An Educational Intervention to Improve Physician Confidence and Knowledge About Transvaginal Sonographic Cervical Assessment in Obstetric Patients

Abstract

Local Mentor: David Forstein, DO APGO Advisors: Jody Steinauer, MD, MAS, and Sonya Erickson, MD PURPOSE: To evaluate the effect of an educational intervention about transvaginal sonographic cervical length (CL) measurement on obstetrics and gynecology residents' confidence and knowledge. BACKGROUND: Preterm labor admissions are costly. Transvaginal ultrasound measurement of CL has a high negative predictive value for preterm delivery, and can help triage patients with symptoms. Education about transvaginal CL measurement may increase use of this screening tool when triaging patients with preterm labor symptoms. METHODS: This was a before and after study of OB/Gyn residents at a single institution. The intervention consisted of an educational module adapted from a preexisting module from AIUM. Nine pre- and post-test questions evaluated knowledge. Residents were asked about their confidence with each answer and in doing CL measurements. Chi-squared tests were used to compare proportions and ordinal data, and Wilcoxon rank sum test the proportion of correct answers. RESULTS: Twenty-one residents participated. The proportion of residents answering 89% or more of the questions correctly increased from 5% before to 81% (P<.01). The level of confidence about answers to knowledge-based questions about the technique increased significantly, (P<.01) however confidence in doing CL measurement did not change, with 52% of residents saying they were not confident before and 38% after the intervention (P=.4). DISCUSSION: An educational module can increase knowledge about the utility and performance of cervical length measurement, but does not change confidence in doing the measurement. Future efforts should include curricula to teach the actual measurement.