Ultrasound Training Course Research Articles

Effect of ultrasound training of physicians working in the prehospital setting.

BackgroundAdvances in technology have made ultrasound (US) devices smaller and portable, hence accessible for prehospital care providers. This study aims to evaluate the effect of a four-hour, hands-on US training course for physicians working in the prehospital setting. The primary outcome measure was US performance assessed by the total score in a modified version of the Objective Structured Assessment of Ultrasound Skills scale (mOSAUS).MethodsPrehospital physicians participated in a four-hour US course consisting of both hands-on training and e-learning including a pre- and a post-learning test. Prior to the hands-on training a pre-training test was applied comprising of five videos in which the participants should identify pathology and a five-minute US examination of a healthy volunteer portraying to be a shocked patient after a blunt torso trauma. Following the pre-training test, the participants received a four-hour, hands-on US training course which was concluded with a post-training test. The US examinations and screen output from the US equipment were recorded for subsequent assessment. Two blinded raters assessed the videos using the mOSAUS.ResultsForty participants completed the study. A significant improvement was identified in e-learning performance and US performance, (37.5 (SD: 10.0)) vs. (51.3 (SD: 5.9) p = < 0.0001), total US performance score (15.3 (IQR: 12.0-17.5) vs. 17.5 (IQR: 14.5-21.0), p = < 0.0001) and in each of the five assessment elements of the mOSAUS.ConclusionIn the prehospital physicians assessed, we found significant improvements in the ability to perform US examinations after completing a four-hour, hands-on US training course.

Bedside ultrasound training at Muhimbili National Hospital in Dar es Salaam, Tanzania and Hospital San Carlos in Chiapas, Mexico.

IntroductionIn resource-rich settings, bedside ultrasound has rapidly evolved to be a crucial part of emergency centre practice and a growing part of critical care practice. This portable and affordable technology may be even more valuable in resource-limited environments where other imaging modalities are inaccessible, but the optimal amount of training required to achieve competency in bedside ultrasound is largely unknown. We sought to evaluate the feasibility of implementation of a mixed-modality bedside ultrasound training course for emergency and generalist acute care physicians in limited resource settings, and to provide a description of our core course components, including specific performance goals, to facilitate implementation of similar initiatives.MethodsWe conducted a standardised training course at two distinct sites—one large, urban tertiary hospital in Tanzania with a dedicated Emergency Centre, and one small, rural, hospital in southern Mexico with a general, acute intake area. We report on pre-training ultrasound use at both sites, as well as pre- and post-training views on most useful indications.ResultsOverall, participants were very satisfied with the course, although approximately one-third of the providers at both sites would have preferred more hands-on training. All participants passed a standardised exam requiring image acquisition and interpretation.DiscussionIntroducing bedside ultrasound training in two distinct resource-limited settings was feasible and well-received. After a brief intensive period of training, participants successfully passed a comprehensive examination, including demonstration of standardised image acquisition and accurate interpretation of normal and abnormal studies.

Resident Accuracy of Electromyography Needle Electrode Placement Using Ultrasound Verification

BackgroundElectromyography (EMG) and musculoskeletal (MSK) ultrasound (US) are core learning objectives during physical medicine and rehabilitation (PM&R) training. However, there have been no prior studies using MSK US to assess the acquisition of EMG procedural skills during residency training. This study aims to demonstrate the differences in skillful needle placement between junior and senior physiatry residents. The integration of both EMG and MSK US may have tremendous potential for additional learning opportunities related to electrodiagnostic education. ObjectiveTo determine the accuracy of anatomic landmark–guided EMG needle electrode placement in commonly used muscles by PM&R resident physicians. DesignCross-sectional study. SettingAn academic PM&R residency program. ParticipantsTwelve (5 postgraduate year [PGY] –3 and 7 PGY-4) PM&R resident physicians participating in a MSK US training course. MethodsTwelve PM&R residents in the eighth month of their third and fourth years of postgraduate training performed anatomic landmark–guided needle placement to the extensor indicis proprius (EIP), pronator teres (PT), peroneus longus (PL), and soleus muscles of live subjects. Once the needle electrode was satisfactorily placed, needle localization was verified with US. Main Outcome MeasuresAccuracy of EMG needle electrode placement. ResultsThe overall accuracy of needle electrode placement for all resident participants was 68.8%. The mean accuracy of the 4 selected muscles was 50% by PGY-3 residents and 82.1% for PGY-4 residents (P = .01). EIP was the most commonly missed muscle, with correct placement performed by 20% of PGY-3 and 42.9% of PGY-4 residents. PGY-3 residents demonstrated 60% accuracy with localizing the PT, PL, and soleus muscles. PGY-4 residents demonstrated 85.7% accuracy for PT, and 100% accuracy for both PL and soleus muscles. ConclusionsSenior residents demonstrated greater accuracy of landmark-guided needle placement than junior residents. EMG procedural skills are important milestones in PM&R training, and MSK US may be a useful tool to enhance resident learning.

