Obstetric Ultrasound Training Research Articles

Current status of ultrasound training in obstetrics and gynecology: a scoping literature review

IntroductionAs a widely accessible, cost-effective, and safe imaging tool, obstetric and gynecologic (OB/GYN) ultrasound (ULS) plays a vital role in diagnostics and patient care. With its growing relevance, the demand for comprehensive education in this field increases. The objective of this work was to outline the current state of OB/GYN ULS education.MethodsA scoping literature search was performed until May 2023 using the medical database PubMed according to PRISMA guidelines. Using specific keywords, relevant publications were filtered. Subsequently, abstracts were independently reviewed by two authors and the inclusion of each publication was assessed against pre-defined key search terms. Full-text versions of the included publications were scrutinized and pertinent information was extracted.ResultsIn this review, 126 articles from the literature search matched the inclusion criteria and were investigated. Our findings revealed a diverse range of course concepts and programs, a lot of them not meeting the expectations of trainees and international guidelines. OB/GYN ULS training primarily targets residents, yet opportunities for early exposure and continuing education are underexplored. International organizations, such as the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and the German Society for Ultrasound in Medicine (DEGUM) have proposed guidelines and curricula for standardized training. However, adoption remains varied. There is an emergent need to innovate teaching methods.ConclusionThere is consensus that standardizing OB/GYN ULS curricula could enhance training quality and streamline the creation of new programs, ultimately improving patient care. Further research is needed to define the most effective strategies for curriculum development and implementation.

Pioneering point-of-care obstetric ultrasound integration in midwifery education – the MEPOCUS study

BackgroundUltrasound technology is indispensable in perinatal care due to its non-invasive and painless nature, offering vital insights into foetal development and childbirth. With the academisation of midwifery in Germany, there is a growing necessity to incorporate ultrasound training into midwifery education. This paper discusses the development and implementation of an introductory obstetric ultrasound curriculum tailored for midwifery students, focusing on fundamental ultrasound techniques in obstetrics.Materials and methodsWe used Kern’s six-step approach of curricular development comprising [1] problem identification and general needs assessment [2], needs assessment of the targeted learners [3], goals and objectives [4], educational strategies [5], implementation, and [6] evaluation and feedback. The individual components of the curriculum were meticulously designed based on comprehensive literature reviews, thorough consultations with experienced ultrasound experts and evaluated needs of participants prior to the course instruction.ResultsTwenty-seven ultrasound-naive midwifery students participated in the newly developed obstetric ultrasound course. Structured as a modular and integrated framework, the course aimed to provide theoretical and practical instruction in basic obstetric ultrasound, with intrapartum sonography and focused assessment with abdominal sonography for trauma (FAST) as key supplementary specialisations. The results demonstrated a significant increase in the students’ overall knowledge and practical skills, as evidenced by the median post-course total score rising from 20 to 60 out of 75 (p < 0.001) in the objective structured clinical examination (OSCE) and from 9 to 19 out of 20 (p = 0.001) in the knowledge test. Additionally, students reported high satisfaction with the course and noted substantial personal benefits.ConclusionThe integration of basic obstetric ultrasound training within the midwifery curriculum is feasible and effective to teach fundamental knowledge and skills of obstetric ultrasound examinations to midwifery students. Expansion, standardisation and regulatory structures are critical components for a continued improvement and realistic integration into midwifery educational frameworks and thus the further development of the midwifery profession.

Innovations in ultrasound training in obstetrics.

Ultrasound technology is critical in obstetrics, enabling detailed examination of the fetus and maternal anatomy. However, increasing complexity demands specialised training to maximise its potential. This study explores innovative approaches to ultrasound training in obstetrics, focussing on enhancing diagnostic skills and patient safety. This review examines recent innovations in ultrasound training, including competency-based medical education (CBME), simulation technologies, technology-based resources, artificial intelligence (AI), and online-learning platforms. Traditional training methods such as theoretical learning, practical experience, and peer learning are also discussed to provide a comprehensive view of current practises. Innovations in ultrasound training include the use of high-fidelity simulators, virtual reality (VR), augmented reality (AR), and hybrid-learning platforms. Simulation technologies offer reproducibility, risk-free learning, diverse scenarios, and immediate feedback. AI and machine learning facilitate personalised-learning paths, real-time feedback, and automated-image analysis. Online-learning platforms and e-learning methods provide flexible, accessible, and cost-effective education. Gamification enhances learning motivation and engagement through educational games and virtual competitions. The integration of innovative technologies in ultrasound training significantly improves diagnostic skills, learner confidence, and patient safety. However, challenges such as high costs, the need for comprehensive instructor training, and integration into existing programs must be addressed. Standardisation and certification ensure high-quality and consistent training. Future developments in AI, VR, and 3D printing promise further advancements in ultrasound education. Innovations in ultrasound training in obstetrics offer significant improvements in medical education and patient care. The successful implementation and continuous development of these technologies are crucial to meet the growing demands of modern obstetrics.

