanities curricula in medical students. A meta-review of narrative and systematic reviews.

To assess the expected learning outcomes of medical humanities subjects in medical studies curricula. To connect those expected learning outcomes with the types of knowledge to be acquired in medical education. Meta-review of systematic and narrative reviews. Cochrane Library, MEDLINE (Pubmed), Embase, CINAHL, and ERIC were searched. In addition, references from all the included studies were revised, and the ISI Web of Science and DARE were searched. A total of 364 articles were identified, of which six were finally included in the review. Learning outcomes describe the acquisition of knowledge and skills to improve the relationship with patients, as well as the incorporation of tools to reduce burnout and promote professionalism. Programs that focus on teaching humanities promote diagnostic observation skills, the ability to cope with uncertainty in clinical practice, and the development of empathetic behaviors. The results of this review show heterogeneity in the teaching of medical humanities, both in terms of content and at the formal level. Humanities learning outcomes are part of the necessary knowledge for good clinical practice. Consequently, the epistemological approach provides a valid argument for including the humanities in medical curricula.

Erythematous Papules and Nodules on the Left Arm

ABSTRACT An 81-year-old man was found to have pruritic papules and nodules spreading on his left arm over the past 2 weeks. Readers will be asked to identify the correct diagnosis based on history and clinical presentation. The purpose of this case is to improve diagnostic skills to properly recognize this condition and provide the appropriate treatment.

Empowering future pharmacists - Embedding prescribing in the United Kingdom pharmacy undergraduate degree

IntroductionPharmacy education within the United Kingdom (UK) is on the cusp of a major change with the integration of pharmacist independent prescribing into the undergraduate Master of Pharmacy (MPharm) degree and foundation year. This presents an opportunity for schools of pharmacy to completely review and redesign the MPharm degree in order to embed prescribing. This commentary details what needs to change within the MPharm degree and how these changes can be enacted. CommentaryThe learning outcomes for the new degree place greater emphasis on diagnostic and consultation skills, risk management, professional judgement, and leadership. Course content needs to be sequenced so that complexity builds throughout the programme and clinical skills are taught and practised within the context of prescribing. There will be more emphasis on higher-order cognitive skills, such as collaborative clinical decision-making, considering potential risks and benefits. Teaching will need to align with learning on placements and time needs built into the curriculum for preparation and debrief sessions following placements and simulation scenarios. The increased responsibility that comes with prescribing rights will require review of how professional identity is formed and professionalism skills are taught and assessed. ImplicationsPharmacists' expertise in medicines means that they are well-placed to be prescribers, which will help meet health service demands. Long-term funding will be required for placements in community, general practice, and hospital settings, including the provision of training and support to pharmacists mentoring students on placements. In spite of the challenges of curriculum redesign, this opportunity is wholeheartedly welcomed.

Multidisciplinary simulation of local anaesthetic systemic toxicity improves diagnostic and treatment skills and self-confidence for pain clinic procedural staff

Local anaesthetic systemic toxicity (LAST) is a rare complication after outpatient interventional pain procedures, which can present as an emergent and life-threatening condition. Proficiency and confidence in managing this rare...

Does skin of colour education make a difference? A cross-sectional study at the University of Bristol.

At the University of Bristol, the dermatology curriculum was updated in 2020 to incorporate more teaching on skin of colour. In this article we summarize the findings of our cross-sectional study to establish whether improving teaching content on skin of colour results in a more confident cohort of students with better diagnostic skills in skin of colour.

ChatGPT and Medical Education: A Double-Edged Sword

ChatGPT has gained attention worldwide. In the medical education field, ChatGPT, or any similar large language model, provides a convenient way for students to access information and practice their skills. ChatGPT can simulate patient interactions, allowing students to practice their diagnostic and communication skills in a safe and controlled environment. ChatGPT can also answer questions and provide explanations for complex medical concepts. There have been attempts involving ChatGPT to assist researchers in writing journal articles. Due to its capabilities, ChatGPT has the potential to be abused and sparking ethical concerns. Unwise researchers can now employ ChatGPT to write academic articles. Similarly, irresponsible students, might utilize ChatGPT to cheat during exams. We investigated whether ChatGPT, in its current state, can answer Indonesian medical doctor examination problems. Among the 3 problems that we have picked, ChatGPT can only correctly answer 1 question. We also examine whether ChatGPT-generated abstracts can fool professionals and educators. We have brought 6 abstracts, 3 of which are taken from actual published papers, while the other 3 were generated by ChatGPT. We recruited 12 participants with either a medical doctor (M.D.), a doctorate (Ph.D.), or an M.D., Ph.D. degree from various institutions in Indonesia. Surprisingly, 4 of the participants couldn't guess a single abstract correctly, 6 could only identify 1 abstract accurately, one correctly guessed 2 abstracts, and one correctly identified 3 abstracts. Therefore, it is safe to say that ChatGPT, in its current state, has been able to fool professionals and educators.

