Analysis of Training Formats for Point of Care Obstetrics in the Third Trimester of Pregnancy

Abstract

The availability of point of care (POC) obstetric ultrasound services has improved the outcome for mothers and babies in remote regions around the world. However, there is an increasing demand to create efficient, cost effective POC training courses for monitoring of the fetus. This is particularly important for Outreach programs in regions where access to training and resources are limited. To evaluate the efficacy of targeted ultrasound point-of-care training programs, that assesses the fetus during the third trimester. Over a 12month period the skill teaching curriculum of five obstetric POC courses was evaluated. The specific parameters include: • 45 learners’: 4-20 / course Nil with prior ultrasound experience • 12 learners’ had English as a second language (EASL) 5 medical graduates & 7 midwives • Course duration: 4-10 hours • Didactic lecture time: 0-4 hours (0-60%) • Practical time: 2.5-7 hours (60-100%) • Tutor/learner ratio 1:6 maximum All courses included the teaching of probe manipulation, image optimization (depth, focus & gain), & limited knobology. Practical sessions included supervised scanning of various commercial & hand made phantoms prior to scanning standardized patients who were in the 3rd trimester of pregnancy. The teaching outcomes that were assessed included: image optimization, determine fetal lie, measure fetal heart rate, measure the single deepest pocket of amniotic fluid, & identify the cervix and placental position. All 45 participants achieved the limited course objectives, regardless of the mix of the course curriculum. However, there were five EASL learner’s (4 midwives and 1 medical graduate) who were unable to complete a post lecture written test as they identified that this was due to the language barrier. Conclusion: This study has confirmed that obstetric POC training courses can guide the initial psychomotor skills that are required for limited third trimester scanning. However performance beyond the course practice session requires further research. The educational value of this teaching format has yet to be evaluated as to its ability to equip the learner with the skills that are required to practice beyond the course duration.