Expert-led didactic versus self-directed audiovisual training of confocal laser endomicroscopy in evaluation of mucosal barrier defects.

Abstract

Background and study aims Confocal laser endomicroscopy (CLE) allows mucosal barrier defects along the intestinal epithelium to be visualized in vivo during endoscopy. Training in CLE interpretation can be achieved didactically or through self-directed learning. This study aimed to compare the effectiveness of expert-led didactic with self-directed audiovisual teaching for training inexperienced analysts on how to recognize mucosal barrier defects on endoscope-based CLE (eCLE). Materials and methods This randomized controlled study involved trainee analysts who were taught how to recognize mucosal barrier defects on eCLE either didactically or through an audiovisual clip. After being trained, they evaluated 6 sets of 30 images. Image evaluation required the trainees to determine whether specific features of barrier dysfunction were present or not. Trainees in the didactic group engaged in peer discussion and received feedback after each set while this did not happen in the self-directed group. Accuracy, sensitivity, and specificity of both groups were compared. Results Trainees in the didactic group achieved a higher overall accuracy (87.5 % vs 85.0 %, P = 0.002) and sensitivity (84.5 % vs 80.4 %, P = 0.002) compared to trainees in the self-directed group. Interobserver agreement was higher in the didactic group (k = 0.686, 95 % CI 0.680 – 0.691, P < 0.001) than in the self-directed group (k = 0.566, 95 % CI 0.559 – 0.573, P < 0.001). Confidence (OR 6.48, 95 % CI 5.35 – 7.84, P < 0.001) and good image quality (OR 2.58, 95 % CI 2.17 – 2.82, P < 0.001) were positive predictors of accuracy. Conclusion Expert-led didactic training is more effective than self-directed audiovisual training for teaching inexperienced analysts how to recognize mucosal barrier defects on eCLE.