Difference between revisions of "Level 4 equivalent of 2014"

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Level 4 equivalent of 2014 (view source)

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'''Level 4 equivalent''', abbreviated '''L4E''', is a [[workload measurement system]] endorsed by the Canadian Association of [[pathologist]]s.<ref name=Can_J_Pathol_2010_2_8-19>{{Cite journal  | last1 = Maung | first1 = R. | title = [http://andrewjohnpublishing.com/images/cjp%202-1.pdf Canadian Association of Pathologists guidelines for measurement of workload] | journal = Canadian Journal of Pathology | volume = 2 | issue = 1 | pages = 8-19 | month = | year = 2010 | doi =  | PMID = }}</ref>
'''Level 4 equivalent of 2014''', abbreviated '''L4E (2014)''', is a [[workload measurement system]] endorsed by the Canadian Association of [[pathologist]]s.<ref name=Can_J_Pathol_2010_2_8-19>{{Cite journal  | last1 = Maung | first1 = R. | title = [http://andrewjohnpublishing.com/images/cjp%202-1.pdf Canadian Association of Pathologists guidelines for measurement of workload] | journal = Canadian Journal of Pathology | volume = 2 | issue = 1 | pages = 8-19 | month = | year = 2010 | doi =  | PMID = }}</ref>


The development is described in a paper by Maung published in 2010.<ref name=pmid15762279>{{Cite journal  | last1 = Maung | first1 = RT. | title = What is the best indicator to determine anatomic pathology workload? Canadian experience. | journal = Am J Clin Pathol | volume = 123 | issue = 1 | pages = 45-55 | month = Jan | year = 2005 | doi =  | PMID = 15762279 }}</ref> The system was revised in 2014 and is comprehensive with regard to academic practice and community practice.<ref>URL: [https://www.cap-acp.org/wkload.php https://www.cap-acp.org/wkload.php]. Accessed on: 14 July 2017.</ref>
The development is described in a paper by Maung published in 2010.<ref name=pmid15762279>{{Cite journal  | last1 = Maung | first1 = RT. | title = What is the best indicator to determine anatomic pathology workload? Canadian experience. | journal = Am J Clin Pathol | volume = 123 | issue = 1 | pages = 45-55 | month = Jan | year = 2005 | doi =  | PMID = 15762279 }}</ref> The system was revised in 2014 and is comprehensive with regard to academic practice and community practice.<ref>URL: [https://www.cap-acp.org/wkload.php https://www.cap-acp.org/wkload.php]. Accessed on: 14 July 2017.</ref>


This article covers the 2018 revision of L4E.  The original system is covered in the article ''[[Level 4 equivalent of 2010]]''.  The 2014 version is covered in ''[[Level 4 equivalent of 2014]]''.
This article covers the 2014 revision of L4E.  The original system is covered in the article ''[[Level 4 equivalent of 2010]]''.


==Revised L4E of 2018==
==Revised L4E of 2014==
One L4E unit is considered to be roughly equivalent to 10 minutes.
One L4E unit is considered to be roughly equivalent to 10 minutes.