Enhancing trainee performance in obstetric ultrasound through an artificial intelligence system: randomized controlled trial.

Performing obstetric ultrasound scans is challenging for inexperienced operators; therefore, the prenatal screening artificial intelligence system (PSAIS) software was developed to provide real-time feedback and guidance for trainees during their scanning procedures. The aim of this study was to investigate the potential benefits of utilizing such an artificial intelligence system to enhance the efficiency of obstetric ultrasound training in acquiring and interpreting standard basic views. A prospective, single-center randomized controlled study was conducted at The First Affiliated Hospital of Sun Yat-sen University. From September 2022 to April 2023, residents with no prior obstetric ultrasound experience were recruited and assigned randomly to either a PSAIS-assisted training group or a conventional training group. Each trainee underwent a four-cycle practical scan training program, performing 20 scans in each cycle on pregnant volunteers at 18-32 gestational weeks, focusing on acquiring and interpreting standard basic views. At the end of each cycle, a test scan evaluated trainees' ability to obtain standard ultrasound views without PSAIS assistance, and image quality was rated by both the trainees themselves and an expert (in a blinded manner). The primary outcome was the number of training cycles required for each trainee to meet a certain standard of proficiency (i.e. end-of-cycle test scored by the expert at ≥ 80%). Secondary outcomes included the expert ratings of the image quality in each trainee's end-of-cycle test and the discordance between ratings by trainees and the expert. In total, 32 residents and 1809 pregnant women (2720 scans) were recruited for the study. The PSAIS-assisted trainee group required significantly fewer training cycles compared with the non-PSAIS-assisted group to meet quality requirements (P = 0.037). Based on the expert ratings of image quality, the PSAIS-assisted training group exhibited superior ability in acquiring standard imaging views compared with the conventional training group in the third (P = 0.012) and fourth (P < 0.001) cycles. In both groups, the discordance between trainees' ratings of the quality of their own images and the expert's ratings decreased with increasing training time. A statistically significant difference in overall trainee-expert rating discordance between the two groups emerged at the end of the first training cycle and remained at every cycle thereafter (P < 0.013). By assisting inexperienced trainees in obtaining and interpreting standard basic obstetric scanning views, the use of artificial intelligence-assisted systems has the potential to improve training effectiveness. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Successful Implementation of the AIUM Standardized 4-Year Residency Ultrasound Curriculum in Obstetrics and Gynecology: Lessons Learned and Way Forward.

Significant disparities in sonographic education exist in Obstetrics and Gynecology programs in the United States. To address the lack of standardization in ultrasound teaching, the American Institute of Ultrasound in Medicine (AIUM) assembled a multi-society task force in 2018 that resulted in the publication of a Consensus Report outlining a standardized ultrasound curriculum and competency assessment. The primary objective of the study was to implement the AUIM standardized curriculum within an Obstetrics and Gynecology residency program at a tertiary medical center, and report on the early implementation experience. The secondary objective was to assess current national practices in ultrasound training in Obstetrics and Gynecology residency programs. Study design was an effectiveness-implementation hybrid study of a structured ultrasound educational program based on the 2018 AIUM Consensus Report. The theoretical portion of the curriculum consisted of 26 hours of didactic lectures distributed over 4 years. For the practical component, residents received instruction from faculty and sonographers and independently acquired the required images as part of their regular clinical work. Simulator app access was also provided for additional opportunities to practice and acquire images. Deidentified images for the required competencies were uploaded to a WhatsApp group for review. Theoretical knowledge was assessed with a series of multiple-choice exams. Practical skills were assessed through grading of images submitted through WhatsApp as well as direct observations of resident scans. At the completion of 4 years, the assessment of both theoretical knowledge and practical skills was carried out using the ISUOG Basic Training Examination. National patterns in the area of ultrasound education were assessed with a four-question electronic survey of Obstetrics and Gynecology program directors in the United States. Analysis of both portions of the study was primarily descriptive. Four Obstetrics and Gynecology residents completed the curriculum spanning postgraduate years 1 through 4. The number of competencies completed ranged from 7 to 19 out of 41. All of the residents passed the theoretical and practical components of the ISUOG Basic Training Examination. For the residency program director survey portion of the study, response rate was 20% (59 of 290). Among the respondents, 55.9% reported having a structured curriculum and 34.4% reported implementing the AIUM curriculum. The two most commonly cited obstacles to implementation of structured ultrasound teaching were uncertainty with how to start the process (49.2%) and lack of faculty engagement (49.2%). Implementation of the AIUM Curriculum within the framework of an Obstetrics and Gynecology residency program at a tertiary medical center is feasible. In our experimental group, completion of the curriculum resulted in passing of an internationally recognized validated assessment. Obstacles to implementation in our program included a wide range of engagement and participation among residents, and limited opportunities to obtain some of the required competencies. Identification of obstacles to implementation from the perspective of residency program directors is critical for developing targeted approaches to ensure widespread implementation. Successful standardized validated sonographic training of graduating Obstetrics and Gynecology residents is crucial for this operator-dependent modality that has tremendous implications on patient safety and clinical care.