Point-of-care ultrasonography improves the diagnosis of splenomegaly in hospitalized patients.

BackgroundIt is important to detect splenomegaly as it can have important diagnostic implications. Previous studies, however, have shown that the traditional physical examination is limited in its ability to rule in or rule out splenomegaly.ObjectiveTo determine if performing point-of-care ultrasonography (POCUS) in addition to the traditional physical examination improves the sensitivity and specificity for diagnosing splenomegaly.MethodsThis was a prospective trial of diagnostic accuracy. Physical and sonographic examinations for splenomegaly were performed by students, residents and attending physicians enrolled in an ultrasound training course. Participants received less than 1 h training for ultrasound diagnosis of splenomegaly. The findings were compared to radiographic interpretation of gold standard studies.Setting/patientsHospitalized adult patients at an academic medical center without severe abdominal pain or recent surgery who had abdominal CT, MRI or ultrasound performed within previous 48 h.ResultsThirty-nine subjects were enrolled. Five patients had splenomegaly (12.5 %). The physical examination for splenomegaly had a sensitivity of 40 % (95 % CI 12–77 %) and specificity of 88 % (95 % CI 74–95 %) while physical examination plus POCUS had a sensitivity of 100 % (95 % CI 57–100 %) and specificity of 74 % (95 % CI 57–85 %). Physical examination alone for splenomegaly had an LR+ of 3.4 (95 % CI 0.83–14) and LR− of 0.68 (95 % CI 0.33–1.41); for physical exam plus POCUS the LR+ was 3.8 (2.16–6.62) and LR− was 0.ConclusionsPoint-of-care ultrasonography significantly improves examiners’ sensitivity in diagnosing splenomegaly.

The Experience of Emergency Pediatric Ultrasound Education Course

Purpose The purpose of this paper is to assess the experience and satisfaction of the trainees participating in the Emergency Pediatric Ultrasound Training Course, which has been developed from a close cooperation between the Korean Society of Pediatric Emergency Medicine and Society of Emergency and Critical Care Imaging. Methods A task-force team was formed consisting of 8 members, collectively from both Korean Society of Pediatric Emergency Medicine and Society of Emergency and Critical Care Imaging. Over 9 separate discussion sessions, the team reviewed related articles to reach a consensus on an educational framework, a curriculum for the training course, and teaching methods to adapt to the conditions of Pediatric Emergency Medicine in South Korea. Results After running the course twice with a developed curriculum, the trainees were polled for their training experiences. A total of 36 trainees completed <one of> the course. The response rates were 81.3% and 40% in the first and second course, respectively. On average, the ratings by participants in the survey were above a 4 for all questions, which are significantly high scores. Over sixty percent of participants rated 4 or above in the Likert scale for all of the questions. Conclusion Korean Society of Pediatric Emergency Medicine and Emergency Imaging Study Group (now renamed to Society of Emergency & Critical Care Imaging) successfully developed the Emergency Pediatric Ultrasound Course, which was rated significantly favorably by the trainees. Key Words: Ultrasonography; Pediatrics; Emergency Medicine; Education

Feasibility of a focused ultrasound training course for medical undergraduate students

Feasibility of a focused ultrasound training course for medical undergraduate students

Feasibility and Acceptability of a Structured Curriculum in Teaching Procedural and Basic Diagnostic Ultrasound Skills to Internal Medicine Residents

