45 Outcomes and potential impact of a virtual hands-on training program on MRI staging confidence and performance in rectal cancer 3 User feedback and effect of virtual training on diagnostic confidence. Table 3 compares the perceived difficulty scores assigned by the 42 participants before and after completion of the course. Overall there was a significant decrease in the perceived difficulty level (p=0.03), indicating an improved diagnostic confidence. Pre-course, on average 17% of the cases were perceived as difficult, which decreased to 8% after completion of the course. When asked to rate the usefulness of the current virtual training approach compared to an on-site workshop on a 5-point scale, the average score received by the participants was 3.7 (suggesting a preference for online training). Table 3 Perceived difficulty scores assigned to the seven test cases by the 42 participants Pre-test Post-test Easy 27% 24% Moderate 56% 67% Difficult 17% 8% Note. Percentages are average scores for the 42 participants multiplied by the 7 test cases (i.e. 294 responses in total). A mixed effect model was used to test the effect of the course on the perceived difficulty scores. A logistic regression using the pre- and post-course as the main outcome and the difficulty scores as a covariate showed an estimate of -1.02 (p=0.03) Discussion Using a newly developed web platform for online teaching, a group of 42 international radiologists participated in a dedicated stepwise online training program focused on MRI staging of rectal cancer comprised of online lectures, MDT meeting demonstrations, independent case-based training with online feedback, and online expert feedback sessions. Though we fully acknowledge that our study was not powered to perform a detailed analysis or draw any firm conclusions on the merit of our course program on the diagnostic performance of individual staging variables, we did observed some interesting global trends. When comparing the baseline staging results of the participating radiologists to their post-course results, we observed overall tendency towards an increase in diagnostic staging accuracy ranging from +2 to +17%, albeit largely not statistically significant in our small number of test cases. This was accompanied by an improved interobserver agreement and significantly increased staging confidence. Several previous studies have demonstrated the impact of radiologists’ expertise levels – and hence the importance of dedicated training and teaching – when staging rectal cancer on MRI[1–4, 15]. For example, Rafaelsen et al. showed a significant difference
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