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Groos J, Walter A, Wittek A, Strizek B, Gembruch U, Recker F. Shaping ultrasound in midwifery: towards an evidence-based training framework for enhanced prenatal care. Arch Gynecol Obstet 2024; 310:23-43. [PMID: 38771531 PMCID: PMC11169037 DOI: 10.1007/s00404-024-07558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
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.
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Affiliation(s)
- Julia Groos
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Adeline Walter
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Agnes Wittek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
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Matschl J, Gembruch U, Strizek B, Recker F. Shaping the future of obstetric/gynecological ultrasound training. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:717-722. [PMID: 38031232 DOI: 10.1002/uog.27554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Affiliation(s)
- J Matschl
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - B Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - F Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Bidner A, Bezak E, Parange N. Antenatal ultrasound needs-analysis survey of Australian rural/remote healthcare clinicians: recommendations for improved service quality and access. BMC Public Health 2023; 23:2268. [PMID: 37978505 PMCID: PMC10655468 DOI: 10.1186/s12889-023-17106-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Ultrasound is the primary diagnostic tool in pregnancy, capable of identifying high-risk pregnancies and life-threatening conditions, allowing for appropriate management to prevent maternal and fetal morbidity and mortality. Women and babies from rural and remote Australia and low-resource areas worldwide experience poorer health outcomes and barriers to accessing antenatal care and imaging services. Healthcare clinicians working in these regions face significant challenges practising with limited resources and accessing training opportunities. OBJECTIVE To perform an exploratory needs-analysis survey investigating the availability, accessibility and use of antenatal ultrasound in rural Australia, exploring rural clinicians' interest in and access to ultrasound training opportunities. METHODS The survey tool for this cross-sectional study was designed and distributed as an anonymous online questionnaire targeting healthcare clinicians (doctors, nurses, midwives, clinic managers, Aboriginal healthcare workers) providing antenatal care in rural regions. Descriptive analysis was applied to quantitative data and thematic analysis was used to explore qualitative components. RESULTS A total of 114 valid survey responses were analysed. Overall, 39% (43/111) reported ultrasound was not used when providing antenatal care to patients at their clinic, stating 'Lack of ultrasound equipment (73%,29/40) and inaccessibility of training opportunities (47%,19/40) as the main reasons. For those with ultrasound (61%,68/111), estimating due date (89%,57/64) was the main use, and limited training/skills to operate the equipment (59%,38/64) and inaccessibility/distance of training opportunities (45%,29/64) were the most commonly reported barriers. Clinicians described a lack of childcare options (73%,74/102), long distances to reach ultrasound services (64%,65/102), appointment (59%,60/102) and transport availability/times (46%,47/102) as the main obstacles to patient access. Increased attendance, compliance with care directives, parental bonding and improved lifestyle choices were described by respondents as positive outcomes of antenatal ultrasound use. CONCLUSIONS Future efforts to combat inequitable service access must adopt a coordinated approach to meet the needs of pregnant women in low-resource settings. Providing portable ultrasound equipment, training in antenatal Point-of-Care ultrasound (PoCUS) with ongoing support/mentoring and accreditation of health professionals could strengthen rural workforce capacity. This, along with addressing the complex economic, environmental and socio-cultural barriers faced by patients, could improve service access and pregnancy outcomes in rural and remote communities.
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Affiliation(s)
- Amber Bidner
- Allied Health and Human Performance, The University of South Australia, Corner of North Terrace and Frome Road, Adelaide, SA, 5001, Australia.
