Randomized controlled trial of self-directed versus in-classroom teaching of narrow-band imaging for diagnosis of Barrett's esophagus-associated neoplasia.
OBJECTIVE
Previous studies have shown that narrow-band imaging (NBI) can be taught to inexperienced gastroenterologists. However, it is unknown whether in-person training is more effective than self-directed training. The objective of this study was to compare the accuracy of diagnosing Barrett's esophagus (BE)-associated neoplasia by trainees with no prior NBI experience between in-classroom and self-directed didactic training programs.


METHODS
This was a randomized controlled trial that took place at 2 tertiary-care medical centers, involving 33 participants--12 second-year medical students, 8 first-year gastroenterology fellows, 7 second-year gastroenterology fellows, and 6 third-year gastroenterology fellows. A teaching module was developed for all participants to review. Half of the participants were taught in a classroom setting by an endoscopist with expertise in NBI, whereas the other participants were in a self-directed group that received an automated version of the presentation with audio commentary. Participants completed a test of 40 randomized NBI images, predicting the histology and indicating their confidence levels in the diagnosis.


RESULTS
There was no difference in accuracy between the in-classroom and self-directed groups (57.5% vs 57.2%; P = 1.0). The in-classroom group had a significantly higher percentage of high-confidence answers (57.2% vs 41.1%; P ≤ .01), but there was no significant difference in accuracy with these high-confidence answers (60.7% vs 66.4%; P = .34). There was no significant difference in overall accuracy or accuracy with high-confidence predictions between the 2 study sites (57.4% vs 55.9%, P = .58; 63.1% vs 61.4%, P = .69) or between gastroenterology fellows and medical students (57.8% vs 54.6%, P = .27; 62.8% vs 60.8%, P = .62).


CONCLUSIONS
The overall accuracy of predicting NBI patterns in BE were modest in our study participants, and there was no difference between self-directed and in-classroom didactic training. Self-directed learning of NBI is adequate for teaching NBI to trainees.
Department of Gastroenterology, Loyola University Medical Center, Maywood, Illinois, USA.
Claire
C
Daly
Department of Gastroenterology, Kansas City Veterans Affairs, Kansas, USA; Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Prashanth
P
Vennalaganti
Department of Gastroenterology, Loyola University Medical Center, Maywood, Illinois, USA.
Samad
S
Soudagar
Department of Gastroenterology, Kansas City Veterans Affairs, Kansas, USA; Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Ben
B
Hornung
Department of Gastroenterology, Kansas City Veterans Affairs, Kansas, USA; Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Prateek
P
Sharma
Department of Gastroenterology, Loyola University Medical Center, Maywood, Illinois, USA.
Neil
N
Gupta
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology; D002983:Clinical Competence; D004501:Education, Medical / Q000379:methods*; D004503:Education, Medical, Graduate; D004504:Education, Medical, Undergraduate; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004945:Esophagoscopy / Q000193:education*; D005762:Gastroenterology / Q000193:education*; D006801:Humans; D062048:Narrow Band Imaging; D060787:Neoplasm Grading; D011380:Programmed Instructions as Topic