title: Web-based system for training and dissemination of a magnification chromoendoscopy classification.
abstract: OBJECTIVE
  To evaluate the use of web-based technologies to assess the learning curve and reassess reproducibility of a simplified version of a classification for gastric magnification chromoendoscopy (MC).
  
  
  METHODS
  As part of a multicenter trial, a hybrid approach was taken using a CD-ROM, with 20 films of MC lasting 5 s each and an "autorun" file triggering a local HTML frameset referenced to a remote questionnaire through an Internet connection. Three endoscopists were asked to prospectively and independently classify 10 of these films randomly selected with at least 3 d apart. The answers were centrally stored and returned to participants together with adequate feedback with the right answer.
  
  
  RESULTS
  For classification in 3 groups, both intra- [Cohen's kappa (kappa) = 0.79-1.00 to 0.89-1.00] and inter-observer agreement increased from 1st (moderate) to 6th observation (kappa = 0.94). Also, agreement with reference increased in the last observations (0.90, 1.00 and 1.00, for observers A, B and C, respectively). Validity of 100% was obtained by all observers at their 4th observation. When a 4th (sub)group was considered, inter-observer agreement was almost perfect (kappa = 0.92) at 6th observation. The relation with reference clearly improved into kappa (0.93-1.00) and sensitivity (75%-100%) at their 6th observations.
  
  
  CONCLUSIONS
  This MC classification seems to be easily explainable and learnable as shown by excellent intra- and inter-observer agreement, and improved agreement with reference. A web system such as the one used in this study may be useful for endoscopic or other image based diagnostic procedures with respect to definition, education and dissemination.
authors.affiliation: Gastroenterology Department, Portuguese Oncology Institute, Porto 4200-072, Portugal. mario@med.up.pt
authors.forename: Mario
authors.initials: M
authors.lastname: Dinis-Ribeiro
authors.forename: Ricardo
authors.initials: R
authors.lastname: Correia
authors.forename: Cristina
authors.initials: C
authors.lastname: Santos
authors.forename: Sonia
authors.initials: S
authors.lastname: Fernandes
authors.forename: Ernesto
authors.initials: E
authors.lastname: Palhares
authors.forename: Rui-Almeida
authors.initials: RA
authors.lastname: Silva
authors.forename: Pedro
authors.initials: P
authors.lastname: Amaro
authors.forename: Miguel
authors.initials: M
authors.lastname: Areia
authors.forename: Altamiro
authors.initials: A
authors.lastname: Costa-Pereira
authors.forename: Luis
authors.initials: L
authors.lastname: Moreira-Dias
mesh_terms: D003194:Computer-Assisted Instruction / Q000145:classification*; D016099:Endoscopy, Gastrointestinal / Q000145:classification*; D006801:Humans; D020407:Internet; D015588:Observer Variation; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology