Randomized controlled trial of self-directed versus in-classroom teaching of narrow-band imaging for diagnosis of Barrett’s esophagus-associated neoplasia

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• 作者：Claire Daly ; MS¹ ; ; Prashanth Vennalaganti ; MD² ; ³ ; Samad Soudagar ; MD¹ ; Ben Hornung ; MD² ; ³ ; Prateek Sharma ; MD² ; ³ ; Neil Gupta ; MD ; MPH¹
• 关键词：BE ; Barrett&rsquo ; s esophagus ; HGD/CA ; high-grade dysplasia and/or cancer ; NBI ; narrow-band imaging
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：83
• 期：1
• 页码：101-106
• 全文大小：680 K

文摘

Previous studies have shown that narrow-band imaging (NBI) can be taught to inexperienced gastroenterologists. However, it is unknown whether in-person training is more effective than self-directed training. The objective of this study was to compare the accuracy of diagnosing Barrett’s esophagus (BE)–associated neoplasia by trainees with no prior NBI experience between in-classroom and self-directed didactic training programs.

Methods

This was a randomized controlled trial that took place at 2 tertiary-care medical centers, involving 33 participants—12 second-year medical students, 8 first-year gastroenterology fellows, 7 second-year gastroenterology fellows, and 6 third-year gastroenterology fellows. A teaching module was developed for all participants to review. Half of the participants were taught in a classroom setting by an endoscopist with expertise in NBI, whereas the other participants were in a self-directed group that received an automated version of the presentation with audio commentary. Participants completed a test of 40 randomized NBI images, predicting the histology and indicating their confidence levels in the diagnosis.

Results

There was no difference in accuracy between the in-classroom and self-directed groups (57.5% vs 57.2%; m>Pm> = 1.0). The in-classroom group had a significantly higher percentage of high-confidence answers (57.2% vs 41.1%; m>Pm> ≤ .01), but there was no significant difference in accuracy with these high-confidence answers (60.7% vs 66.4%; m>Pm> = .34). There was no significant difference in overall accuracy or accuracy with high-confidence predictions between the 2 study sites (57.4% vs 55.9%, m>Pm> = .58; 63.1% vs 61.4%, m>Pm> = .69) or between gastroenterology fellows and medical students (57.8% vs 54.6%, m>Pm> = .27; 62.8% vs 60.8%, m>Pm> = .62).

Conclusions

The overall accuracy of predicting NBI patterns in BE were modest in our study participants, and there was no difference between self-directed and in-classroom didactic training. Self-directed learning of NBI is adequate for teaching NBI to trainees.