===Most surgical pathology===
===Most surgical pathology===
As per L4E definition (2018) adapted from CAP-ACP:<ref name=capacp2018>Workload and Workforce Committee of the CAP-ACP. Workload Measurement Guidelines. Canadian Association of Pathologists (CAP-ACP). 2018. URL: [https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP_Workload_Model_2018_Final_2020180907(1).pdf https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP_Workload_Model_2018_Final_2020180907(1).pdf]. Accessed on: 19 May 2019.</ref>  
As per L4E definition (2014) adapted from CAP-ACP:<ref name=capacp2014>Workload and Workforce Committee of the CAP-ACP. Workload Measurement Guidelines. Canadian Association of Pathologists (CAP-ACP). 2014. URL: [https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP%202014%20Workload%20FINAL.pdf https://www.cap-acp.org/cmsUploads/CAP/File/CAP-ACP%202014%20Workload%20FINAL.pdf]. Accessed on: 17 October 2017.</ref>  
{| class="wikitable sortable"
{| class="wikitable sortable"
! Code
! Code
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|-
|-
| L1
| L1
| 0.125
| 0.15
| gross only specimens
| gross only specimens
| itemized in the "specimen list and codes"
| itemized in the "specimen list and codes"
|-
|-
| L2
| L2
| 0.25
| 0.333
| confirmation of normal
| confirmation of normal
| must include histology
| must include histology
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| 0.5
| 0.5
| small/simple biopsies
| small/simple biopsies
| includes most skin, cysts, GI tract specimens, small benign specimens - detailed in [[L4E rule 1-3 (2018)|rules 1, 2 and 3]]
| includes most skin, cysts, GI tract specimens, small benign specimens - detailed in [[L4E rule 1-3 (2014)|rules 1, 2 and 3]]
|-  
|-  
| L4
| L4
| 1
| 1
| biopsies - most internal organs
| biopsies - most internal organs
| detailed in [[L4E rule 1-3 (2018)|rules 1, 2 and 3]]
| detailed in [[L4E rule 1-3 (2014)|rules 1, 2 and 3]]
|-  
|-  
| L5
| L5
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| 10
| 10
| radical resections for malignancy
| radical resections for malignancy
| detailed in [[L4E rule 9 (2018)|rule 9]]
| detailed in [[L4E rule 9 (2014)|rule 9]]
|-
|}
|}


====All other surgical pathology cases====
====All other surgical pathology cases====
As per L4E definition (2018) adapted from CAP-ACP:<ref name=capacp2018/>
As per L4E definition (2014) adapted from CAP-ACP:<ref name=capacp2014/>
{| class="wikitable sortable"
{| class="wikitable sortable"
! L4E units
! L4E units
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| L2/block
| L2/block
| non-radical and benign resections, non-biopsy/non-L6 cases
| non-radical and benign resections, non-biopsy/non-L6 cases
| 12 blocks = 12 x L2; 10 x L2 = 3 L4Es; details in [[L4E rule 4 (2018)|rule 4]]
| 10 blocks = 10 x L2; 10 x L2 = 3.33 L4Es; details in [[L4E rule 4 (2014)|rule 4]]
|}
|}


===Cytopathology===
===Cytopathology===
As per L4E definition (2018) adapted from CAP-ACP:<ref name=capacp2018/>
As per L4E definition (2014) adapted from CAP-ACP:<ref name=capacp2014/>
{| class="wikitable sortable"
{| class="wikitable sortable"
! Code
! Code
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| C1
| C1
| 1
| 1
| all cytology, ''except'' fine needle aspirations (FNAs)
| simple (exfoliative) cytology
| pap test, urine, sputum, fluids (peritoneal, pleural)
| pap test, urine, sputum, fluids (peritoneal, pleural)
|-
|-
| C2
| C2
| 2
| 2
| fine needle aspirations (FNAs)
| complex cytology
|  
| FNAs, brushes, washes
|-
|-
|}
|}


===Additional block/levels===
===Additional block/levels===
Deeper cuts and the submission of additional tissue are dealt with in [[L4E rule 6 (2018)|rule 6]].
Deeper cuts and the submission of additional tissue are dealt with in [[L4E rule 6 (2014)|rule 6]].


===Special stains and IHC===
===Special stains and IHC===
Special stains and immunostains are dealt with in [[L4E rule 7-8 (2018)|rule 7 and rule 8]].
Special stains and immunostains are dealt with in [[L4E rule 7-8 (2014)|rule 7 and rule 8]].


===Adjustments for micro only and teaching===
===Adjustments for micro only and teaching===
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===Total workload===  
===Total workload===  
Recommended workload per pathologist:<ref name=capacp2018/>
Recommended workload per pathologist:<ref name=capacp2014/>
{| class="wikitable sortable"
{| class="wikitable sortable"
! Mean annual L4E units
! Mean annual L4E units
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*[[Workload measurement]].
*[[Workload measurement]].
*[[Level 4 equivalent of 2010]].
*[[Level 4 equivalent of 2010]].
*[[Level 4 equivalent of 2014]].
*[[L4E rules of 2014]].
*[[L4E rules of 2018]].
*[[L4E quizzes]].
*[[L4E quizzes]].


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