title: In-class didactic versus self-directed teaching of the probe-based confocal laser endomicroscopy (pCLE) criteria for Barrett's esophagus.
abstract: OBJECTIVE
  Optimal teaching methods for disease recognition using probe-based confocal laser endomicroscopy (pCLE) have not been developed. Our aim was to compare in-class didactic teaching vs. self-directed teaching of Barrett's neoplasia diagnosis using pCLE.
  
  
  METHODS
  This randomized controlled trial was conducted at a tertiary academic center. Study participants with no prior pCLE experience were randomized to in-class didactic (group 1) or self-directed teaching groups (group 2). For group 1, an expert conducted a classroom teaching session using standardized educational material. Participants in group 2 were provided with the same material on an audio PowerPoint. After initial training, all participants graded an initial set of 20 pCLE videos and reviewed correct responses with the expert (group 1) or on audio PowerPoint (group 2). Finally, all participants completed interpretations of a further 40 videos.
  
  
  RESULTS
  Eighteen trainees (8 medical students, 10 gastroenterology trainees) participated in the study. Overall diagnostic accuracy for neoplasia prediction by pCLE was 77 % (95 % confidence interval [CI] 74.0 % - 79.2 %); of predictions made with high confidence (53 %), the accuracy was 85 % (95 %CI 81.8 % - 87.8 %). The overall accuracy and interobserver agreement was significantly higher in group 1 than in group 2 for all predictions (80.4 % vs. 73 %; P = 0.005) and for high confidence predictions (90 % vs. 80 %; P < 0.001). Following feedback (after the initial 20 videos), the overall accuracy improved from 73 % to 79 % (P = 0.04), mainly driven by a significant improvement in group 1 (74 % to 84 %; P < 0.01). Accuracy of prediction significantly improved with time in endoscopy training (72 % students, 77 % FY1, 82 % FY2, and 85 % FY3; P = 0.003).
  
  
  CONCLUSIONS
  For novice trainees, in-class didactic teaching enables significantly better recognition of the pCLE features of Barrett's esophagus than self-directed teaching. The in-class didactic group had a shorter learning curve and were able to achieve 90 % accuracy for their high confidence predictions.
authors.affiliation: Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Fadi
authors.initials: F
authors.lastname: Rzouq
authors.affiliation: Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri, USA.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vennalaganti
authors.affiliation: Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Kavous
authors.initials: K
authors.lastname: Pakseresht
authors.affiliation: Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kanakadandi
authors.affiliation: Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Sravanthi
authors.initials: S
authors.lastname: Parasa
authors.affiliation: Pathology Department, Veterans Affairs Medical Center, Kansas City, Missouri, USA.
authors.forename: Sharad C
authors.initials: SC
authors.lastname: Mathur
authors.affiliation: Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Alsop
authors.affiliation: Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hornung
authors.affiliation: Division of Gastroenterology, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D001471:Barrett Esophagus / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004945:Esophagoscopy / Q000193:education* / Q000379:methods; D004947:Esophagus / Q000473:pathology*; D005762:Gastroenterology / Q000193:education; D006801:Humans; D059032:Learning Curve; D018613:Microscopy, Confocal / Q000379:methods*; D008866:Microsurgery / Q000193:education*; D011446:Prospective Studies; D013664:Teaching Materials