Classifying Inflammation on Intestinal Ultrasound Images and Cineloops-A Learning Curve Study

Author:

Madsen Gorm Roager1234ORCID,Tolsgaard Martin Grønnebæk356,Gecse Krisztina7ORCID,Novak Kerri8ORCID,Boscardin Christy9,Attauabi Mohamed12410ORCID,Burisch Johan1246ORCID,Boysen Trine1246ORCID,Wilkens Rune4611ORCID

Affiliation:

1. Gastrounit, Medical Division, Copenhagen University Hospital - Amager and Hvidovre , Hvidovre , Denmark

2. Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre , Hvidovre , Denmark

3. Copenhagen Academy for Medical Education and Simulation, Centre for HR and Education , Capital Region of Denmark, Copenhagen , Denmark

4. Copenhagen Intestinal UltraSound , Copenhagen , Denmark

5. Department of Obstetrics, Copenhagen University Hospital , Rigshospitalet , Denmark

6. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark

7. Department of Gastroenterology and Hepatology, Amsterdam University Medical Center , Amsterdam , The Netherlands

8. Department of Medicine, Division of Gastroenterology, University of Calgary , Calgary, AB , Canada

9. Department of Medicine and Anesthesia, University of California San Francisco , San Francisco, CA , USA

10. Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev , Herlev , Denmark

11. Digestive Disease Center, Copenhagen University Hospital - Bispebjerg , Copenhagen , Denmark

Abstract

Abstract Background and Aims Intestinal ultrasound has become a crucial tool for assessing inflammation in patients with inflammatory bowel disease, prompting a surge in demand for trained sonographers. Whereas educational programmes exist, the length of training needed to reach proficiency in correctly classifying inflammation remains unclear. Our study addresses this gap partly by exploring the learning curves associated with the deliberate practice of sonographic disease assessment, focusing on the key disease activity parameters of bowel wall thickness, bowel wall stratification, colour Doppler signal, and inflammatory fat. Methods Totals of 21 novices and six certified intestinal ultrasound practitioners engaged in an 80-case deliberate practice online training programme. A panel of three experts independently graded ultrasound images representing various degrees of disease activity and agreed upon a consensus score. We used statistical analyses, including mixed-effects regression models, to evaluate learning trajectories. Pass/fail thresholds distinguishing novices from certified practitioners were determined through contrasting-groups analyses. Results Novices showed significant improvement in interpreting bowel wall thickness, surpassing the pass/fail threshold, and reached mastery level by Case 80. For colour Doppler signal and inflammatory fat, novices surpassed the pass/fail threshold but did not achieve mastery. Novices did not improve in assessing bowel wall stratification. Conclusions We found considerable individual- and group-level differences in learning curves, supporting the concept of competency-based training for assessing bowel wall thickness, colour Doppler signal, and inflammatory fat. However, despite practice over 80 cases, novices did not improve in their interpretation of bowel wall stratification, suggesting that a different approach is needed for this parameter.

Publisher

Oxford University Press (OUP)

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