Effectiveness of Focused Obstetric Ultrasound Training to Nurses from Remote Health Posts to Improve Pregnancy Outcome and Reduce Morbidity.

A rural ultrasound program was started in Nepal in order to detect complicated pregnancies early in health post where radiologists are not available to provide their services. The study aims to investigate whether focused obstetric ultrasound trained nurses were capable of detecting high risk pregnancy at an early stage in their health post and refer them to higher centre timely so that they are taken care properly. The study site for research were health posts and hospitals where the rural ultrasound program had been conducted in districts of Sudurpashchim province. The referral centres within Sudurpashchim province were assessed for cross verification of diagnosis and pregnancy outcome of referred cases. Quantitative data was collected from health posts and hospitals ultrasound log book where women who had accessed obstetric ultrasound services during pregnancy. Qualitative data was collected from nurses who have completed training. The data was verified from log-book registered in the health post and hospitals. All the quantitative data was entered and analysed. Cross verified data revealed that focused obstetric ultrasound received nurses identified cases been verified same diagnosis in referral hospitals with 66 cases. In-depth interview with 28 nurses revealed that training received by them was effective in minimizing preventable maternal and neonatal mortality and morbidity. Focused obstetric ultrasound in rural and under-resources communities like in Nepal has the potential to improve access and quality of health care services and can result in an increased uptake of antenatal care service utilisation.

Point of care obstetric ultrasound training for midwives and nurses: implementation and experiences of trainees at a rural based hospital in Sub-saharan Africa: a qualitative study

BackgroundPoint of care ultrasound training has been successfully implemented in some settings. This has been done due to a shortage of radiology human resource gap especially in the rural areas of low-resource settings. The purpose of the study was to implement a point of care obstetric ultrasound training program for midwives and nurses and explore their experiences following the training at a rural based hospital in Uganda.MethodsIt was an exploratory qualitative study with some elements of implementation research design involving midwives and nurses that had undergone obstetric ultrasound training at Kiwoko hospital, a rural-based hospital in Uganda. Purposive sampling was used to select twenty-five midwives and nurses. These participants underwent a 6-weeks training in point of care obstetric ultrasound. Following the training, in-depth interviews were conducted to obtain the experiences of the participants.ResultsThe training was conducted by qualified radiologists and sonographers and it involved both didactic sessions and rigorous practical and clinical demonstrations and eventually real-time scanning of the women. Three key themes emerged from the interviews: (1) Gaining important obstetric ultrasound skills, (2) Improving management of pregnant women and (3) Positive for task-shifting.ConclusionThe point of care obstetric ultrasound training program was successfully implemented at Kiwoko Hospital. The trainees reported positive experiences from the training and while only conducted at one rural health facility, the overwhelmingly positive experience from trainees underscores the importance of point of care obstetric ultrasound in delivering imaging services.

