Patel Samir N, Martinez-Castellanos Maria Ana, Berrones-Medina David, Swan Ryan, Ryan Michael C, Jonas Karyn E, Ostmo Susan, Campbell J Peter, Chiang Michael F, Chan R V Paul
Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
Asociación para Evitar la Ceguera en México, Mexico City, Mexico.
Ophthalmology. 2017 Jul;124(7):953-961. doi: 10.1016/j.ophtha.2017.02.014. Epub 2017 Apr 3.
To evaluate a tele-education system developed to improve diagnostic competency in retinopathy of prematurity (ROP) by ophthalmologists-in-training in Mexico.
Prospective, randomized cohort study.
Fifty-eight ophthalmology residents and fellows from a training program in Mexico consented to participate. Twenty-nine of 58 trainees (50%) were randomized to the educational intervention (pretest, ROP tutorial, ROP educational chapters, and posttest), and 29 of 58 trainees (50%) were randomized to a control group (pretest and posttest only).
A secure web-based educational system was created using clinical cases (20 pretest, 20 posttest, and 25 training chapter-based) developed from a repository of over 2500 unique image sets of ROP. For each image set used, a reference standard ROP diagnosis was established by combining the clinical diagnosis by indirect ophthalmoscope examination and image-based diagnosis by multiple experts. Trainees were presented with image-based clinical cases of ROP during a pretest, posttest, and training chapters.
The accuracy of ROP diagnosis (e.g., plus disease, zone, stage, category) was determined using sensitivity and specificity calculations from the pretest and posttest results of the educational intervention group versus control group. The unweighted kappa statistic was used to analyze the intragrader agreement for ROP diagnosis by the ophthalmologists-in-training during the pretest and posttest for both groups.
Trainees completing the tele-education system had statistically significant improvements (P < 0.01) in the accuracy of ROP diagnosis for plus disease, zone, stage, category, and aggressive posterior ROP (AP-ROP). Compared with the control group, trainees who completed the ROP tele-education system performed better on the posttest for accurately diagnosing plus disease (67% vs. 48%; P = 0.04) and the presence of ROP (96% vs. 91%; P < 0.01). The specificity for diagnosing AP-ROP (94% vs. 78%; P < 0.01), type 2 ROP or worse (92% vs. 84%; P = 0.04), and ROP requiring treatment (89% vs. 79%; P < 0.01) was better for the trainees completing the tele-education system compared with the control group. Intragrader agreement improved for identification of plus disease, zone, stage, and category of ROP after completion of the educational intervention.
A tele-education system for ROP education was effective in improving the diagnostic accuracy of ROP by ophthalmologists-in-training in Mexico. This system has the potential to increase competency in ROP diagnosis and management for ophthalmologists-in-training from middle-income nations.
评估为提高墨西哥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学系统。
前瞻性随机队列研究。
来自墨西哥一个培训项目的58名眼科住院医师和研究员同意参与。58名学员中的29名（50%）被随机分配到教育干预组（前测、ROP教程、ROP教育章节和后测），58名学员中的29名（50%）被随机分配到对照组（仅前测和后测）。
使用从超过2500个独特的ROP图像集库中开发的临床病例（20个前测病例、20个后测病例和25个基于章节的培训病例）创建了一个安全的基于网络的教育系统。对于所使用的每个图像集，通过间接检眼镜检查的临床诊断与多位专家基于图像的诊断相结合，建立了参考标准ROP诊断。在进行前测、后测和培训章节时，向学员展示基于图像的ROP临床病例。
通过计算教育干预组与对照组前测和后测结果的敏感性和特异性，确定ROP诊断（如附加病变、区域、阶段、类别）的准确性。使用未加权kappa统计量分析两组学员在前测和后测期间对ROP诊断的评分者内一致性。
完成远程教学系统的学员在附加病变、区域、阶段、类别以及侵袭性后部ROP（AP-ROP）的ROP诊断准确性方面有统计学显著提高（P<0.01）。与对照组相比，完成ROP远程教学系统的学员在后测中对附加病变的准确诊断表现更好（67%对48%；P=0.04），以及对ROP存在的诊断（96%对91%；P<0.01）。与对照组相比，完成远程教学系统的学员对AP-ROP的诊断特异性（94%对78%；P<0.01）、2型或更严重ROP的诊断特异性（92%对84%；P=0.04）以及需要治疗的ROP的诊断特异性（89%对79%；P<0.01）更高。完成教育干预后，评分者内对附加病变、区域、阶段和ROP类别的识别一致性有所提高。
用于ROP教育的远程教学系统有效地提高了墨西哥眼科住院医师对ROP的诊断准确性。该系统有可能提高中等收入国家眼科住院医师在ROP诊断和管理方面的能力。
