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

Abstract

Background: In many countries, gastric cancer is not diagnosed until an advanced stage. An Internet-based e-learning system to improve the ability of endoscopists to diagnose gastric cancer at an early stage was developed and was evaluated for its effectiveness.

Methods: The study was designed as a randomized controlled trial. After receiving a pre-test, participants were randomly allocated to either an e-learning or non-e-learning group. Only those in the e-learning group gained access to the e-learning system. Two months after the pre-test, both groups received a post-test. The primary endpoint was the difference between the two groups regarding the rate of improvement of their test results.

Findings: 515 endoscopists from 35 countries were assessed for eligibility, and 332 were enrolled in the study, with 166 allocated to each group. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group were included in the analysis. The mean improvement rate (standard deviation) in the e-learning and non-e-learning groups was 1·24 (0·26) and 1·00 (0·16), respectively (P<0·001).

Interpretation: This global study clearly demonstrated the efficacy of an e-learning system to expand knowledge and provide invaluable experience regarding the endoscopic detection of early gastric cancer (R000012039).

Keywords: E-learning; Endoscopic diagnosis; Gastric cancer; International multicenter randomized controlled trial.

Fig. 1

An example of the pre- and post-test. a. When the participant starts the test, an endoscopic image appears. The first question is whether or not a localized lesion is present. If the participant clicks “present” as shown by “A1” in the slide, the second instruction is for the participant to click on the center of the detected lesion on the image as shown by “Q1”. b. The third question is whether the detected lesion is malignant or benign. c. The participant is then offered the chance to identify any additional lesion.

Fig. 2

An example of a video clip. On the lecture page, lecture video clips can be viewed online or can be downloaded.

Fig. 3

An example of the self-exercise tests for diagnosis of 100 cases. a. One case comprises a set of three slides. The 1st slide showes one endoscopic photo where one lesion is present. First,the participant should click to choose whether the lesion is cancer or non-cancer. b. Immediately after clicking on their choice, an illustration indicating whether the answer is correct or incorrect appears as the 2nd slide. c. The 3rd slide indicates brief instructions on how to characterize the endoscopic findings so as to make a correct diagnosis, and shows the original endoscopic image again.

Fig. 4

Details regarding enrollment of participants, randomization and e-tests. IC: informed consent.