Online Self-Evaluation of Fetal Ultrasound Images for Medical Continuing Education: A Randomised Controlled Trial

Suha Jaudi,Marc Dommergues,Louise Chevalier,Nicolas Fries,Sophie Tezenas Du Montcel,Alain Daher

doi:10.11648/j.edu.20190805.17

Abstract

Continuing medical education in the field of fetal ultrasound imaging is based on expert audit of still images, a time consuming approach. Our objective was to determine if self-evaluation of the images a professional produced is as effective as audit and feedback by an expert as a method of continuous medical education. We designed a prospective blinded randomized controlled trial. 321 ultrasonographers uploaded on a continuous medical education website a first set of 30 biometry images (10 cephalic, 10 abdominal and 10 femoral) from 10 consecutive second or third trimester normal screening scans. In arm 1: participants (N = 151) assessed their own images online according to a standardized procedure, and received feedback with detailed recommendations for change, automatically generated based on their assessment. The images were also audited by an expert, but participants remained blinded to the expert’s rating. In arm 2: participants (N = 177) had their images assessed by an expert and received a feedback, formatted as in arm 1, automatically generated based on the expert’s assessment Three to 6 months later, participants uploaded a second set of images, audited by an expert. A total of 19,680 images were audited. In the self-assessment group, the percentage of images meeting all criteria (IMAC) rose from 55 to 62.2 (p < 0.0001). In the expert-assessment and feedback group, the percentage of IMAC rose from 54.2 to 59.1 (p < 0.0001). Improvement in image quality was equivalent in both groups with a difference in IMAC increase of 2.3 percentage points (95%CI: -1.7 to + 6.4). In conclusion, online training based on self-assessment of fetal ultrasound images was as effective as expert audit and feedback. NCT02074592.

Highlights

Audit and feedback of ultrasound images is widely used in continuous medical education as a strategy to improve practice [1]
The fact that self-evaluation was not applied to continuing medical education for producing sonographic imaging is unexpected, since ultrasound basically consists in producing images meeting predefined criteria
As judged by the increase in images meeting all criteria (IMAC), improvement in image quality was equivalent in both groups

Summary

Introduction

Audit and feedback of ultrasound images is widely used in continuous medical education as a strategy to improve practice [1]. Various programs of audit and feedback of second trimester ultrasound images are available [2,3,4,5] Online audit and feedback programs have the advantage of being user friendly, and allow for blind evaluation of the trainee. They are time consuming for the experts in charge of evaluating the images submitted by the participants. The fact that self-evaluation was not applied to continuing medical education for producing sonographic imaging is unexpected, since ultrasound basically consists in producing images meeting predefined criteria. Measurements made on a poor still image are flawed, underscoring the importance of appropriate images

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Conclusion