SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Endoscopy
  2015/10  
 
  2015 Oct  
  Epub ahead of print  
 
  In-class didactic versus self-directed teaching of the probe-based confocal laser endomicroscopy (pCLE) criteria for Barrett's esophagus  
 
  Rzouq F, Vennalaganti P, Pakseresht K, Kanakadandi V, Parasa S, Mathur SC, Alsop BR, Hornung B, Gupta N, Sharma P  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=In-class+didactic+versus+self-directed+teaching+of+the+probe-based+confocal+laser+endomicroscopy+%28pCLE%29+criteria+for+Barrett%27s+esophagus  
 
 

Background and aims: 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).

Conclusion: For novice trainees, in-class didactic teaching enables significantly betterrecognition 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.

 

 
Question posée
 
Quelle est la meilleure méthode pédagogique pour apprendre à interpréter l’endomicroscopie ?
 
Question posée
 
Dans cette étude centrée sur l’apprentissage des critères endomicroscopiques de l’EBO (donc relativement complexes), l’enseignement interactif en présence d’un expert était significativement supérieur à un enseignement sur le même support powerpoint sonorisé. L’interaction avec l’expert permettait à la fois de raccourcir la courbe d’apprentissage et de parvenir à un meilleur taux de réponses correctes pour le diagnostic endomicroscopique.
 
Commentaires

De plus en plus d’études s’intéressent à la pédagogie en endoscopie. Celle-ci est un modèle du genre, avec une méthodologie randomisée et contrôlée. L’impact de ces séances d’apprentissage avec l’expert ‘dans la vraie vie’ et la durabilité des performances acquises restent bien sûr à déterminer.

 
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