| | - Eva Bezak
- Allied Health and Human Performance, The University of South Australia, Corner of North Terrace and Frome Road, Adelaide, SA, 5001, Australia
- Department of Physics, The University of Adelaide, North Terrace, Adelaide, SA, 5001, Australia
| | - Nayana Parange
- Allied Health and Human Performance, The University of South Australia, Corner of North Terrace and Frome Road, Adelaide, SA, 5001, Australia
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4
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Ultrasound Examinations Performed by Registered Nurses in Obstetric, Gynecologic, and Reproductive Medicine Settings: Clinical Competencies and Education Guide, Fifth Edition. Nurs Womens Health 2023; 27:e12-e25. [PMID: 36759284 DOI: 10.1016/j.nwh.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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5
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Ultrasound Examinations Performed by Registered Nurses in Obstetric, Gynecologic, and Reproductive Medicine Settings: Clinical Competencies and Education Guide, Fifth Edition. J Obstet Gynecol Neonatal Nurs 2023; 52:e9-e22. [PMID: 36759268 DOI: 10.1016/j.jogn.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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6
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Casmod Y, Armstrong SJ. Obstetric ultrasound training programmes for midwives: A scoping review. Health SA 2023; 28:2163. [PMID: 36873781 PMCID: PMC9983282 DOI: 10.4102/hsag.v28i0.2163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/06/2022] [Indexed: 02/04/2023] Open
Abstract
Background Antenatal care is essential for all expectant mothers and assists in reducing maternal mortality rates thus addressing the Sustainable Development Goal 3. Obstetric ultrasound complements antenatal care and is used in pregnancy to identify and monitor high-risk pregnancies. However, disparities exist and in low- and middle-income countries, ultrasound services are not readily available. This contributes to maternal and neonatal morbidity and mortality within these populations. Short ultrasound training programmes for midwives can be beneficial in alleviating some of the challenges experienced. Aim The aim of this scoping review was to identify global ultrasound education programmes for midwives. Method Articles containing suitable keywords were retrieved from databases suitable to nursing, education and ultrasound. Themes were developed based on the articles included in the review. Results A total of 238 articles were identified, and after the duplicates and irrelevant studies were removed, 22 articles were included. Articles were analysed and discussed under the identified themes and categories. Conclusion It is essential that sufficient training is provided to medical professionals performing obstetric ultrasound so that adequate and safe care is offered to expectant mothers. With the introduction of ultrasound in low-resource settings, the knowledge of safety and competencies required to operate the equipment necessitate adequate training. Developed programmes have been found to meet the demands of the ever-changing workforce and allow for midwives to perform focused obstetric ultrasound examinations. Contribution This scoping review highlighted ultrasound training programmes for midwives and provided guidance on the development of future midwifery ultrasound training programmes.
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Affiliation(s)
- Yasmin Casmod
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Medical Imaging and Radiation Sciences, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Susan J Armstrong
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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7
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Bidner A, Bezak E, Parange N. Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study. BMC MEDICAL EDUCATION 2022; 22:906. [PMID: 36585662 PMCID: PMC9805197 DOI: 10.1186/s12909-022-03888-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 11/10/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND There is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically. METHODS This prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees' knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians . The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees' clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees. RESULTS Pre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8, P < 0.0001). At 6 months, 62% of trainees were performing PoCUS that had assisted in patient management and clinical diagnosis, and 46% reported earlier diagnosis and changes to patient management. 74% of trainees had increased scanning frequency and 93% reported improved scanning confidence. CONCLUSION This study demonstrated intensive 2-day workshops can equip clinicians with valuable antenatal PoCUS skills, offering a viable solution to assist in the assessment and management of pregnant women in the rural/resource-poor setting where access to ultrasound services is limited or non-existent. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the continuing professional development of remote trainees and the implementation of PoCUS.