Point-of-care ultrasound has emerged as a powerful diagnostic tool and is also being increasingly used by clinicians to guide procedures. Many current and future internists desire training, yet no formal, multiple-application, program-wide teaching interventions have been described. We describe a structured 30-hour ultrasound training course in diagnostic and procedural ultrasound implemented during intern orientation. Internal medicine interns learned basic ultrasound physics and machine skills; focused cardiac, great vessel, pulmonary, and abdominal ultrasound diagnostic examinations; and procedural applications. In postcourse testing, learners demonstrated the ability to acquire images, had significantly increased knowledge scores (P < .001), and demonstrated good performance on practical scenarios designed to test abilities in image acquisition, interpretation, and incorporation into medical decision making. In the postcourse survey, learners strongly agreed (4.6 of 5.0) that ultrasound skills would be valuable during residency and in their careers. A structured ultrasound course can increase knowledge and can result in learners who have skills in image acquisition, interpretation, and integration in management. Future work will focus on refining and improving these skills to allow these learners to be entrusted with the use of ultrasound independently for patient care decisions.

A Unique Model for Ultrasound Assessment of Optic Nerve Sheath Diameter

Ultrasonic assessment of optic nerve sheath diameter (ONSD) as a non-invasive measure of intracranial pressure (ICP) has been evaluated in the literature as a potential valid technique for rapid ICP estimation in the absence of invasive intracranial monitoring. The technique can be challenging to perform and little literature exists surrounding intra-operator variability. In this study we describe the creation of a novel model of ONSD to be utilized in ultrasound training of this technique. We demonstrate the realistic ultrasonographic images created utilizing this novel model. We designed ocular models composed of gelatin spheres and variable three dimensional printed cylinders, which simulate the globe of the eye and variable ONSD's respectively. These models were suspended in a gelatin background and ultrasound of the ONSD was conducted using standard techniques described in the literature. This model produces clear and accurate representation of ONSD that closely mimics in vivo images. It is affordable and easy to produce in large quantities, portending its use in an educational environment. Utilizing the standard linear array ultrasound probe for ONSD measurements in our model provided realistic images comparable to in vivo. This provides an affordable and exciting means to test intra- and inter- operator variability in a standardized environment. Knowing this, we can further apply this novel model of ONSD to ultrasound teaching and training courses with confidence in its ability and the technique's ability to produce consistent results.

P33 Thoracic ultrasound training: How are we doing?—A national web-based survey

IntroductionThe 2010 British Thoracic Society guidelines strongly recommend the use of thoracic ultrasound for the investigation and management of pleural disease. Respiratory specialty trainees are expected to achieve level 1...

Education research: 33. Evaluation of the First BSR Ultrasound Anatomy Training Course

Education research: 33. Evaluation of the First BSR Ultrasound Anatomy Training Course

Feasibility of a focused ultrasound training programme for medical undergraduate students

Although ultrasound is a core skill for many clinical specialties, UK medical schools are not currently required to teach this skill. The College of Emergency Medicine (CEM) has championed the use of ultrasound to answer focused clinical questions in emergency settings. We have designed and piloted an ultrasound training course for undergraduate medical students addressing one important indication: ultrasound assessment of the abdominal aorta. Fourteen clinical students, who had no prior experience of using ultrasound, received focused ultrasound training in the form of didactic instruction, a short bedside practical workshop and self-directed learning over a 20-day period. At the end of this period, the students were assessed by a structured viva and an observed structured clinical examination (OSCE) used for accreditation by the CEM. The primary endpoint was the number of students who passed the assessment. The secondary endpoint was the accuracy of the students' anatomical measurements. Thirteen of the 14 (93%) students completed the training and assessment. Eight of the 13 (62%) students passed both the viva and OSCE, and were deemed to have achieved the CEM standard. The measurements by the competent students were not statistically different from those of experienced practitioners. We have shown for the first time that it is feasible to train inexperienced undergraduate students to scan the abdominal aorta to a professional standard using a focused training course. It is time for the medical education community to address whether focused ultrasound training should accompany traditional clinical skills, such as using a stethoscope, in UK medical school curricula.

