title: Assessment of a Tele-education System to Enhance Retinopathy of Prematurity Training by International Ophthalmologists-in-Training in Mexico.
abstract: To evaluate a tele-education system developed to improve diagnostic competency in retinopathy of prematurity (ROP) by ophthalmologists-in-training in Mexico.
  
  
  
  Prospective, randomized cohort study.
  
  
  
  Fifty-eight ophthalmology residents and fellows from a training program in Mexico consented to participate. Twenty-nine of 58 trainees (50%) were randomized to the educational intervention (pretest, ROP tutorial, ROP educational chapters, and posttest), and 29 of 58 trainees (50%) were randomized to a control group (pretest and posttest only).
  
  
  
  A secure web-based educational system was created using clinical cases (20 pretest, 20 posttest, and 25 training chapter-based) developed from a repository of over 2500 unique image sets of ROP. For each image set used, a reference standard ROP diagnosis was established by combining the clinical diagnosis by indirect ophthalmoscope examination and image-based diagnosis by multiple experts. Trainees were presented with image-based clinical cases of ROP during a pretest, posttest, and training chapters.
  
  
  
  The accuracy of ROP diagnosis (e.g., plus disease, zone, stage, category) was determined using sensitivity and specificity calculations from the pretest and posttest results of the educational intervention group versus control group. The unweighted kappa statistic was used to analyze the intragrader agreement for ROP diagnosis by the ophthalmologists-in-training during the pretest and posttest for both groups.
  
  
  
  Trainees completing the tele-education system had statistically significant improvements (P < 0.01) in the accuracy of ROP diagnosis for plus disease, zone, stage, category, and aggressive posterior ROP (AP-ROP). Compared with the control group, trainees who completed the ROP tele-education system performed better on the posttest for accurately diagnosing plus disease (67% vs. 48%; P = 0.04) and the presence of ROP (96% vs. 91%; P < 0.01). The specificity for diagnosing AP-ROP (94% vs. 78%; P < 0.01), type 2 ROP or worse (92% vs. 84%; P = 0.04), and ROP requiring treatment (89% vs. 79%; P < 0.01) was better for the trainees completing the tele-education system compared with the control group. Intragrader agreement improved for identification of plus disease, zone, stage, and category of ROP after completion of the educational intervention.
  
  
  
  A tele-education system for ROP education was effective in improving the diagnostic accuracy of ROP by ophthalmologists-in-training in Mexico. This system has the potential to increase competency in ROP diagnosis and management for ophthalmologists-in-training from middle-income nations.
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
authors.forename: Samir N
authors.initials: SN
authors.lastname: Patel
authors.affiliation: Asociación para Evitar la Ceguera en México, Mexico City, Mexico.
authors.forename: Maria Ana
authors.initials: MA
authors.lastname: Martinez-Castellanos
authors.affiliation: Asociación para Evitar la Ceguera en México, Mexico City, Mexico.
authors.forename: David
authors.initials: D
authors.lastname: Berrones-Medina
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Ryan
authors.initials: R
authors.lastname: Swan
authors.affiliation: Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ryan
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College, New York, New York; Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Karyn E
authors.initials: KE
authors.lastname: Jonas
authors.affiliation: Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon.
authors.forename: Susan
authors.initials: S
authors.lastname: Ostmo
authors.affiliation: Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Campbell
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon; Department of Ophthalmology, Casey Eye Institute at Oregon Health & Science University, Portland, Oregon.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College, New York, New York; Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois; Center for Global Health, College of Medicine, University of Illinois at Chicago, Chicago, Illinois. Electronic address: rvpchan@uic.edu.
authors.forename: R V Paul
authors.initials: RVP
authors.lastname: Chan
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet; D008800:Mexico; D000072163:Ophthalmologists / Q000193:education*; D009885:Ophthalmology / Q000193:education*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D017216:Telemedicine / Q000379:methods*