355 Learning Curves Using Cumulative Sum Analysis (CUSUM) for the Histologic Characterization of Diminutive Colorectal Polyps Using a Computer-Based Teaching Module and Narrow Band Imaging (NBI) Videos: Implications for Resect and Discard Strategy

355 Learning Curves Using Cumulative Sum Analysis (CUSUM) for the Histologic Characterization of Diminutive Colorectal Polyps Using a Computer-Based Teaching Module and Narrow Band Imaging (NBI) Videos: Implications for Resect and Discard Strategy Swati G. Patel*, Amit Rastogi, Gregory L. Austin, Matthew Hall, Brittany a. Siller, Kenneth Berman, Ajay Bansal, Roy D. Yen, Dennis J. Ahnen, Sachin Wani Division of Gastroenterology & Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO; Division of Gastroenterology & Hepatology, Veterans Affairs Medical Center, Kansas City, MO; Division of Gastroenterology & Hepatology, Veterans Affairs Medical Center, Denver, CO Background: A paradigm shift of a “diagnose, resect and discard” strategy for diminutive ( 5 mm) colorectal polyps has been proposed. ASGE has established thresholds for this strategy in the recently published PIVI document. Appropriate training tools to achieve these benchmarks need to be developed and assessed before this strategy can be considered in clinical practice. Aims: To determine the impact of a computer-based training tool on the ability of GI trainees to correctly characterize diminutive polyp histology using NBI video clips and to establish the learning curve of this training among GI trainees. Methods: A 20 min audiovisual teaching tool was presented to GI trainees describing validated NBI criteria to distinguish adenomas from hyperplastic polyps. Trainees then viewed 80 randomly distributed short videos of polyps 5 mm under NBI without magnification (52 adenomas, 28 hyperplastic polyps). Trainees reported predicted polyp histology and degree of confidence (high90%, low90%). After each video, feedback was provided regarding histology by reviewing NBI criteria that supported the diagnosis. Trainee performance was measured by comparing predicted and actual histology. Cochran-Armitage test for trend was used to determine if accuracy and proportion of high confidence diagnoses improved as trainees progressed through the videos. In order to detect a change in accuracy of 70% to 85% with 90% power and of 0.05, 348 observations were required. CUSUM analysis was used to produce a learning curve for each trainee. Acceptable and unacceptable failure rates of 10% and 15%, respectively, were used. Results: 12 GI trainees [1st year (n 3), 2nd year (n 4), 3rd year (n 5)] with varying levels of colonoscopy experience (51 to 500 procedures) completed the study. Trainee performance is summarized in Table 1. There was a significant improvement in accuracy rates and proportion of high-confidence predictions as trainees progressed through video blocks (p value for trend 0.001). With active feedback, all trainees achieved a 90% accuracy rate and 90% NPV for adenomatous histology by the end of the session. Trainees had a variable threshold for achieving acceptable performance, ranging from 46 to 58 videos (Figure). A median of 49 videos was required to achieve competency. Year of training, number of colonoscopies performed, and training track had no impact on achieving competency. Conclusion: Using a novel structured computer-based teaching tool combined with NBI videos presented with targeted and dynamic feedback, this study demonstrates a learning curve of 50 videos for trainees to achieve 90% accuracy for diagnosing diminutive polyp histology. Defining the learning curve is an important step towards making real-time histology prediction a reality and these results need to be validated during live colonoscopy procedures. Trainee Performance and Percentage of High Confidence Diagnoses (95% Confidence Intervals) by Polyp Video Block