Kronz J D, Silberman M A, Allsbrook W C, Epstein J I
Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Cancer. 2000 Oct 15;89(8):1818-23.
The Internet, although it is in widespread use in medicine, to the authors' knowledge has not been tested rigorously as an educational tool. The authors investigated, as a model to validate web-based education for physicians, the Gleason grading of images of prostate carcinoma tissue specimens that were obtained by needle biopsy, which provides critical information for patient management.
A free, web-based program (available at www. pathology.jhu.edu/prostate) was developed. It consisted of 20 pretutorial quiz images of prostate carcinoma specimens that were obtained by needle biopsy for grading, followed by 24 tutorial images with text describing the Gleason grading system. Subsequently, pathologists took a posttutorial quiz, which consisted of the same 20 images that were used in the pretutorial quiz.
In 16 months, there were 2021 visits with 916 participants completing the entire web site; 643 participants (70.2%) were practicing pathologists and formed the basis of the current study. Only the location of practice within the United States compared with outside the United States (P < 0.0001) and < 5 years in practice (P = 0.003) were correlated independently with a higher pretutorial quiz score. Overall, the web-based tutorial significantly improved grading in 15 of 20 images. Of these, on average, there was an 11.9% increase (range, 6-25.3%) in assigning the correct Gleason score. Improvements were noted in images of tumors with the following grades: Gleason score, 2-4 (0 of 1 images); Gleason score, 5-6 (5 of 7 images); Gleason score, 7 (4 of 6 images); and Gleason score, 8-10 (6 of 6 images). Greater improvement after taking the tutorial was correlated with lower pretutorial scores (P < 0.0001).
A web-based tutorial improves the accuracy of Gleason grading of practicing pathologists. To the authors' knowledge the current study is the first large scale, international study that has evaluated and validated the use of a web-based program to educate a population of widely dispersed physicians.
互联网虽在医学领域广泛应用，但据作者所知，其作为一种教育工具尚未经过严格测试。作者以经针吸活检获取的前列腺癌组织标本图像的Gleason分级作为验证面向医生的基于网络教育的模型，因为该分级可为患者管理提供关键信息。
开发了一个免费的基于网络的程序（可在www.pathology.jhu.edu/prostate获取）。它包括20张用于分级的经针吸活检获取的前列腺癌标本的预习测验图像，随后是24张带有描述Gleason分级系统文本的辅导图像。随后，病理学家进行了课后测验，测验内容包括预习测验中使用的相同20张图像。
在16个月内，有2021次访问，916名参与者完成了整个网站；643名参与者（70.2%）为执业病理学家，构成了本研究的基础。仅在美国境内与境外的执业地点（P < 0.0001）以及执业年限< 5年（P = 0.003）与预习测验较高分数独立相关。总体而言，基于网络的辅导显著提高了20张图像中15张的分级准确性。其中，正确分配Gleason评分平均提高了11.9%（范围为6 - 25.3%）。在以下分级的肿瘤图像中观察到了改善：Gleason评分2 - 4（1张图像中0张）；Gleason评分5 - 6（7张图像中5张）；Gleason评分7（6张图像中4张）；以及Gleason评分8 - 10（6张图像中6张）。辅导后更大的改善与较低的预习测验分数相关（P < 0.0001）。
基于网络的辅导提高了执业病理学家Gleason分级的准确性。据作者所知，本研究是首个评估并验证使用基于网络的程序对广泛分布的医生群体进行教育的大规模国际研究。