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Affiliation(s)
- Amber Bidner
- Allied Health and Human Performance, The University of South Australia, Corner of North Terrace and Frome Road, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Eva Bezak
- Allied Health and Human Performance, The University of South Australia, Corner of North Terrace and Frome Road, GPO Box 2471, Adelaide, SA 5001 Australia
- Department of Physics, The University of Adelaide, North Terrace, Adelaide, SA 5001 Australia
| | - Nayana Parange
- Allied Health and Human Performance, The University of South Australia, Corner of North Terrace and Frome Road, GPO Box 2471, Adelaide, SA 5001 Australia
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8
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Bidner A, Bezak E, Parange N. Evaluation of antenatal Point-of-Care Ultrasound (PoCUS) training: a systematic review. MEDICAL EDUCATION ONLINE 2022; 27:2041366. [PMID: 35382705 PMCID: PMC8986272 DOI: 10.1080/10872981.2022.2041366] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION There is limited access to life-saving antenatal ultrasound in rural and low-resource settings largely due to shortages in skilled staff. Studies have shown healthcare practitioners can be upskilled in PoCUS through focused training, offering a viable solution to this deficit. However, standards for training and competency assessment are unclear and regulation surrounding practice is lacking. We aimed to review published literature examining antenatal PoCUS training programs, comparing teaching approaches and study methodologies. METHODS A search of electronic databases EMBASE, MEDLINE and Google Scholar was conducted. Original research articles evaluating antenatal PoCUS training of healthcare professionals worldwide were identified for analysis. Articles with limited detail on the PoCUS training intervention and those describing comprehensive diagnostic training programs were excluded. Evaluations were compared against the Kirkpatrick Evaluation Framework (KEF). RESULTS Twenty-seven studies were included from an initial search result of 484 articles. There was considerable heterogeneity between the PoCUS training programs described. Course duration ranged from 3 hours to 2 years, with 11 of the 27 studies delivering obstetric-exclusive content. 44% trained multidisciplinary groups of health professionals. Long-term follow-up training and skills assessments were lacking in over half of the reviewed studies. Study quality and reporting detail varied, but overall beneficial outcomes were reported with 3/4s of the studies reaching upper KEF levels 3 and 4. CONCLUSION PoCUS performed by upskilled healthcare professionals offers an attractive solution to the problem of inequitable access to antenatal ultrasound. A review of available literature highlighted a paucity of comparable high-quality studies needed to establish a stronger evidence base for antenatal PoCUS, and a need to standardise training and competency assessment. This review may inform educators, researchers and policy-makers on existing training formats and methodologies to assist in establishing best practice antenatal PoCUS training methods for safe service delivery by remote healthcare professionals.
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Affiliation(s)
- Amber Bidner
- Department of Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia
- CONTACT Amber Bidner Department of Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia
| | - Eva Bezak
- Department of Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia
- Department of Physics, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nayana Parange
- Department of Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia
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Maeda Y, Hasegawa A, Miyake R, Dofutsu M, Higuchi Y, Osaku D, Suemitsu T, Onodera Y, Shozu M, Miura K, Yoshida Y, Komatsu H, Watari H. Association of online activities with obstetrics and gynecology specialty choice: a nationwide online survey. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:261-266. [PMID: 36183190 PMCID: PMC9905000 DOI: 10.5116/ijme.6320.36eb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To investigate the association between online activities and the number of new obstetrics and gynecology senior residents. METHODS A nationwide web-based, self-administered anonymous survey was conducted to investigate recruitment and clerkship activities during the coronavirus disease 2019 pandemic. An online questionnaire was sent to 576 obstetrics and gynecology training institutions in Japan between December 21, 2020, and January 31, 2021. Overall, 334 institutions that gave valid responses were included (response rate: 58.0%). Multivariate logistic regression analysis examined the association between online activities, including recruitment and clerkship activities, and the number of new obstetrics and gynecology senior residents in 2021. The stratified analysis by implementing face-to-face activities was conducted to clarify the association. RESULTS The number of new senior residents increased in 187 facilities (56.0%) and decreased in 147 facilities (44.0%). The facilities that implemented face-to-face and online activities were 185 (55.4%) and 120 (35.9%), respectively. In multivariate logistic regression analysis, an increased number of new obstetrics and gynecology senior residents was significantly associated with face-to-face activities (adjusted odds ratio (AOR)=2.58, 95% confidence interval (CI): 1.11-5.97, p<.001) but not with online activities. In the stratified analysis, online activities were significantly associated with an increased number of new obstetrics and gynecology senior residents among the facilities without face-to-face activities (AOR=3.81, 95% CI: 1.40-10.32, p=.009) but not among those with face-to-face activities (AOR=0.87, 95% CI: 0.42-1.78). CONCLUSIONS Online activities were associated with an increased number of new obstetrics and gynecology senior residents among the facilities that did not conduct face-to-face activities.
