Training and Assessment of Clinician’s Utilization of the Los Angeles Classification for Reflux Esophagitis

Background: Endoscopic recognition of reflux esophagitis is critical for the evaluation and treatment of patients with gastroesophageal reflux disease; however, there are limited data on the need for education to minimize interobserver disagreement in clinical practice. Methods: We created an educational program for the LA classification on the International Working Group for the Classification of Oesophagitis (IWGCO) website that included endoscopic video recordings of the distal esophagus. Participants completed an entry survey before the training module and were able to proceed to subsequent training videos once they provided the correct LA classification. Participants then completed a test module—an 80% score was required to pass. Descriptive analyses and regression analyses were performed to analyze data. Results: In the entry survey, 83/90 (92%) participants reported using the LA classification for the majority or all patients with reflux symptoms. However, only 31/90 (34%) participants reported feeling very or completely confident in the use of the LA classification. Only 3/71 (4.2%) participants correctly classified all 9 training videos on their first attempt. The testing module was completed by 60 participants, 16 (26.7%) of whom passed after one attempt, with 32 (53.3%), 8 (13.3%), and 1 (1.7%) passing after 2, 3, and 4 attempts, respectively. There was no significant correlation between the number of attempts to successfully pass the testing module and participant characteristics. Conclusion: Even after a training module, >75% of participants required more than one attempt to correctly classify the test videos. Further structured education around the LA classification is needed.