Division of Gastroenterology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, United States.
Department of Biostatistics and Informatics, Center for Innovative Design and Analysis, Colorado School of Public Health, Aurora, United States.
Endoscopy. 2024 Jun;56(6):421-430. doi: 10.1055/a-2245-6526. Epub 2024 Jan 15.
Although polyp size dictates surveillance intervals, endoscopists often estimate polyp size inaccurately. We hypothesized that an intervention providing didactic instruction and real-time feedback could significantly improve polyp size classification.
We conducted a multicenter randomized controlled trial to evaluate the impact of different components of an online educational module on polyp sizing. Participants were randomized to control (no video, no feedback), video only, feedback only, or video + feedback. The primary outcome was accuracy of polyp size classification into clinically relevant categories (diminutive [1-5mm], small [6-9mm], large [≥10mm]). Secondary outcomes included accuracy of exact polyp size (inmm), learning curves, and directionality of inaccuracy (over- vs. underestimation).
36 trainees from five training programs provided 1360 polyp size assessments. The feedback only (80.1%, =0.01) and video + feedback (78.9%, P=0.02) groups had higher accuracy of polyp size classification compared with controls (71.6%). There was no significant difference in accuracy between the video only group (74.4%) and controls (=0.42). Groups receiving feedback had higher accuracy of exact polyp size (inmm) and higher peak learning curves. Polyps were more likely to be overestimated than underestimated, and 29.3% of size inaccuracies impacted recommended surveillance intervals.
Our online educational module significantly improved polyp size classification. Real-time feedback appeared to be a critical component in improving accuracy. This scalable and no-cost educational module could significantly decrease under- and overutilization of colonoscopy, improving patient outcomes while increasing colonoscopy access.
尽管息肉大小决定了监测间隔，但内镜医生通常会不准确地估计息肉大小。我们假设提供教学指导和实时反馈的干预措施可以显著提高息肉大小分类的准确性。
我们进行了一项多中心随机对照试验，以评估在线教育模块的不同组成部分对息肉大小分类的影响。参与者被随机分配到对照组（无视频，无反馈）、仅视频组、仅反馈组或视频+反馈组。主要结局是将息肉大小准确分类为临床相关类别（微小[1-5mm]、小[6-9mm]、大[≥10mm]）的准确性。次要结局包括准确测量息肉大小（inmm）的准确性、学习曲线和不准确的方向性（高估与低估）。
来自五个培训计划的 36 名学员提供了 1360 次息肉大小评估。仅反馈组（80.1%，=0.01）和视频+反馈组（78.9%，P=0.02）的息肉大小分类准确性高于对照组（71.6%）。仅视频组（74.4%）与对照组之间的准确性无显著差异（=0.42）。接受反馈的组具有更高的息肉大小精确性准确性和更高的峰值学习曲线。息肉更可能被高估而不是低估，29.3%的大小不准确会影响推荐的监测间隔。
我们的在线教育模块显著提高了息肉大小分类的准确性。实时反馈似乎是提高准确性的关键组成部分。这种可扩展且无成本的教育模块可以显著减少结肠镜检查的过度使用和不足，改善患者的预后，同时增加结肠镜检查的机会。