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Affiliation(s)
- Yuto Maeda
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akihiro Hasegawa
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryuta Miyake
- Department of Obstetrics and Gynecology, Nara Medical University, Japan
| | - Mihoko Dofutsu
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yayoi Higuchi
- Department of Obstetrics and Gynecology, Kochi University, Kochi, Japan
| | - Daiken Osaku
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Tokumasa Suemitsu
- Department of Obstetrics and Gynecology, Kameda Medical Center, Chiba, Japan
| | - Yohei Onodera
- Department of Obstetrics and Gynecology, Akita University Graduate School of Medicine, Akita, Japan
| | - Makio Shozu
- Evolution and Reproductive Biology, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Kiyonori Miura
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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10
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Baatarpurev B, Tsogbadrakh B, Bandi S, Samdankhuu GE, Nyamjav S, Badamdorj O. Online continuing medical education in Mongolia: needs assessment. KOREAN JOURNAL OF MEDICAL EDUCATION 2022; 34:191-200. [PMID: 36070989 PMCID: PMC9452369 DOI: 10.3946/kjme.2022.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/17/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Due to the shortage in the healthcare workforce, insufficient qualifications, a lack of infrastructure and limited resources in Mongolia, it is not always possible for healthcare workers in rural areas who wish to attend continuous training and retraining courses to do so. However, in order to provide high-quality care, the demand for distance learning and the upgrading of knowledge and practice of many medical topics (especially related to morbidity and mortality) are necessary for the rural population. This study aimed to assess the needs of e-learning medical education, of graduates in Mongolia. METHODS A cross-sectional research design was implemented. We collected data from 1,221 healthcare professionals (nursing professionals, physicians, midwives, and feldshers) who were randomly selected from 69 government hospitals in Mongolia. Data were collected using self-assessment questionnaires which captured the needs assessment in a survey for online continuous medical education in Mongolia. Data were analyzed using descriptive statistics and Kruskal-Wallis statistical test. RESULTS Ninety percent of the respondents reported that they plan on attending online continuous medical education with the most preferred specialty area being emergency medicine. Results using the Kruskal-Wallis statistical technique suggested the preferred specialty area, educational content, appropriate time schedule, available devices, and tools were statistically significant and were different between the nursing professionals, physicians, midwives, and feldshers (p<0.05). CONCLUSION Findings provide important evidence for the implementation of measures and strategies which can assist healthcare professionals in low and middle-income areas/countries to constructively address their need for enhanced knowledge and practice through distance learning.
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Affiliation(s)
- Baljinnyam Baatarpurev
- Division for Faculty Development and E-Learning, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Basbish Tsogbadrakh
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Solongo Bandi
- School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Gal-Erdene Samdankhuu
- Division for Faculty Development and E-Learning, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Sumberzul Nyamjav
- Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
| | - Oyungoo Badamdorj
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar,
Mongolia
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11
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Messina MP, Piccioni MG, Petrella C, Vitali M, Greco A, Ralli M, Ceccanti M, Ferraguti G, Neri I, Ricchi A, Fiore M, D'Angelo A. Advanced midwifery practice: intrapartum ultrasonography to assess fetal head station and comparison with vaginal digital examination. Minerva Obstet Gynecol 2021; 73:253-260. [PMID: 33851805 DOI: 10.23736/s2724-606x.21.04687-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Vaginal digital examination is considered the gold standard to evaluate patients during labor and delivery. However, transperineal ultrasound has been suggested as an effective tool in determining fetal head station during labor. Angle of progression (AOP), head-perineal distance (HPD) and head-symphysis distance (HSD) are reliable parameters to assess fetal head station during labor. The study aims were to evaluate how midwives can use AOP, HSD, HPD to assess the accuracy of digital vaginal exploration limited to the fetal head station. METHODS Trained midwives for ultrasound analyses performed transperineal ultrasounds during the first stage of labor with 2D-convex probe in 62 pregnant women at term with a single fetus in cephalic presentation. Immediately before the intrapartum ultrasound, the birth attendant performed a digital examination to assess cervical dilatation and head station. The ultrasound scans were compared to the digital vaginal examination through the Tutschek's formula. RESULTS AOP was wider in women who delivered vaginally without any complication if compared to "complicated delivery" group. HPD and HSD were greater in women who underwent an operative vaginal delivery or caesarean section. The vaginal exploration accuracy was 34%, but when ±1 cm was considered as tolerated, the overall accuracy was 74.19%. CONCLUSIONS Midwives may include ultrasounds in their clinical practice after adequate training or under the supervision of an ultrasound professional as an adjunct tool during labor to evaluate its progress and prevent any deviation from physiology.
