Self-directed teaching adequate for learning to diagnose Barrett's esophagus-related neoplasia with NBI
Trainees learning to diagnose Barrett’s esophagus-associated neoplasia with narrow-band imaging achieved comparable results with self-directed and in-classroom training programs, according to data from a randomized controlled trial.
Researchers compared the effectiveness of self-directed vs. in-class training programs by evaluating the accuracy of Barrett’s esophagus-associated neoplasia diagnoses made by trainees using narrow-band imaging (NBI). The trial involved 12 second-year medical students, eight first-year gastroenterology fellows, seven second-year gastroenterology fellows and six third-year gastroenterology fellows from the Veterans Affairs Medical Center in Kansas City and Loyola University Medical Center who were randomly assigned to be taught by an expert endoscopist in a classroom for one 1-hour session, or by a self-directed training module they had 2 weeks to complete. All participants then completed an examination requiring them to predict the histology of 40 random NBI images and indicate their diagnostic confidence levels.
They found the diagnostic accuracy of both groups were modest but comparable (57.5% vs. 57.2%). The in-classroom group had more high-confidence answers (57.2% vs. 41.1%; P ≤ .01), but the accuracy of high-confidence answers was comparable (60.7% vs. 66.4%). Overall accuracy (57.4% vs. 55.9%) and accuracy of high-confidence answers (63.1% vs. 61.4%) were also comparable between the two centers, and between gastroenterology fellows and medical students (57.8% vs. 54.6% and 62.8% vs. 60.8%, respectively).
“In conclusion, we found that although in-person training leads to more confidence in diagnosis, overall accuracy and accuracy during high-confidence predictions were not different between in-classroom and self-directed teaching,” the investigators wrote. “In addition, accuracy rates for both groups were well below rates previously published for experts, suggesting that teaching NBI in [Barrett’s esophagus] requires a well-validated classification system and/or more extensive training. Furthermore, teaching NBI for [Barrett’s esophagus] may be different compared with teaching NBI for other diagnoses, such as colon polyps.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.