Rationale for the Use of Radiological Investigations; Assessment of Awareness Among Healthcare Workers of a Tertiary Care Hospital in Southern Punjab

Background: During recent times, radiological investigations have been playing a very beneficial role in diagnosis, confirmation and surveillance of multiple diseases in the medical science; thus increasing our diagnostic and management skills in a positive manner which was not previously possible. Now-a-days, these radiological investigations have become an integral part of our management system due to their easy availability. But this easy availability has increased the chances of misuse of these modalities as well. This cross-sectional study was aimed to assess the rationale for the use of these radiological investigations among our healthcare providers serving at Sheikh Zayed Hospital, Rahim Yar Khan. The study data was collected from study subjects via a pre-designed questionnaire from January 2022 to April 2022. Then the collected data was analyzed through SPSS software. Results of this study, including 250 study subjects (56% males and 44% females; 38.8% consultants and 61.2% PGRs/MOs), showed that the consultants primarily decide about the radiological investigations needed for the patients while the senior PGR/MO play the role in their absence. Majority of the study subjects (90%, n=225) were found well aware of the radiation hazards related to different radiological investigations. Conclusion: The healthcare providers working in different departments of SZH,RYK have enough awareness and knowledge about the rationale for the use of radiological modalities; but were not able to specify the exact limitations for the radiation doses per exposure or total dosage allowed per year to the patients associated with their harmful effects. Keywords: Knowledge; Radiological Investigations; Health Hazards; Healthcare Workers

Integrated Case Presentation Seminar: Bridging Parallel Fields to Improve Psychiatry and Psychology Learner Experience.

Daily clinical practice of mental health professionals often requires interaction between providers from diverse training and professional backgrounds. Efforts to engage mental health trainees across disciplines are necessary and have had varied outcomes. The current study reviews the development and implementation of a monthly one-hour integrated case presentation seminar (ICPS) as part of independent psychology and psychiatry two-year fellowships at a Midwestern teaching hospital. The training integrated a semi-structured seminar to facilitate case presentation within a group setting. The focus of the seminar was to allow for exposure to conceptualization, diagnostic, and treatment strategies and skills, as well as science-based practice techniques for trainees. Learner survey results and the sustained offering of the seminar suggest the format and goals of the seminar are feasible and acceptable. Based on the current preliminary findings, similar training programs may find benefit in strategies to enhance integrated training opportunities for psychiatry and psychology trainees.

Abstract P6-04-19: Engaging pathologists in a social peer-to-peer learning collaborative to discuss the emergence of HER2-low breast cancer

Abstract Introduction: Recent advances in research have shown clinical effectiveness when targeting the lower range of HER2 expression (ie, HER2-low) in patients with metastatic breast cancer. American Society for Clinical Pathology worked in collaboration with Q Synthesis to develop a peer-to-peer learning collaborative to proactively prepare pathologists for HER2-low and to discuss the clinical implications around this emerging classification. This CME project was supported by an educational grant from AstraZeneca Pharmaceuticals LP and Daiichi Sankyo Inc. Methods: ASCP launched a peer-to-peer (P2P) learning collaborative (HER2 Breast Trailblazers) where small groups of pathologists met to discuss some of the practical implications associated with HER2-low. 38 pathologists from a mix of academic and community settings participated in this CME program. For foundational knowledge, learners completed online modules covering scientific updates on HER2-low. Through small-group, case-based discussions, learners reviewed operational challenges and opportunities to prepare for HER2-low. They applied this knowledge to lead projects at their own institutions focusing on the anticipated changes around HER2-low. ASCP also launched a series of peer-led Twitter Chats that were designed to reach a broad audience and foster open dialogue about the emerging science of HER2-low breast cancer. This approach engaged Twitter users who were eager to share and disseminate the education to their colleagues. Twitter Chats provided peer-to-peer feedback regarding ways to navigate obstacles, barriers, and other challenges affecting HER2 testing in breast cancer. Results: The learners identified the following challenges and opportunities: Defining HER2-low: Several learners had heard misconceptions around the definition of HER2-low. Recent studies have defined HER2-low as IHC 1+ or IHC 2+ with ISH-negative. Interobserver concordance with IHC 0 vs 1+: Several learners discussed the challenges around interpreting IHC 0 vs 1+. They felt that some pathologists may need guided feedback to improve their diagnostic skills. Use of IHC vs. ISH: Several learners only performed ISH for HER2 testing on all breast cancer samples. If HER2-low emerges as a third category, they would need to return to IHC. Implications for non-metastatic breast cancer: Recent HER2-low studies have focused on patients with metastatic breast cancer. If HER2-low emerges as a third category, it is unclear whether this designation will also be used in patients who have early-stage breast cancer. Leadership: As pathologists prepare for HER2-low, they have opportunities to lead projects to assess and improve IHC interobserver concordance, coach others on IHC interpretation, increase operational efficiency, strength communication skills, and build up the team by proactively anticipating challenges around HER2-low. Conclusions: HER2-low breast cancer appears to be emerging as a new classification and pathologists need to be prepared to ensure accurate testing and interpretation. Through a peer-to-peer learning collaborative, pathologists identified ways to proactively prepare and demonstrate leadership so that cancer centers and laboratories may be ready to embrace a new paradigm of HER2 classification in breast cancer. A series of public Twitter Chats broadened this discussion and increased awareness among pathologists. Citation Format: Joseph Kim, Kellie Beumer, Melissa Kelly. Engaging pathologists in a social peer-to-peer learning collaborative to discuss the emergence of HER2-low breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-04-19.