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Affiliation(s)
- Marisa P Messina
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Maria G Piccioni
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Rome, Italy
| | | | - Antonio Greco
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Mauro Ceccanti
- SIFASD - Italian Society for the Study of Fetal Alcohol Spectrum Disorder, Rome, Italy
| | | | - Isabella Neri
- University of Modena and Reggio Emilia, Modena, Italy
| | - Alba Ricchi
- University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Rome, Italy - marcofiore.roma @gmail.com.,Department of Sense Organs, Sapienza University, Rome, Italy
| | - Alessio D'Angelo
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
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12
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Smith CJ, Matthias T, Beam E, Wampler K, Pounds L, Nickol D, Shope RJ, Carlson K, Michael K. A Mixed-Methods Evaluation of Medical Residents' Attitudes Towards Interprofessional Learning and Stereotypes Following Sonography Student-Led Point-of-Care Ultrasound Training. J Gen Intern Med 2020; 35:3081-3086. [PMID: 32779142 PMCID: PMC7572976 DOI: 10.1007/s11606-020-06105-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) training is growing across internal medicine graduate medical education, but lack of trained faculty is a barrier to many programs. Interprofessional education (IPE) may offer a solution but must overcome potential biases of trainees. AIM To evaluate the impact of an interprofessional POCUS training on residents' attitudes towards interprofessional learning and stereotypes. SETTING Midwestern health sciences university. PARTICIPANTS Diagnostic medical sonography (DMS) students (n = 13) served as teachers for first-year internal medicine residents (IMR) (n = 49). PROGRAM DESCRIPTION DMS students participated in a train-the-trainer session to learn teaching strategies via case-based simulation, then coached IMR to acquire images of the kidneys, bladder, and aorta on live models. PROGRAM EVALUATION Mixed-methods evaluation, including pre-/post-surveys and focus group interviews. The survey response rate was 100% (49/49 IMR). Composite survey scores evaluating residents' attitudes towards IPE and stereotyping of sonographers improved significantly following the intervention. Qualitative analysis of focus group interviews yielded four themes: enhanced respect for other disciplines, implications for future practice, increased confidence of DMS students, and interest in future IPE opportunities. DISCUSSION Interprofessional POCUS education can improve residents' perceptions towards IPE, increase their level of respect for sonographers, and motivate interest in future interprofessional collaboration.
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Affiliation(s)
- Christopher J Smith
- Department of Internal Medicine, Division of General Internal Medicine, Section of Hospital Medicine, Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, USA.
- Interprofessional Academy of Educators, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Tabatha Matthias
- Department of Internal Medicine, Division of General Internal Medicine, Section of Hospital Medicine, Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
- Interprofessional Academy of Educators, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elizabeth Beam
- Interprofessional Academy of Educators, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kathryn Wampler
- Interprofessional Academy of Educators, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Medical Imaging & Therapeutic Sciences, Diagnostic Medical Sonography Program, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lea Pounds
- Interprofessional Academy of Educators, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Devin Nickol
- Interprofessional Academy of Educators, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Internal Medicine, Division of General Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ronald J Shope
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kristy Carlson
- Department of Internal Medicine, Division of General Internal Medicine, Section of Hospital Medicine, Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kimberly Michael
- Interprofessional Academy of Educators, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Medical Imaging & Therapeutic Sciences, Diagnostic Medical Sonography Program, University of Nebraska Medical Center, Omaha, NE, USA
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13
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Zimmermann R, Mousty E, Mares P, Letouzey V, Huberlant S. [Optimizing training in limited obstetric ultrasound for midwives through a combination of e-learning and simulation]. ACTA ACUST UNITED AC 2019; 47:836-840. [PMID: 31634587 DOI: 10.1016/j.gofs.2019.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate a training program in limited obstetric ultrasound, combining e-learning and simulation. METHODS This a descriptive cohort study in Single-center study conducted in a French university hospital. Thirty-three practicing midwives who had not received basic training in ultrasonography had unlimited access to an e-learning platform offering interactive theoretical instruction modules. Then, they attended a one-day simulator-based obstetric ultrasound workshop. A theoretical competency test was taken before the e-learning component (T1), then before (T2) and after (T3) the simulation workshop. Their competency in specific practical tasks was assessed before and after the workshop. A learner satisfaction questionnaire was completed after the program. RESULTS The mean score obtained in the theoretical competency test was 46.6% (range 8.3-83.3%) at T1, 87.2% (66.6-100%) at time T2, and 91.6% (66.6-100%) at T3. Significant improvements were observed between times T1 and T2 (P<0.001) or T3 (P<0.001), as well as in the performance of certain practical tasks, such as placental location (P=0.02) and visualization of the cervix (P=0.03). The mean number of logins to the e-learning platform during the program was 11.2 per participant (6-24). Most participants were satisfied with the training and reported an improvement in their daily practice. CONCLUSION Training in limited obstetric ultrasound, combining e-learning to acquire theoretical knowledge and a hands-on simulation workshop, appears to meet the needs of practicing midwives. Most participants were satisfied with the proposed teaching and the rapid acquisition of ultrasound skills applicable to their clinical practice.