Brief history parallel to the enthusiasm showed by rheumatologists at the American College of Rheumatology meeting for the musculoskeletal ultrasound

Musculoskeletal ultrasonography (MSU), a successful procedure widely used by European rheumatologists for years, was received with enormous enthusiasm by North American attendees at the recent American College of Rheumatology meeting held in Philadelphia. Primarily, this expectation was because musculoskeletal ultrasound (MSU) provides multiple beneWts in the diagnosis and interventions in rheumatology. This “tool” also promises a future in the follow-up and monitoring of patients with modern biological drugs; it has shown more accuracy in detecting disease activity in arthritic patients rather than clinical and serologic parameters [1–3]. At this meeting, some rheumatologists were mentioned that have been contributors to the increasing interest about MSU in the United States and who have responded also to the increased academic training demand in recent years. However, a very important and integral historic passage was omitted, which should be refreshing to new generations of rheumatologists. One decade ago, Dr. Antonio J. Reginato, originally from Chile, a brilliant rheumatologist and researcher, who was also closely linked with the studies of crystalline arthropathies, travelled to Switzerland, in April of 2000 to attend a EULAR Musculoskeletal Ultrasound training course. He had the same appreciation and enthusiasm that the European rheumatologists had for musculoskeletal ultrasound. Upon his return to New Jersey, he procured a GE LOGIQ 200 Pro Series machine (Fig. 1) while working at Cooper University Hospital and started clinical-based MSU. At the same time, he enthusiastically organized a wonderful workshop entitled: Cutting edge diagnostic techniques and invasive rheumatology for the millennium (Fig. 2), named after his mentor, Dr. Joseph Lee Hollander. This three-day course included three cores: diagnostic and surgical arthroscopy, intra-articular and peri-articular inWltrations and the minor surgical procedures, and an introductory workshop of musculoskeletal ultrasound. The ultrasound core was taught by experienced rheumatologists from Italy and Spain: Dr. Walter Grassi, Dr. Esperanza Naredo and Dr. Jacquelin Uson, and also Dr. Antonio BouVard, a senior musculoskeletal radiologist from Henry Ford Health System in Detroit, and expert in musculoskeletal ultrasound. The Hollander Workshop was the Wrst of its kind in the United States about MSU that involved international rheumatologists, and the course was attended by rheumatologists from the United States, Central, South and Latin America, as well as other parts of the world. Although, it did not receive any support from the American College of Rheumatology, there were 155 total attendees that participated in the three cores. Compared to recent workshops today accomplishing the rheumatologist dream’s [4, 5] this attendance seems minimal, but it was the beginning of ultrasound training for rheumatologist in United States. Dr. Reginato planned the next Cooper course of musculoskeletal ultrasound in 2003 with his then new Attending, Dr. Ralf Thiele and assistant, Debra Donato, for May 7–9, 2004. Unfortunately, he had been suVering from ALS and had an untimely death May 4, 2004. After his death, his assistant, named the January, 2005 course, “The Antonio J. Reginato—Musculoskeletal Ultrasound for Rheumatologists” as a tribute to him. This was followed by nine consecutive non-CME courses, successfully organized by A. Checa (&) Division of Rheumatology, Drexel University College of Medicine, 219 N Broad Street, Philadelphia, PA 19107, USA e-mail: checaag@comcast.net

Quality assured ultrasound simulator training for the detection of fetal malformations

Sonographic training in obstetrics differs broadly in Germany, although there are clearly defined quality-oriented requirements. In order to improve professional education, a training concept was devised utilizing an ultrasound simulator system. Between October 2004 and May 2006, 100 obstetric ultrasound training courses were held in 12 federal states of Germany. In these daily courses, doctors were trained in the detection of the most common malformations. One hundred training courses with a total of 1,266 participants. As a measure of quality assurance, a standardized questionnaire focusing on testing sonographic proficiency before and after the courses was issued in order to analyze the effect of these simulator-based ultrasound courses. Effectiveness of the method with reference to its potential role in structured sonographic training. The concept found prevailing approval (90%) at the level of principle, practical implementation, and clinical usefulness. Of the participants, 91% estimated their subjective training effect as good. The questionnaire analysis showed significant improvement. On average, 75.3% of the questions relating to sonographic proficiency were answered correctly at the end of the course as opposed to 48.6% at the beginning. Structured ultrasound training courses based on an ultrasound simulator system seem to be useful for defining a basic standardized quality of training and significantly improving examiners' skills. This is a suitable additional instrument to improve the education in obstetric ultrasound.

