Education for Retinopathy of Prematurity (ROP): Development and Assessment of a Novel Web-Based Educational Tool to Improve ROP Training

Abstract

 

Purpose

 

To provide ophthalmologists-in-training and practicing ophthalmologists a resource to learn how to diagnose and manage ROP. The efficacy of a web-based system to improve diagnostic competency in ROP by ophthalmologists-in-training will be determined.

 

Methods

 

A secure web-based educational system was developed utilizing a repository of over 2500 unique image sets of ROP. For each image set used in the system, a reference standard ROP diagnosis was established. This was done by combining the clinical diagnosis and the image reading by multiple experts. In order to assess the effectiveness of this system in improving competency of ROP diagnosis, ophthalmologists-in-training from the United States and Canada participated in the ROP training system. The training consisted of four sections: a pre-test examination, a ROP tutorial, ROP educational chapters, and a post-test examination. Sensitivity and specificity calculations were performed to determine if the participant improved on the post-test as compared to the pre-test.

 

Results

 

Five ophthalmology training programs were contacted and 58 ophthalmology residents were given access to the ROP training system. 32 ophthalmology residents completed the ROP training program. When analyzing all training levels together (PGY-2 to PGY-4 only), a statistically significant (p<0.05) increase was observed in sensitivity for accuracy of the diagnosis of Zone (I, II, and III), Stage, presence of Plus disease, Category (No ROP, Mild ROP, Type-2 Prethreshold or Pre-Plus, and Treatment-requiring ROP), and the presence of aggressive posterior ROP (APROP). The largest improvement was observed for identifying the presence of APROP, which saw a 44 percent increase in sensitivity between the pre-test and post-test. The smallest statistically significant increase in sensitivity was observed for the ability to diagnose mild or worse ROP, which saw an increase of 4 percentage points. Statistically significant changes in specificity for identification of Stage 2 or worse and Pre-plus were observed.

 

Conclusions

 

The web-based system for retinopathy of prematurity education we have created is effective in improving diagnostic accuracy of ROP by ophthalmologists-in-training. A web-based system can improve access to practicing ophthalmologists around the world who are interested in learning and improving their skills in ROP diagnosis.