Development of an E-Learning System for the Endoscopic Diagnosis of Early Gastric Cancer: an International Multicenter Randomized Controlled Trial

Abstract
Background: Gastric cancer is the second highest cause of cancer deaths worldwide. Apart from Japan and Korea where screening programs are implemented, most gastric cancer patients worldwide are diagnosed at an advanced stage because of limited knowledge and experience of endoscopists. An internet-based e-learning system to teach detection of early gastric cancer using standard endoscopy has been developed and this study evaluated its effectiveness. Methods: The study was designed as a randomized controlled trial. Participants worldwide signed a consent form before first undertaking a pre-test via the internet, after which they were randomly allocated to the e-learning and non-e-learning groups. Pre-adjustment strata were the pre-test score, experience of endoscopy, being a nurse endoscopist or a medical practitioner, and medical institution and country. Only the participants in the e-learning group were allowed to access the e-learning system, which consisted of video lectures on basic knowledge and self-exercise tests to accumulate experience. A post-test in both groups was conducted 2 months after the pre-test. The pre-determined primary endpoint was the difference in the rate of improvement of the test result (post-test score/pre-test score) between groups. After completion of the post-test, the e-learning system was opened for all participants. Results: Among the 515 endoscopists from 35 countries assessed for eligibility, 322 participants who met the study’s inclusion criteria completed the pre-test and were enrolled: 166 were allocated to the e-learning group and 166 to the non-e-learning. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group completed the post-test, and were included in the analysis. The mean rate of improvement (standard deviation) of the test result in the e-learning and non-elearning groups was 1.24 (0.26) and. 1.00 (0.16), respectively (P!0.001, Student’s ttest). Conclusion: This global study clearly demonstrated the efficacy of an e-learning system to improve knowledge and experience on endoscopic detection of early gastric cancer. Its effectiveness will be further evaluated in a study of improvements in the rate of early gastric cancer detection by all participants in actual clinical practice (UMIN: R000012039)
Source: Universidad Peruana de Ciencias Aplicadas - UPC
URL http://hdl.handle.net/10757/550921