Online training on how to diagnose anoperineal lesions of Crohn's disease: Do pictures matter? A nationwide randomized study

Summary

Any gastroenterologist must be trained to properly diagnose anoperineal lesions in patients with Crohn's disease (APLOC). The aim of this study was to establish whether adding pictures would improve teaching effectiveness of the diagnosis of APLOC to French gastroenterology trainees.

Method

Trainees were asked to answer a first web-based survey consisting of evaluating 12 pictures of APLOC with a closed answer questionnaire. They were then randomized in 2 groups. Group A received an online teaching with typical pictures and APLOC definitions and group B definitions only. Trainees were asked again seven days later to answer a second survey with 12 other pictures of APLOC and 14 experts also answered this survey. Diagnostic scores were expressed in %. The primary endpoint was the comparison of the score of survey 2 between the two groups of trainees. Secondary endpoints were to compare results of survey 2 between trainees of both groups and experts, and assess diagnosis of each lesion.

Results

Two hundred fourty eight trainees among 465 answered survey 1, and 195 survey 2. The diagnostic score was 71.9% for groups A and B and 74.6% for experts (differences NS). After training diagnosis of ulceration was 72% for group A and 72.9% for group B, fistulae 85.2% versus 85.8%, erythema 44.1% vs. 55.6%, anoperineal scars 67.5% vs. 65.6%, and abscess 100% (differences NS).

Conclusion

There was no difference between the two teaching methods. Further research should be performed aiming at improving teaching material and quotation baremes.

Introduction

Anopernieal lesions are frequent during Crohn's disease (APLOC), heterogeneous and their presence and nature influence the prognosis and treatment strategies [1], [2], [3], [4], [5]. Definitions of lesions, classifications and scores have been established [4], [5], [6], [7], [8]. They must be known to specialists and be subject to initial and continuous training. We previously showed that ulceration, fistulae, inflammatory external openings of fistulae, erythema and abscess obtained an acceptable inter-observer agreement between specialists [8]. During their training, future gastroenterologists have to learn how to diagnose those lesions and their diagnostic skills have to reach the level of specialists.

The use of photographic, film and e-learning media is becoming increasingly important in education and has proved its effectiveness in several areas [9], [10].

The main objective of our study was to evaluate if an e-learning training with iconographic support was more efficient than an identical training but without image, for the diagnosis of APLOC by trainees in gastroenterology. The secondary objectives were to identify whether some lesions were more easily diagnosed after training with photos, and whether the trainings allowed students to achieve learning outcomes i.e. an acceptable level of APLOC diagnosis compared to senior experts.