ABSTRACT
Introduction As more specialists become dual accredited in internal medicine, non-gastroenterology specialists have greater exposure to gastroenterology patients over the course of their training, especially via the acute take. Simultaneously, the COVID pandemic has meant most regular local teaching has moved online with varying quality. This project aimed to evaluate 1) whether a standardised protocol can be used to successfully deliver large scale digital gastroenterology teaching that 2) is non-inferior when compared with traditional face to face teaching. Methods Teaching was delivered to internal medical trainees on the acute management of ulcerative colitis and chronic liver disease. Two sessions were delivered a year apart, initially regionally, and then nationally. This was delivered via Zoom, using a standardised protocol based on guidelines to ensure consistency, with live-polled multiple-choice questions to encourage interaction. Each session was followed by Q&A related to that topic. Feedback was taken after each session. Outcome measures analysed were: number in attendance, whether viewers would recommend this teaching to others, whether they thought it ran smoothly, and how they felt about it when compared with face-to-face teaching as measured on a Likert scale. Given the subjective nature of our hypotheses, we accept that these are surrogate markers. Results 171 trainees attended the initial regional teaching session and 469 the subsequent session. Following the first session, 98.9% of trainees would recommend the teaching to others, rising to 99.7% after the second session. 99% and 99.5% respectively agreed or strongly agreed with the statement the initial session ran smoothly, while 84.5% and 88.8% agreed or strongly agreed that digital teaching was as effective as face to face. The benefits of digital teaching were no travel (90%) ability to watch later (86%), whereas the downsides were loss of social interaction (60%) and harder to get study leave (39%). Conclusions Gastroenterology teaching for non-specialists can be delivered successfully at a large scale using a standardised protocol for digital teaching. The vast majority of trainees felt that digital sessions were as effective as face-to-face teaching with a lack of travel and flexibility on viewing time the main reported benefits.
ABSTRACT
Objective: Asthma diagnostic guidelines from NICE mandate up to five tests in a sequential algorithm, three of which are aerosol generating procedures (AGPs) [spirometry, reversibility (BDR), bronchial challenge testing (BCT)]. The SARS-CoV-2 pandemic has resulted in significant restrictions to AGPs, highlighting the urgent need for an alternative diagnostic model. We aimed to develop a 'rule-in' diagnostic model using non AGPs [chest auscultation, exhaled nitric oxide (FeNO), two week-peak flow variability (PEFv) and serum eosinophils (eos)] which would enable GPs to confidently diagnose asthma in a subgroup of patients and reduce the need for AGPs and onward referral. Methods: Symptomatic but untreated patients with physician-suspected asthma were referred into the RADicA (Rapid Access Diagnostics in Asthma) study. Patients underwent clinical consultation followed by tests including FeNO, spirometry, BDR, PEFv, BCT, and eos. Asthma diagnosis was made on the basis of all available information (including response to eight weeks inhaled corticosteroid treatment) by a panel of respiratory physicians. Data from patients coded as 'definite asthma' or 'not asthma' were evaluated, individually and in combination in order to investigate which non-AGP tests could predict asthma. PEFv was classified as a non-AGP because it is not performed in the clinical setting. Results: Of 61 symptomatic adults [median (IQR) age 32(26-44)yrs, 62% female] 61% had 'definite asthma' by expert panel decision. Each of the four non-AGP tests were able to predict asthma with low sensitivity and high specificity (figure 1). Using established cut-offs (PEFv>20%, FeNO≥40ppb, eos>0.4 × 109/L), an algorithm which simply required the presence of two or more positive tests was able to 'rule-in' asthma with a specificity (95% CI) of 100(78-100)%, sensitivity 20(8-39)%. In comparison using all available tests required for the NICE algorithm resulted in a sensitivity of 53(34-72)%, specificity 100(79-100)%. Conclusion: Four simple non-AGPs could be used in primary care to accurately diagnose asthma. The majority of patients (Figure presented) with negative tests would still require further investigation, and so it is clear that AGPs, or novel alternatives, are still required for the diagnosis of asthma in most patients.