Rzouq Fadi, Vennalaganti Prashanth, Pakseresht Kavous, Kanakadandi Vijay, Parasa Sravanthi, Mathur Sharad C, Alsop Benjamin R, Hornung Benjamin, Gupta Neil, Sharma Prateek
Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri, USA.
Endoscopy. 2016 Feb;48(2):123-7. doi: 10.1055/s-0034-1393118. Epub 2015 Oct 1.
Optimal teaching methods for disease recognition using probe-based confocal laser endomicroscopy (pCLE) have not been developed. Our aim was to compare in-class didactic teaching vs. self-directed teaching of Barrett's neoplasia diagnosis using pCLE.
This randomized controlled trial was conducted at a tertiary academic center. Study participants with no prior pCLE experience were randomized to in-class didactic (group 1) or self-directed teaching groups (group 2). For group 1, an expert conducted a classroom teaching session using standardized educational material. Participants in group 2 were provided with the same material on an audio PowerPoint. After initial training, all participants graded an initial set of 20 pCLE videos and reviewed correct responses with the expert (group 1) or on audio PowerPoint (group 2). Finally, all participants completed interpretations of a further 40 videos.
Eighteen trainees (8 medical students, 10 gastroenterology trainees) participated in the study. Overall diagnostic accuracy for neoplasia prediction by pCLE was 77 % (95 % confidence interval [CI] 74.0 % - 79.2 %); of predictions made with high confidence (53 %), the accuracy was 85 % (95 %CI 81.8 % - 87.8 %). The overall accuracy and interobserver agreement was significantly higher in group 1 than in group 2 for all predictions (80.4 % vs. 73 %; P = 0.005) and for high confidence predictions (90 % vs. 80 %; P < 0.001). Following feedback (after the initial 20 videos), the overall accuracy improved from 73 % to 79 % (P = 0.04), mainly driven by a significant improvement in group 1 (74 % to 84 %; P < 0.01). Accuracy of prediction significantly improved with time in endoscopy training (72 % students, 77 % FY1, 82 % FY2, and 85 % FY3; P = 0.003).
For novice trainees, in-class didactic teaching enables significantly better recognition of the pCLE features of Barrett's esophagus than self-directed teaching. The in-class didactic group had a shorter learning curve and were able to achieve 90 % accuracy for their high confidence predictions.
基于探头的共聚焦激光内镜检查（pCLE）用于疾病识别的最佳教学方法尚未确立。我们的目的是比较课堂讲授式教学与自我指导式教学在使用pCLE诊断巴雷特肿瘤形成方面的效果。
本随机对照试验在一家三级学术中心进行。没有pCLE经验的研究参与者被随机分为课堂讲授式教学组（第1组）或自我指导式教学组（第2组）。对于第1组，由一位专家使用标准化教学材料进行课堂教学。第2组的参与者通过音频PowerPoint获得相同的材料。初始培训后，所有参与者对20个pCLE视频的初始集进行评分，并与专家（第1组）或通过音频PowerPoint（第2组）回顾正确答案。最后，所有参与者完成另外40个视频的解读。
18名学员（8名医学生，10名胃肠病学实习生）参与了研究。pCLE对肿瘤形成预测的总体诊断准确率为77%（95%置信区间[CI] 74.0% - 79.2%）；在高置信度预测（53%）中，准确率为85%（95%CI 81.8% - 87.8%）。对于所有预测（80.4%对73%；P = 0.005）以及高置信度预测（90%对80%；P < 0.001），第1组的总体准确率和观察者间一致性显著高于第2组。在反馈（初始20个视频之后）后，总体准确率从73%提高到79%（P = 0.04），主要是由第1组的显著提高（74%到84%；P < 0.01）推动的。在内镜检查培训中，预测准确率随时间显著提高（医学生为72%，第一年住院医生为77%，第二年住院医生为82%，第三年住院医生为85%；P = 0.003）。
对于新手学员，课堂讲授式教学在识别巴雷特食管的pCLE特征方面比自我指导式教学显著更好。课堂讲授式教学组的学习曲线更短，并且在高置信度预测中能够达到90%的准确率。
