Effect of an online educational module incorporating real-time feedback on accuracy of polyp sizing in trainees: a randomized controlled trial

Abstract

Background and study aims. Although polyp size dictates surveillance intervals, endoscopists estimate polyp size inaccurately. We hypothesized that an intervention providing didactic instruction and real-time feedback could significantly improve polyp size classification. Methods. We conducted a multicenter randomized controlled trial to evaluate the impact of different components of an online educational module on polyp sizing. Participants were randomized to: control (no video, no feedback), video-only, feedback-only, and video + feedback. The primary outcome was accuracy of polyp size classification into clinically relevant categories [diminutive (1-5 mm), small (6-9 mm), and large (≥10 mm)]. Secondary outcomes included accuracy of exact polyp size (in mm), learning curves, and directionality of inaccuracy (over vs underestimation). Results. 36 trainees from five training programs provided 1,360 polyp size assessments. The feedback-only (80.1%, p=0.010) and video + feedback (78.9%, p=0.023) groups had higher accuracy of polyp size classification compared to control (71.6%). There was no significant difference in accuracy between the video-only group (74.4%, p=0.420) and control. Groups receiving feedback had higher accuracy of exact polyp size (in mm) and higher peak learning curves. Polyps were more likely to be overestimated than underestimated. 29.3% of size inaccuracies impacted recommended surveillance intervals. Conclusions. Our online educational module significantly improves polyp size classification. Real-time feedback appears to be a critical component to improving accuracy. This scalable and no-cost educational module can significantly decrease under- and over-utilization of colonoscopy, improving patient outcomes while opening up colonoscopy access. ClinicalTrials.gov (Identifier NCT 05846295) Keywords. Polyp size; accuracy; surveillance intervals; colorectal cancer.