Chan R V Paul, Patel Samir N, Ryan Michael C, Jonas Karyn E, Ostmo Susan, Port Alexander D, Sun Grace I, Lauer Andreas K, Chiang Michael F
Department of Ophthalmology, Weill Cornell Medical College, New York, New York, Oregon Health & Science University, Portland, Oregon.
Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
Trans Am Ophthalmol Soc. 2015;113:T2.
To describe the design, implementation, and evaluation of a tele-education system developed to improve diagnostic competency in retinopathy of prematurity (ROP) by ophthalmology residents.
A secure Web-based tele-education system was developed utilizing a repository of over 2,500 unique image sets of ROP. For each image set used in the system, a reference standard ROP diagnosis was established. Performance by ophthalmology residents (postgraduate years 2 to 4) from the United States and Canada in taking the ROP tele-education program was prospectively evaluated. Residents were presented with image-based clinical cases of ROP during a pretest, posttest, and training chapters. Accuracy and reliability of ROP diagnosis (eg, plus disease, zone, stage, category) were determined using sensitivity, specificity, and the kappa statistic calculations of the results from the pretest and posttest.
Fifty-five ophthalmology residents were provided access to the ROP tele-education program. Thirty-one ophthalmology residents completed the program. When all training levels were analyzed together, a statistically significant increase was observed in sensitivity for the diagnosis of plus disease, zone, stage, category, and aggressive posterior ROP (P<.05). Statistically significant changes in specificity for identification of stage 2 or worse (P=.027) and pre-plus (P=.028) were observed.
A tele-education system for ROP education is effective in improving diagnostic accuracy of ROP by ophthalmology residents. This system may have utility in the setting of both healthcare and medical education reform by creating a validated method to certify telemedicine providers and educate the next generation of ophthalmologists.
描述一个为提高眼科住院医师对早产儿视网膜病变(ROP)的诊断能力而开发的远程教育系统的设计、实施和评估。
利用一个包含2500多个独特ROP图像集的数据库开发了一个基于网络的安全远程教育系统。对于系统中使用的每个图像集,都建立了ROP诊断的参考标准。对来自美国和加拿大的眼科住院医师(研究生2至4年级)参加ROP远程教育项目的表现进行前瞻性评估。在预测试、后测试和培训章节中,向住院医师展示基于图像的ROP临床病例。使用预测试和后测试结果的敏感性、特异性和kappa统计计算来确定ROP诊断(如加性病变、区域、阶段、类别)的准确性和可靠性。
55名眼科住院医师获得了ROP远程教育项目的访问权限。31名眼科住院医师完成了该项目。当对所有培训水平进行综合分析时,观察到在诊断加性病变、区域、阶段、类别和侵袭性后部ROP方面的敏感性有统计学显著提高(P<0.05)。在识别2期或更严重病变(P = 0.027)和加性病变前期(P = 0.028)的特异性方面观察到有统计学显著变化。
用于ROP教育的远程教育系统在提高眼科住院医师对ROP的诊断准确性方面是有效的。该系统通过创建一种经过验证的方法来认证远程医疗提供者并教育下一代眼科医生,可能在医疗保健和医学教育改革中具有实用价值。