On a cold winter's day

Winter is here, it is cold outside. From my windows I can see that the Sound between Denmark and Sweden is covered with ice – like in the cold winter of 1658 when the Swedes used the frozen waterways to transport military troops. We were defeated and lost one third of Denmark to the Swedes. Like in those days, we did not expect a cold winter this year. Leading up to the Climate Summit in Copenhagen last December we had all expected a warm winter. Based on observational studies and extrapolations – admittedly poor evidence not higher than level 5 – we believed that the carbon dioxide we produced in recent years had changed the climate. And we thought that we would be able to control the weather by a slight change in behaviour. Did we insult the weather gods? Did we get too close to their jurisdiction? Was it Hybris to even suggest and discuss a plan for how to avoid climate changes? The answer is blowing in the cold wind. In times of uncertainty and even despair, it is nice to know that we have ACTA – the journal that publishes only scientific papers. Even if this issue of ACTA does not provide evidence that changes the World, it may give you some thoughts and ideas to come closer to an understanding of the nature of women, and the results of our care and interventions. In this issue of ACTA you will find an invitation to come to the European (EBCOG) and Nordic (NFOG) meetings this late spring. The chairman of EBCOG, Peter Hornnes, appraises the state of the current level of collaboration and harmonisation within Europe: It is too soon to have common European guidelines – they are simply unattainable. However, EBCOG wants to develop common standards – not to regulate the actual medical treatment – but to set up a framework to point out which issues we need to address and how. Examples of such standards are found in the guest comment. A European project on serious rare complications at delivery has been initiated by Marian Knight and Peter Brocklehurst from NPEU, Oxford. The project is based on reportings from delivery units in UK, who does not collect background data like the Nordic countries. In this issue of ACTA, colleagues from Italy (Stivanello et al.) report on peripartum hysterectomy and how far you can get with routine registration, without prospective collection of data in a specific project. The Nordic countries have started to collect case based data on peripartum hystertectomy, uterine rupture, placenta accreta and excessive postpartum bleeding using identical specific questionnaires – the NOSS project (www.noss.nu) – and will in this way update our knowledge on risk factors and current treatment modalities in these serious complications. We already have information on the background population and medical history and follow up in cases and controls in our medical birth registries and patient registers, which will enable us to get a more complete picture of the consequences of different attitudes towards cesarean delivery in obstetrics. In a commentary three UK researchers convey a dream that serum biomarkers may be used for a diagnosis of ectopic pregnancies in the future. Admittedly, we will need a lot of research before we have a kit – and we still need to select the women to test. Bols et al. have written an outstanding and very detailed systematic review of longitudinal studies on fecal incontinence after delivery – one of the subjects raised when we discuss mode of delivery and when we repair sphincter ruptures. They found that a third or fourth degree tear was the only factor that was associated with subsequent fecal incontinence. Now we only need good studies on how to prevent the ruptures – it seems that good Norwegian studies are on their way. Tyldum et al. in a well-defined cohort could not find any protective effect of pre-pregnancy physical activity on preeclampsia risk. This is an important message to convey to the prepregnant women who are on endorphins. The study is a good example of

An Unseen Danger: Frequency of Posterior Vessel Wall Penetration by Needles During Attempt to Place Internal Jugular Vein Central Catheters Using Ultrasound Guidance: Blaiva M, Adhikari S. Crit Care Med 2009;37:2345–9

This prospective, single-blinded study evaluated for posterior vessel wall penetration during ultrasound-guided internal jugular (IJ) catheter placement. It was conducted at an urban Level I trauma center with emergency medicine residents. The 25 residents that participated in the study had more than 2 years experience in ultrasound, performed more than 100 ultrasound-guided vascular-access procedures before the study, and participated in a 2-day ultrasound-training course. Each resident was asked to place an IJ catheter using ultrasound guidance in the short access view on life-sized torso models.

Ultrasound methods to distinguish between malignant and benign adnexal masses in the hands of examiners with different levels of experience