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Affiliation(s)
- R Zimmermann
- Département de gynécologie obstétrique, centre hospitalier Alès, 30100 Alès, France
| | - E Mousty
- Département de gynécologie obstétrique, centre hospitalo-universitaire Caremeau, 30029 Nîmes, France
| | - P Mares
- Département de gynécologie obstétrique, centre hospitalo-universitaire Caremeau, 30029 Nîmes, France; École de maïeutique, université de Montpellier, site de Nîmes, 30000 Nîmes, France
| | - V Letouzey
- Département de gynécologie obstétrique, centre hospitalo-universitaire Caremeau, 30029 Nîmes, France
| | - S Huberlant
- Département de gynécologie obstétrique, centre hospitalo-universitaire Caremeau, 30029 Nîmes, France.
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Smith CJ, Matthias T, Beam E, Wampler K, Pounds L, Nickol D, Carlson K, Michael K. Building a bigger tent in point-of-care ultrasound education: a mixed-methods evaluation of interprofessional, near-peer teaching of internal medicine residents by sonography students. BMC MEDICAL EDUCATION 2018; 18:321. [PMID: 30591050 PMCID: PMC6307233 DOI: 10.1186/s12909-018-1437-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Point-of-care-ultrasound (POCUS) training is expanding in undergraduate and graduate medical education, but lack of trained faculty is a major barrier. Two strategies that may help mitigate this obstacle are interprofessional education (IPE) and near-peer teaching. The objective of this study was to evaluate a POCUS course in which diagnostic medical sonography (DMS) students served as near-peer teachers for internal medicine residents (IMR) learning to perform abdominal sonography. METHODS Prior to the IPE workshop, DMS students participated in a train-the-trainer session to practice teaching and communication skills via case-based simulation. DMS students then coached first-year IMR to perform POCUS examinations of the kidney, bladder, and gallbladder on live models. A mixed-methods evaluation of the interprofessional workshop included an objective structured clinical exam (OSCE), course evaluation, and qualitative analysis of focus group interviews. RESULTS Twenty-four of 24 (100%) IMR completed the OSCE, averaging 97.7/107 points (91.3%) (SD 5.2). Course evaluations from IMR and DMS students were globally positive. Twenty three of 24 residents (96%) and 6/6 DMS students (100%) participated in focus group interviews. Qualitative analysis identified themes related to the learning environment, scanning technique, and suggestions for improvement. IMR felt the interprofessional training fostered a positive learning environment and that the experience complimented traditional faculty-led workshops. Both groups noted the importance of establishing mutual understanding of expectations and suggested future workshops have more dedicated time for DMS student demonstration of scanning technique. CONCLUSION An interprofessional, near-peer workshop was an effective strategy for teaching POCUS to IMR. This approach may allow broader adoption of POCUS in medical education, especially when faculty expertise is limited.
