摘要
目的 探索利用线上阅片培训的远程医疗教育模式对提升新疆维吾尔自治区(以下简称"新疆地区")眼科医师眼底疾病诊断能力的可行性与效果.方法 建立新疆生产建设兵团系统师级医院-兵团医院-北京协和医院三级阅片培训体系.2022年6月至2023年1月连续收集自新疆地区兵团医院和兵团医疗系统内4家师级医院眼科的后极部彩色眼底像4 159张.其中,高血压视网膜病变、糖尿病视网膜病变、渗出型年龄相关性黄斑变性(AMD)、萎缩型AMD、视网膜静脉阻塞分别为3 073、651、43、186、206张.图像按病种比例均分为3轮次(初次、二次、末次)阅片的图像集.参与培训(以下简称"参训")医师来自新疆地区兵团医院和兵团系统师级医院的15名眼科医师.其中,男性7名,女性8名;年龄(38.1±4.0)岁.职称正高级、副高级、中级、初级分别为1、6、5、3名;学历本科、硕士分别为13、2名.从事眼底病专科工作时间(9.6±3.3)年.第一轮标注前进行阅片系统培训,每轮阅片后由北京协和医院医师对阅片结果进行反馈和讲解.每轮次阅片间诊断一致率、灵敏度、特异性比较行成对样本t检验;参训医师诊断水平提高与职称、学历、年龄、眼底病专业工作时间的相关性行Spearman或Pearson相关性分析.结果 所有参训医师均完成初次、二次、末次阅片.每一轮次阅片结束后均进行了阅片总结,时间2h.所有参训医师初次、二次、末次阅片的平均诊断一致率分别为53.0％、67.0％、75.0％;灵敏度和特异性分别为0.38、0.69、054和0.66、0.85、0.96.初次与末次阅片诊断一致率比较,差异有统计学意义(P＜0.001);二次阅片灵敏度较初次阅片明显提高,末次阅片灵敏度较二次阅片明显下降,差异均有统计学意义(P＜0.05);二次阅片较初次阅片、末次阅片较二次阅片的特异性明显提高,差异均有统计学意义(P＜0.05).参训医师诊断水平提升与学历(Rho=0.07)、职称(Rho=0.13)、年龄(r=0.20)、眼底病专科工作时间(r=0.26)等因素均无明显相关性(P＞0.05).结论 依托三级线上远程医疗培训,可提升新疆地区眼科医师的眼底疾病诊断能力;初步远程医疗教育模式在偏远地区医疗资源不足的情况下展示了可行性和有效性的潜力.
Abstract
Objective To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region(hereinafter referred to as"Xinjiang Region")in diagnosing fundus diseases.Methods The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established.From June 2022 to January 2023,4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system.Among them,hypertensive retinopathy,diabetic retinopathy,exudative age-related macular degeneration(AMD),atrophic AMD and retinal vein occlusion were 3 073,651,43,186 and 206 cases,respectively.The images were divided into 3 rounds(first,second and last)according to the proportion of diseases.The doctors who participated in the training(hereinafter referred to as the"training")were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system.There were 7 male and 8 female.Age was(38.1±4.0)years.The titles of senior,deputy senior,intermediate and junior are 1,6,5 and 3 respectively;Bachelor's degree and master's degree are 13 and 2 respectively.The working time of fundus disease specialty was(9.6±3.3)years.The film reading system training was conducted before the first round of labeling,and after each round of film reading,the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results.The diagnostic consistency,sensitivity and specificity were compared by paired sample t test.Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title,education,age and working hours of ocular fundus disease.Results All the participating doctors completed the first,second and last reading.After each round of film reading,the film reading summary was carried out for 2 hours.The average diagnostic agreement rates of participating physicians were 53.0％,67.0％and 75.0％,respectively.The sensitivity and specificity were 0.38,0.69,054 and 0.66,0.85,0.96,respectively.There was significant difference between the first and last examination(P＜0.001).The sensitivity of the second reading was significantly higher than that of the first reading,and the sensitivity of the last reading was significantly lower than that of the second reading,with statistical significance(P＜0.05).The specificity of the second reading was significantly higher than that of the first reading,and the last reading was significantly higher than that of the second reading,with statistical significance(P＜0.05).There was no significant correlation(P＞0.05)between the improvement of diagnostic level of participating physicians and educational background(Rho=0.07),professional title(Rho=0.13),age(r=0.20),and working time of ophthalmofundus disease specialty(r=0.26).Conclusions Relying on the three-level online telemedicine training,it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases.The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.
维普
万方数据