To determine the effect of an ultrasound training course on the performance of pattern recognition when used by less experienced examiners and to compare the performance of pattern recognition, a logistic regression model and a scoring system to estimate the risk of malignancy between examiners with different levels of experience. Using ultrasound images of selected adnexal masses, two trainees classified the masses as benign or malignant by using pattern recognition both before and after they had attended a theoretical gynecological ultrasound course. They also classified the masses by using a logistic regression model and a scoring system, but only after they had attended the course. The performance of these three methods when they were used by the trainees was then compared with that when they were used by experts. One hundred and sixty-five adnexal masses were included, of which 42% were malignant (21% invasive tumors and 21% borderline tumors). The area under the receiver-operating characteristics curve of pattern recognition when used by the trainees was similar before and after they had attended the course. Training decreased sensitivity (84% vs. 70% for Trainee 1, P = 0.004; 70% vs. 61% for Trainee 2, P = 0.058) and increased specificity (77% vs. 92% for Trainee 1, P = 0.001; 89% vs. 95% for Trainee 2, P = 0.058). The performance of pattern recognition was poorer in the hands of the trainees than in the hands of the experts. The sensitivities of the logistic regression model were 70% and 54% for the trainees vs. 83% for an expert (P = 0.020 and < 0.001, respectively) and the specificities were 84% and 94% vs. 89% (P = 0.25 and 0.59, respectively). The sensitivities of the scoring system were 59% and 54% for the trainees vs. 75% for the expert (P = 0.002 and < 0.001, respectively), and the specificities were 90% and 93% vs. 85% (P = 0.103 and 0.008, respectively). Theoretical ultrasound teaching did not seem to improve the performance of pattern recognition in the hands of trainees. A logistic regression model and a scoring system to classify adnexal masses as benign or malignant perform less well when they were used by inexperienced examiners than when used by an expert. Before using a model or a scoring system, experience and/or proper training are likely to be of paramount importance if diagnostic performance is to be optimized.

0065: Establishment of Breast Ultrasound Training Course in Japan

0065: Establishment of Breast Ultrasound Training Course in Japan

Introduction of a portable ultrasound unit into the health services of the Lugufu refugee camp, Kigoma District, Tanzania.

BackgroundDiagnostic imaging services are scarce in much of the developing world. Ultrasound is a low-cost, safe, and widely applicable imaging modality.AimsWe delivered a portable ultrasound machine to the Lugufu refugee camp in Tanzania and conducted a course on its use in order to assess the feasibility of introducing this technology into a very low-resource setting.MethodsWe conducted an intensive 4-day ultrasound training course for health care providers at Lugufu and established an exam logbook to track the frequency of use, distribution of ultrasound applications, and gender and age distribution of patients.ResultsBetween 4 October 2005 and 1 November 2007 547 separate ultrasound exams on 460 patients were recorded at Lugufu. Overall, 86% of patients studied were female. Pregnancy-related exams accounted for 24.1% of total usage. The 20- to 29-year-old age group accounted for over one third of total exams performed.ConclusionUltrasound is a feasible and sustainable imaging modality in a very low-resource setting such as the Lugufu refugee camp in Tanzania.

Qualitätsgesichertes Ultraschall-Simulator-Training zur Erkennung fetaler Fehlbildungen - Lässt sich ein Lernerfolg durch das Training am Ultraschall-Simulator belegen?

The factual sonographic training in obstetrics differs in Germany in a broad range. In this context, a tendency towards minimalistic dealings with this issue prevails. In contrast to this, the provisions of the German maternity guidelines relating to ultrasound clearly define quality oriented requirements serving altogether as a basic sonographic standard which mandatorily has to be met by all German Obstetricians. In order to close this gap between professional education and social demand, a training concept regarding obstetric ultrasound was devised by the German Association of Gynecologists utilizing the ultrasound simulator system. The aim of this study was to evaluate the usefulness and the effectiveness of this method and its potential role and benefit in structured sonographic training. Between October 2004 and August 2005, 74 obstetric ultrasound training courses according to the ultrasound simulator concept of the Medical School of Hanover were realized in nine federal states of Germany by the German Academy of Gynecology. The aim of these courses was it to procure ultrasound knowledge regarding the structured sonographic exclusion of fetal malformations in a compact manner. As a measure of quality assurance, a standardized questionnaire was issued before and after the courses in order to analyze the benefit of these simulator-based ultrasound courses. The concept found prevailing approval (90 %) at the level of principle, practical implementation and clinical usefulness. 88,2 % of the participants estimated their subjective training effect as being good. The analysis of the questionnaire showed a statistically significant improvement of sonographic knowledge. On average, 74.1 % of the questions were answered correctly by the end of the course as opposed to a mere 46.3 % at the beginning. Structured ultrasound training courses based on the ultrasound simulator system seem to be able to define a basic quality of training and significantly improves examiners' skills in prenatal medicine possible independent of local or structural factors. Hence they seem to be a suitable instrument to close the gap between the sonographic education worthy of improvement and the existing social demand for efficiacy of obstetric sonography.

Diagnostic Ultrasound Physicians Training Course

Diagnostic Ultrasound Physicians Training Course