Characterizing the Learning Curve and Accuracy of Wireless Capsule Endoscopy Interpretation amongst Digestive Healthcare Practitioners

Abstract

Goals: To prospectively evaluate the accuracy and learning curve of trainees to interpret wireless capsule endoscopy (WCE). Background: Trainees and mid-level providers are often used as first-line readers to earmark WCE images that are subsequently reviewed by an attending gastroenterologist. This practice has been demonstrated to be cost-effective and highly accurate, but the learning curve of trainees and physician extenders has not been well described. Study: Each WCE trainee individually reviewed and interpreted 48 fulllength de-identified WCE studies and recorded significant findings, time required to interpret each study, and confidence of the interpretation. After every 10 studies, each trainee reviewed WCE findings with the expert. The first 10 studies were considered the training period with the next 19 studies considered study period 1 and last 19 studies considered study period 2. Reading times were compared using Wilcoxon rank-sum tests. Results: The median time for WCE interpretation improved significantly from the training period to the first study period for each trainee; GI fellow (41 min vs. 21 min, p<0.002), CRNP fellow (67 min vs. 33 min, p<0.002), RN (82 min vs. 30 min, p<0.001). Median reading times appeared to plateau for the GI fellow and CRNP fellow after 10 and 20-25 studies, respectively. This finding suggests that additional studies are unlikely to improve reading efficiency. The GI nurse never plateaus during the study. Confidence improved for all trainees during the study; however, in the final study period, the GI fellow reported higher confidence than the CRNP fellow, who reported higher confidence than the GI nurse. After the training period of 10 capsule studies, the MD fellow was found to have a higher sensitivity (89%), specificity (95%) and accuracy (92%) compared to other trainees. Conclusion: Reading time, self-reported confidence, and accuracy appear to be good markers for assessing learning. Twenty-five capsule studies appear to be sufficient for trainees enrolled in a GI fellowship program who are actively performing endoscopy; however physician extenders who do not perform endoscopy appear to require interpretation of more than 25 WCE studies before adequate proficiency is achieved.