title: Facilitated Versus Self-guided Training of Non-ophthalmologists for Grading Pre-plus and Plus Disease Using Fundus Images for Retinopathy of Prematurity Screening.
abstract: OBJECTIVE
  Retinopathy of prematurity (ROP) is an important cause of preventable blindness; barriers to screening necessitate novel approaches. Although trained non-ophthalmologists can accurately grade retinal images for ROP, effective training protocols are not established. This study compares the effectiveness of facilitated versus self-guided training of non-ophthalmologists for grading retinal images for pre-plus or plus disease in ROP.
  
  
  METHODS
  Forty-eight undergraduate and graduate students were trained to grade retinal images for the presence of pre-plus or plus disease. Students were randomly assigned to one of two training protocols. Both used identical electronic slideshows: one was guided by an in-person facilitator and the other was self-guided. After completing their respective training, students proficient in grading pre-plus and plus disease graded images in a telemedicine screening scenario. Accuracy of grading was compared to the reference standard of clinical examination.
  
  
  RESULTS
  Eighty-three percent (40 of 48) of trained students (91% in the facilitated vs 77% in the self-guided group, P = .26) were proficient and qualified to grade the ROP telemedicine screening scenario. Median accuracy for grading normal, pre-plus, or plus disease was 69% (70% in the facilitated vs 68% in the self-guided group, P = .91). When considering the designation of pre-plus or plus disease by graders as a screening test for detecting plus disease (confirmed on clinical examination), the median sensitivity and specificity of all students were 95% and 64%, respectively.
  
  
  CONCLUSIONS
  Both facilitated and self-guided teaching protocols yielded similar performance in ROP image grading for pre-plus or plus disease. Self-guided training protocols may be adequate to train non-ophthalmologists to grade retinal images for pre-plus and plus disease with high sensitivity. [J Pediatr Ophthalmol Strabismus. 2016;53(3):179-185.].
authors.forename: Nikolas N
authors.initials: NN
authors.lastname: Raufi
authors.forename: Caleb K
authors.initials: CK
authors.lastname: Morris
authors.forename: Sharon F
authors.initials: SF
authors.lastname: Freedman
authors.forename: David K
authors.initials: DK
authors.lastname: Wallace
authors.forename: S Grace
authors.initials: SG
authors.lastname: Prakalapakorn
mesh_terms: D000488:Allied Health Personnel / Q000193:education* / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D003952:Diagnostic Imaging / Q000592:standards*; D004521:Educational Measurement; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007234:Infant, Premature; D009885:Ophthalmology / Q000193:education*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012171:Retinal Vessels / Q000473:pathology*; D012178:Retinopathy of Prematurity / Q000145:classification* / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000145:classification