[Optimizing training in limited obstetric ultrasound for midwives through a combination of e-learning and simulation]

Shaping ultrasound in midwifery: towards an evidence-based training framework for enhanced prenatal care

BACKGROUND

Academic advancement of the midwifery profession highlights the need to establish standardized qualifications in obstetric ultrasound diagnosis, being a central part of prenatal care. Thus, introduction of an evidence-based training program is warranted. We aimed to reviewed curriculum designs used in midwifery ultrasound education.

METHODS

A systematic literature research was conducted. Embase, PubMed and Google Scholar database was reviewed for publications using the terms "[midwife], [midwives], [midwifery students], [obstetric ultrasound], [midwife sonographer] and [education], [teaching], [program], [course], [curriculum] and [learning]". Papers with full description of curriculum designs or educational programs on obstetrical ultrasound for midwives were included and scrutinized against pre-defined criteria according to the PICO (Population, Intervention, Comparator, Outcomes) scheme.

RESULTS

29 publications were included. Studies demonstrated a significant disparity according to course concepts being used. Differing parameters included: Duration, structure, learning approaches, course content, examination concepts and target groups (practising midwives vs. midwives in education).

CONCLUSION

An evidence-based ultrasound educational program for midwives remains to be developed, including further educational guidelines. Clinical applications by midwives, as well as the distinctions from medical practise, particularly in terms of legal considerations, needs to be defined.

Level of agreement between midwives and obstetricians performing ultrasound examination during labor

OBJECTIVE

To evaluate the level of agreement between ultrasound measurements to evaluate fetal head position and progress of labor by attending midwives and obstetricians after appropriate training.

METHODS

In this prospective study, women in the first stage of labor giving birth to a single baby in cephalic presentation at our Obstetric Unit between March 2018 and December 2019 were invited to participate; 109 women agreed. Transperineal and transabdominal ultrasound was independently performed by a trained midwife and an obstetrician. Two paired measurements were available for comparisons in 107 cases for the angle of progression (AoP), in 106 cases for the head-to-perineum distance (HPD), in 97 cases for the cervical dilatation (CD), and in 79 cases for the fetal head position.

RESULTS

We found a good correlation between the AoP measured by obstetricians and midwives (intra-class correlation coefficient [ICC] = 0.85; 95% confidence interval [CI] 0.80-0.89). There was a moderate correlation between the HPD (ICC = 0.75; 95% CI 0.68-0.82). There was a very good correlation between the CD measured (ICC = 0.94; 95% CI 0.91-0.96). There was a very good level of agreement in the classification of the fetal head position (Cohen's κ = 0.89; 95% CI 0.80-0.98).

CONCLUSIONS

Ultrasound assessment of fetal head position and progress of labor can effectively be performed by attending midwives without previous experience in ultrasound.

Metrics used to evaluate obstetric ultrasound skills on simulators: A systematic review

Obstetric ultrasound simulators are now used for training and evaluating OB/GYN students but there is a lack of literature about evaluation metrics in this setting. In this literature review, we searched MEDLINE and the COCHRANE database using the keywords: (Obstetric OR Fetal) AND (Sonography OR Ultrasound) AND Simulation. Of a total of 263 studies screened, we selected nine articles from the title and the abstract in PubMed, in the past 5 years. Two more article were added from bibliographies. A total of 11 articles were therefore included. from which nine articles were selected from the title and the abstract in PubMed. Two more articles were added from the bibliographies For each study, data about the type of simulation, and the metrics (qualitative or quantitative) used for assessment were collected. The selection of studies shows that evaluation criteria for ultrasound training were qualitative metrics (binary success/fail exercise ; dexterity quoted by an external observer ; Objective Structured Assessment of Ultrasound Skills (OSAUS) Score ; quality of images according to Salomon's score) or quantitative criteria (Accuracy of Biometry - Simulator generated metrics). Most studies used a combination of both. To date, simulator metrics used to discriminate ultrasound skills are performance score quoted by external observers and image quality scoring. Whether probe trajectory metrics can be used to discriminate skills is unknown.