Self-study of the non-extension sign in an e-learning program improves diagnostic accuracy of invasion depth of early gastric cancer
Authors: Kato Minoru , Uedo Noriya , Nagahama Takashi , Yao Kenshi , Doyama Hisashi , Tsuji Shigetsugu , Gotoda Takuji , Kawamura Takuji , Ebi Masahide , Yamamoto Katsumi , Akasaka Tomofumi , Takatori Hajime , Handa Osamu , Akamatsu Takuji , Nishikawa Jun , Hikichi Takuto , Yamashina Takeshi , Imoto Akira , Kitamura Yoko , Mikami Tatsuya , Koike Tomoyuki , Ohara Shuichi , Kitamura Shinji , Yamaguchi Tatsuya , Kinjo Tetsu , Inoue Taro , Suzuki Sho , Kaneko Akihiro , Hirasawa Kingo , Tanaka Kyosuke , Kotachi Takahiro , Miwa Kazuhiro , Toya Yosuke , Kayaba Shoichi , Ikehata Atsushi , Minami Shinya , Mizukami Kazuhiro , Oya Hirohisa , Ara Nobuyuki , Fukumoto Yasushi , Komura Takuya , Yoshio Toshiyuki , Morizono Ryutaro , Yamazaki Kenji , Shimodate Yuichi , Yamanouchi Kohei , Kawata Noboru , Kumagai Masayuki , Sato Yoshinori , Umeki Kiyotaka , Kawai Daisuke , Tanuma Tokuma , Kishino Maiko , Konishi Jun , Sumiyoshi Tetsuya , Oka Shohei , Kono Mitsuhiro , Sakamoto Takeshi , Horikawa Yohei , Ohyauchi Motoki , Hashiguchi Keiichi , Waseda Yohei , Kasai Toyotaka , Aoyagi Hiroyuki , Oyamada Hirokazu , Shoji Masakuni , Kiyotoki Shu , Asonuma Sho , Orikasa Shunsuke , Akaishi Chika , Nagami Yasuaki , Nakata Satoshi , Iida Fumiyo , Nomura Tatsuma , Tominaga Kei , Oka Kohei , Morita Yoshinori , Suzuki Haruhisa , Ozeki Keiji , Kuribayashi Shiko , Akazawa Yoichi , Sasaki Sho , Mikami Tetsuhiko , Miki Goro , Sano Tatsushi , Satoh Hiro , Nakamura Munetaka , Iwai Wataru , Tawa Hideki , Wada Masafumi , Yoshimura Daisuke , Hisanaga Yasuhiro , Shimokawa Toshio , Ishikawa Hideki 
Published: July 2019

Abstract
Background and study aims We developed an e-learning program for endoscopic diagnosis of invasion depth of early gastric cancer (EGC) using a simple diagnostic criterion called non-extension sign, and the contribution of self-study quizzes to improvement of diagnostic accuracy was evaluated.
Methods We conducted a prospective randomized controlled study that recruited endoscopists throughout Japan. After completing a pretest, the participants watched video lectures and undertook post-test 1. The participants were then randomly allocated to either the self-study or non-self-study group, and participants in the first group completed the self-study program that comprised 100-case quizzes. Finally, participants in both groups undertook post-test 2. The primary endpoint was the difference in post-test 2 scores between the groups. The perfect score for the tests was set as 100 points.
Results A total of 423 endoscopists completed the pretest and were enrolled. Post-test 1 was completed by 415 endoscopists and 208 were allocated to the self-study group and 207 to the non-self-study group. Two hundred and four in the self-study group and 205 in the non-self-study group were included in the analysis. Video lectures improved the mean score of post-test 1 from 72 to 77 points. Participants who completed the self-study quizzes showed significantly better post-test 2 scores compared with the non-self-study group (80 vs. 76 points, respectively, P < 0.0001).
Conclusions Our e-learning program showed that self-study quizzes consolidated knowledge of the non-extension sign and improved diagnostic ability of endoscopists for invasion depth of EGC.