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Affiliation(s)
- Christopher J. Smith
- Department of Internal Medicine, University of Nebraska Medical Center, Section of Hospital Medicine, 986430 Nebraska Medical Center, Omaha, NE 68198-6430 USA
| | - Tabatha Matthias
- Department of Internal Medicine, University of Nebraska Medical Center, Section of Hospital Medicine, 986430 Nebraska Medical Center, Omaha, NE 68198-6430 USA
| | - Elizabeth Beam
- University of Nebraska Medical Center, Interprofessional Academy of Educators, 987115 Nebraska Medical Center, Omaha, NE 68198-7115 USA
| | - Kathryn Wampler
- Department of Medical Imaging & Therapeutic Sciences, Diagnostic Medical Sonography Program, University of Nebraska Medical Center, 984545 Nebraska Medical Center, Omaha, NE 68198-4545 USA
| | - Lea Pounds
- Department of Health Promotion, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4320 USA
| | - Devin Nickol
- Department of Internal Medicine, Division of General Internal Medicine, University of Nebraska Medical Center, 986430 Nebraska Medical Center, Omaha, NE 68198-6430 USA
| | - Kristy Carlson
- Department of Internal Medicine, Section of Hospital Medicine, 986430 Nebraska Medical Center, Omaha, NE 68198-6430 USA
| | - Kimberly Michael
- Department of Medical Imaging & Therapeutic Sciences, Diagnostic Medical Sonography Program, University of Nebraska Medical Center, 984545 Nebraska Medical Center, Omaha, NE 68198-4545 USA
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15
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Antony KM, Khurshid N, Trampe B, Gupta VK, Iruretagoyena JI, Stewart KS, Shah D. Structured Training for Fetal Diagnostic Skills in a Maternal-Fetal Medicine Fellowship. AJP Rep 2018; 8:e251-e260. [PMID: 30370179 PMCID: PMC6202070 DOI: 10.1055/s-0038-1675344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 09/05/2018] [Indexed: 11/18/2022] Open
Abstract
Objective The American Institute of Ultrasound in Medicine has described what constitutes a detailed fetal anatomic examination but what comprises an appropriate physician training program has not been described. The purpose of this paper is to describe a highly-structured program developed by our center to train maternal-fetal medicine fellows in a systematic approach to fetal diagnostic imaging. Study Design We describe this approach in three phases. Phase I: Development of Skills as a Perinatal Sonographer, Phase II: Mentored Evolution to a Perinatal Sonologist and Phase III: Supervised Independent Practice as Consultant-in-training. Results This curriculum was implemented in 2006. Of the eight maternal-fetal medicine fellows who completed this program, 100% were capable of following this curriculum and 100% felt comfortable performing and interpreting detailed sonograms including sonograms with significant and uncommon anomalies. Qualitative feedback was also positive. Finally, this structured approach resulted in an increase in the average total number of sonograms interpreted. Conclusion Our curriculum, by following the explicit guidelines and expectations set out by the American Institute of Ultrasound in Medicine and the American Board of Obstetrics and Gynecology for practicing maternal-fetal medicine fellowship graduates, provides an opportunity to explore national standardization for this component of training.
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Affiliation(s)
- Kathleen M Antony
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nauman Khurshid
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, ProMedica Toledo Hospital, University of Toledo, Toledo, Toledo, Ohio
| | - Barbara Trampe
- Meriter Center for Perinatal Care, Meriter-UnityPoint Health, Madison, Wisconsin
| | - Vivek K Gupta
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - J Igor Iruretagoyena
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Katharina S Stewart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Dinesh Shah
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Fullerton J, Butler M, Aman C, Reid T. Global competencies for midwives: external cephalic version; ultrasonography, and tobacco cessation intervention. Women Birth 2018; 32:e413-e420. [PMID: 30174206 DOI: 10.1016/j.wombi.2018.08.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
Abstract
PROBLEM AND BACKGROUND The International Confederation of Midwives (ICM) conducts regular updates to the Essential Competencies for Basic Midwifery Practice to determine the introduction or retention of items in the global scope of midwifery practice guidance document. AIM This article presents the review process that underpinned the deliberation about three specific clinical practices: external cephalic version, prenatal ultrasonography, and tobacco cessation interventions that occurred during the 2016-2017 global update study. METHODS A brief outline of the research methodology used in the 2016-2017 study is provided. Literature summaries about safety and effectiveness of three clinical skills are offered. Data addressing global and regional variations in support of each practice and final disposition of the items are documented. FINDINGS External cephalic version did not receive sufficient document support for inclusion in the initial list of items to be tested in the study. Prenatal ultrasonography was supported as an advanced (76.6%) or country-specific (18.8%) skill that midwives could acquire, to promote wider global access for pregnant women. Midwives' participation in tobacco cessation counselling was supported (≥85%) in each of ICM's regions. Knowledge about World Health Organization recommendations for nicotine replacement therapy was endorsed as an additional (62.4%) or country-specific (29.3%) skill. DISCUSSION AND CONCLUSION The current evidence of safety of midwives performing external cephalic version led to the recommendation that it be considered in the next document update. Conflicting views of midwives' role in acquiring skills to conduct prenatal ultrasound were evident. There was strong support for participation in smoking cessation counselling, but knowledge of World Health Organization recommendations was not highly endorsed.
