Education for Retinopathy of Prematurity (ROP): Assessment of a Tele-education System to Enhance ROP Training Among International Trainees

Abstract

Purpose : The third epidemic of ROP has predominately affected middle-income countries and has been exacerbated by insufficient training in ROP diagnosis and management. Previously, we have demonstrated the utility of a web-based system to improve ROP education among trainees in the USA. The purpose of this study is to assess the effectiveness of a tele-education system for international trainees from a middle-income country.

Methods : A secure web-based educational system was developed using a repository of over 2500 image sets of ROP. 36 infants were used for 65 clinical cases (20 pretest, 20 posttest, and 25 chapter-based training) in the system. 58 trainees from a middle-income country were prospectively evaluated and randomized either to an educational intervention (pretest, ROP tutorial, ROP educational chapters, and posttest) or to a control group (pretest and posttest only). Accuracy and reliability of ROP diagnosis were determined using sensitivity, specificity, and the kappa statistic from the educational intervention and control group.

Results : Trainees completing the educational intervention had significant improvements (P<0.01) in the sensitivity of ROP diagnosis for plus disease, zone, stage, category, and aggressive posterior ROP (APROP) between the pretest and posttest. Compared to the control group, the educational intervention group had statistically significant improvements on the posttest for the sensitivity of presence of ROP (P<0.01), plus disease (P=0.04), and specificity for APROP (P<0.01), type-2 ROP or worse (P=0.04) and treatment-requiring ROP (P<0.01) (Table 1). Intra-grader agreement improved for identification of plus disease, zone, stage, and category of ROP after completion of the tele-education program (Table 2).

Conclusions : A tele-education system for ROP is effective in improving diagnostic accuracy of ROP by trainees from middle-income countries. This system has the potential to increase competency in ROP diagnosis and management for practicing ophthalmologists in middle-income countries to address the third epidemic of ROP.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Table 1 Sensitivity and Specificity of Retinopathy of Prematurity Diagnosis in the Posttest by International Trainees Participating in the ROP Tele-education Program.

 

Table 2 Kappa Statistics for Intra-grader Agreement Among International Trainees in the Pretest and Posttest of the ROP Tele-education Program