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A randomized controlled study of the prediction of diminutive/small colorectal polyp histology using didactic vs. computer based self-learning module in gastroenterology trainees

Samuel C L Smith, John Saltzman, Uday N Shivaji, Brendan C Lethebe, Rosanna Cannatelli, Subrata Ghosh, Marietta Iacucci
Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society 2019 March 7

BACKGROUND AND AIM: The aim of this randomised trial was to evaluate the performance of self-training vs. didactic training, to increase the diagnostic accuracy of diminutive/small colonic polyp histological prediction by trainees.

METHODS: Sixteen trainees reviewed 78 videos (48 iSCAN-OE and 30 NBI) of diminutive/small polyps in a pre-training assessment. Trainees were randomised to receive computer-based self-learning (n=8) or didactic training (n=8) using identical teaching materials and videos. The same 78 videos, in a different randomised order, were assessed. The NICE (NBI International Colorectal Endoscopic) and SIMPLE (Simplified Identification Method for Polyp Labeling during Endoscopy) classification systems were used to classify diminutive/small polyps.

RESULTS: A higher proportion of high confidence predictions of polyps were made by the self-training vs. didactic group both using the SIMPLE classification 77.1% [95% CI 73.4-80.3] vs. 69.9% [95% CI 66.1-73.5%] (p<0.005) and the NICE classification 77% [73.2%-80.4%] vs. 69.8% [95% CI 66-73.4%] (p=0.006). When using NICE, the sensitivity of the self-training group compared with the didactic group was 72% vs. 83% (p<0.0005), and the accuracy was 66.1% vs. 69.1%. The training improved the participants' confidence and SIMPLE was preferred over NICE.

CONCLUSION: Self-learning for the prediction of diminutive/small polyp histology is a method of training that can achieve results similar to didactic training. The availability of adequate self-learning teaching modules could enable more widespread implementation of optical diagnosis in clinical practice. This article is protected by copyright. All rights reserved.


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