LAUSR

ABSTRACT Expert radiologists can quickly extract a basic “gist” understanding of a medical image following less than a second exposure, leading to above-chance diagnostic classification of images. It is currently unclear whether this pattern of results is applicable to pathology, another medical imaging domain demanding visual diagnostic interpretation. To further characterize the rapid interpretation medical images, this study examined eye movements and diagnostic decision-making when pathologists were briefly exposed to digital whole slide images of melanocytic skin biopsies. Twelve resident (N = 5), fellow (N = 5), and attending pathologists (N = 2) with experience interpreting dermatopathology briefly viewed 48 cases presented for 500 ms each, and we tracked their eye movements towards abnormalities, their ability to classify images as containing or not containing invasive melanoma, and their ability to localize critical image regions. Results demonstrated rapid shifts of the eyes towards critical abnormalities, high diagnostic sensitivity and specificity, and surprisingly high accuracy localizing critical diagnostic regions. Furthermore, when pathologists fixated critical regions with their eyes, they were subsequently more likely to successfully localize that region on an outline of the image. Results are discussed relative to models of medical image interpretation and innovative methods for monitoring and assessing expertise development during medical education and training.