Huynh Roy, Ip Matthew, Chang Jeff, Haifer Craig, Leong Rupert W
Faculty of Medicine, UNSW Australia, Sydney, Australia.
Gastroenterology and Liver Services, Bankstown-Lidcombe Hospital, Sydney, Australia.
Endosc Int Open. 2018 Jan;6(1):E115-E122. doi: 10.1055/s-0043-114664. Epub 2018 Jan 16.
Confocal laser endomicroscopy (CLE) allows mucosal barrier defects along the intestinal epithelium to be visualized during endoscopy. Training in CLE interpretation can be achieved didactically or through self-directed learning. This study aimed to compare the effectiveness of expert-led didactic with self-directed audiovisual teaching for training inexperienced analysts on how to recognize mucosal barrier defects on endoscope-based CLE (eCLE).
This randomized controlled study involved trainee analysts who were taught how to recognize mucosal barrier defects on eCLE either didactically or through an audiovisual clip. After being trained, they evaluated 6 sets of 30 images. Image evaluation required the trainees to determine whether specific features of barrier dysfunction were present or not. Trainees in the didactic group engaged in peer discussion and received feedback after each set while this did not happen in the self-directed group. Accuracy, sensitivity, and specificity of both groups were compared.
Trainees in the didactic group achieved a higher overall accuracy (87.5 % vs 85.0 %, = 0.002) and sensitivity (84.5 % vs 80.4 %, = 0.002) compared to trainees in the self-directed group. Interobserver agreement was higher in the didactic group (k = 0.686, 95 % CI 0.680 - 0.691, < 0.001) than in the self-directed group (k = 0.566, 95 % CI 0.559 - 0.573, < 0.001). Confidence (OR 6.48, 95 % CI 5.35 - 7.84, < 0.001) and good image quality (OR 2.58, 95 % CI 2.17 - 2.82, < 0.001) were positive predictors of accuracy.
Expert-led didactic training is more effective than self-directed audiovisual training for teaching inexperienced analysts how to recognize mucosal barrier defects on eCLE.
共聚焦激光内镜显微镜（CLE）可在内镜检查过程中观察肠道上皮的黏膜屏障缺陷。CLE解读培训可通过讲授法或自主学习来实现。本研究旨在比较专家主导的讲授式教学与自主视听教学在培训缺乏经验的分析人员识别基于内镜的CLE（eCLE）上的黏膜屏障缺陷方面的有效性。
这项随机对照研究纳入了实习分析人员，他们通过讲授法或视听片段学习如何识别eCLE上的黏膜屏障缺陷。培训后，他们评估6组，每组30张图像。图像评估要求实习人员确定是否存在屏障功能障碍的特定特征。讲授组的实习人员在每组图像评估后进行同行讨论并接受反馈，而自主学习组则没有。比较两组的准确性、敏感性和特异性。
与自主学习组的实习人员相比，讲授组的实习人员总体准确性更高（87.5%对85.0%，P = 0.002），敏感性更高（84.5%对80.4%，P = 0.002）。讲授组的观察者间一致性高于自主学习组（k = 0.686，95%CI 0.680 - 0.691，P < 0.001）（k = 0.566，95%CI 0.559 - 0.573，P < 0.001）。信心（OR 6.48，95%CI 5.35 - 7.84，P < 0.001）和良好的图像质量（OR 2.58，95%CI 2.17 - 2.82，P < 0.001）是准确性的积极预测因素。
对于教导缺乏经验的分析人员识别eCLE上的黏膜屏障缺陷，专家主导的讲授式培训比自主视听培训更有效。
