Optimizing Inter-Observer Agreement on Esophageal Dysplasia Via Web-Based Self-Directed Learning Modules
Jane H James, John Lee, Jennifer Prather, Gregorio Chejfec, Stephen Sontag, Elizabeth L Wiley. University of Illinois, Chicago, IL; Edward Hines, Jr. VA Hospital, Maywood, IL
Background: Esophageal dysplasia is a well documented diagnostic challenge, with significant inter-observer variation noted in interpretation of low and high grade dysplasia. While previous studies have relied on evaluation of glass slides by small groups, web-based modules allow self-directed learning with pathologists at distant sites. This pilot study evaluates the value of designing and implementing a publically accessible, web-based tutorial in training junior and senior residents.
Design: 75 classic examples of negative, indefinite, low-grade or high grade esophageal dysplasia, along with carcinoma, were selected by expert pathologists. Images from these cases were equally split between pre-training, training, and post-training modules, which were posted online. Scores from residents (n = 15) were analyzed with pairwise percent agreement to assess inter-observer correlation before and after training.
Results: Our findings demonstrate that web-based learning improves inter-observer agreement; overall scores improved from 50%, in the pre-training set, to 76% in the post-training set. While both first year and senior residents shared the same knowledge level at first (42%), training generated a greater improvement in senior residents (66%) than first year residents (62%). The most significant diagnostic challenge in interpreting esophageal biopsies were cases which were “indefinite for dysplasia,” with only 30% agreement among residents taking the pre-test. Training improved this score significantly, with a post-test score of 79%.
Conclusions: This pilot study demonstrates that self-directed modules effectively improve inter-observer correlation among residents. Web-based modules are an excellent supplement to traditional slide-based instruction, with the additional advantage of allowing residents to assess and direct their own learning through text and images. This allows for a richer appreciation for subtle histomorphological cues contributing to each diagnosis. Ultimately, these modules may be used to standardize teaching of challenging diagnoses across multiple institutions. In the future, we plan to build on our experience to create a library of training modules for both residents and pathologists.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 90, Monday Morning