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Affiliation(s)
| | - Michelle Butler
- Faculty of Science and Health, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - Cheryl Aman
- Midwifery Program, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
| | - Tobi Reid
- Midwifery Program, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
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DeLeo A, Geraghty S. iMidwife: midwifery students’ use of smartphone technology as a mediated educational tool in clinical environments. Contemp Nurse 2017; 54:522-531. [DOI: 10.1080/10376178.2017.1416305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Annemarie DeLeo
- School of Nursing & Midwifery, Edith Cowan University, Perth, Western Australia
| | - Sadie Geraghty
- School of Nursing & Midwifery, Edith Cowan University, Perth, Western Australia
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Vinayak S, Sande J, Nisenbaum H, Nolsøe CP. Training Midwives to Perform Basic Obstetric Point-of-Care Ultrasound in Rural Areas Using a Tablet Platform and Mobile Phone Transmission Technology-A WFUMB COE Project. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2125-2132. [PMID: 28716434 DOI: 10.1016/j.ultrasmedbio.2017.05.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 05/22/2017] [Accepted: 05/27/2017] [Indexed: 05/09/2023]
Abstract
Point-of-care ultrasound (POCUS) has become a topical subject and can be applied in a variety of ways with differing outcomes. The cost of all diagnostic procedures including obstetric ultrasound examinations is a major factor in the developing world and POCUS is only useful if it can be equated to good outcomes at a lower cost than a routine obstetric examination. The aim of this study was to assess a number of processes including accuracy of images and reports generated by midwives, performance of a tablet-sized ultrasound scanner, training of midwives to complete ultrasounds, teleradiology solution transmissions of images via internet, review of images by a radiologist, communication between midwife and radiologist, use of this technique to identify high-risk patients and improvement of the education and teleradiology model components. The midwives had no previous experience in ultrasound. They were stationed in rural locations where POCUS was available for the first time. After scanning the patients, an interim report was generated by the midwives and sent electronically together with all images to the main hospital for validation. Unique software was used to send lossless images by mobile phone using a modem. Transmission times were short and quality of images transmitted was excellent. All reports were validated by two experienced radiologists in our department and returned to the centers using the same transmission software. The transmission times, quality of scans, quality of reports and other parameters were recorded and monitored. Analysis showed excellent correlation between provisional and validated reports. Reporting accuracy of scans performed by the midwives was 99.63%. Overall flow turnaround time (from patient presentation to validated report) was initially 35 min but reduced to 25 min. The unique mobile phone transmission was faultless and there was no degradation of image quality. We found excellent correlation between final outcomes of the pregnancies and diagnoses on the basis of reports generated by the midwives. Only 1 discrepancy was found in the midwives' reports. Scan results versus actual outcomes revealed 2 discrepancies in the 20 patients identified as high risk. In conclusion, we found that it is valuable to train midwives in POCUS to use an ultrasound tablet device and transmit images and reports via the internet to radiologists for review of accuracy. This focus on the identification of high-risk patients can be valuable in a remote healthcare facility.
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Affiliation(s)
- Sudhir Vinayak
- Department of Imaging and Diagnostic Radiology, Aga Khan University Hospital, Nairobi, Kenya.
| | - Joyce Sande
- Department of Imaging and Diagnostic Radiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Harvey Nisenbaum
- Department of Medical Imaging, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Christian Pállson Nolsøe
- Department of Abdominal Surgery and Gastroenterology, Ultrasound Section, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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