The training of midwives to perform obstetric ultrasound scan in Africa for task shifting and extension of scope of practice: a scoping review

IntroductionUltrasound scan is one of the essential assessments that is crucial in the early identification of health risks during antenatal care. Its accessibility to women in low-and middle-income countries remains a serious challenge because ultrasound scans are not within the scope of practice for midwives. However, task shifting and extension of scope of practice aim to train midwives to assess pregnant women through an ultrasound scan. This paper aims to report the findings of a scoping review on the training of midwives to perform obstetric ultrasound scans in Africa.MethodsThe 6-step iterative framework for scoping reviews by Arksey and O’Malley was used to determine the extent of qualitative and quantitative evidence available on the training of midwives on obstetric ultrasound scans, which includes specifying the research question, identifying relevant studies, selecting studies, extracting and charting data, collating, summarising, and synthesising and reporting findings.ResultsA total of 12 articles from eight African countries were included in this scoping review. Three main themes and 13 sub-themes emerged and they are: obstetric ultrasound scan training, challenges experienced by midwives from task shifting and extension of scope of practice regarding obstetric ultrasound scan, and the value of task shifting and extension of scope of practice regarding obstetric ultrasound scan to midwives.DiscussionDespite the available evidence that the training of midwives on obstetric ultrasound scans is essential to ensure the accessibility of quality antenatal health services, the training of midwives on obstetric ultrasound scans in some African countries remains a serious challenge. It is evident from this scoping review results that there is a need for African countries to incorporate obstetric ultrasound scans as part of the scope of practice of midwives. Task shifting necessitates prioritising the training of midwives on the use of obstetric ultrasound scans as one of the steps towards the achievement of the United Nations Sustainable Development Goal number 3 targets by 2030.

Assessment of a Brief Standardized Obstetric Ultrasound Training Program for Individuals Without Prior Ultrasound Experience.

Obstetric volume sweep imaging (OB VSI) is a simple set of transducer movements guided by external body landmarks that can be taught to ultrasound-naive non-experts. This approach can increase access to ultrasound in rural/low-resources settings lacking trained sonographers. This study presents and evaluates a training program for OB VSI. Six trainees without previous formal ultrasound experience received a training program on the OB VSI protocol containing focused didactics and supervised live hands-on ultrasound scanning practice. Trainees then independently performed 194 OB VSI examinations on pregnancies >14 weeks with known prenatal ultrasound abnormalities. Images were reviewed by maternal-fetal medicine specialists for the primary outcome (protocol deviation rates) and secondary outcomes (examination quality and image quality). Protocol deviation was present in 25.8% of cases, but only 7.7% of these errors affected the diagnostic potential of the ultrasound. Error rate differences between trainees ranged from 8.6% to 53.8% (P < 0.0001). Image quality was excellent or acceptable in 88.2%, and 96.4% had image quality capable of yielding a diagnostic interpretation. The frequency of protocol deviations decreased over time in the majority of trainees, demonstrating retention of training program over time. This brief OB VSI training program for ultrasound-naive non-experts yielded operators capable of producing high-quality images capable of diagnostic interpretation after 3 hours of training. This training program could be adapted for use by local community members in low-resource/rural settings to increase access to obstetric ultrasound.

Obstetric ultrasound training programmes for midwives: A scoping review.

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. The aim of this scoping review was to identify global ultrasound education programmes for midwives. 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. 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. 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. This scoping review highlighted ultrasound training programmes for midwives and provided guidance on the development of future midwifery ultrasound training programmes.

CAL-Tutor: A HoloLens 2 Application for Training in Obstetric Sonography and User Motion Data Recording.

Obstetric ultrasound (US) training teaches the relationship between foetal anatomy and the viewed US slice to enable navigation to standardised anatomical planes (head, abdomen and femur) where diagnostic measurements are taken. This process is difficult to learn, and results in considerable inter-operator variability. We propose the CAL-Tutor system for US training based on a US scanner and phantom, where a model of both the baby and the US slice are displayed to the trainee in its physical location using the HoloLens 2. The intention is that AR guidance will shorten the learning curve for US trainees and improve spatial awareness. In addition to the AR guidance, we also record many data streams to assess user motion and the learning process. The HoloLens 2 provides eye gaze, head and hand position, ARToolkit and NDI Aurora tracking gives the US probe positions and an external camera records the overall scene. These data can provide a rich source for further analysis, such as distinguishing expert from novice motion. We have demonstrated the system in a sample of engineers. Feedback suggests that the system helps novice users navigate the US probe to the standard plane. The data capture is successful and initial data visualisations show that meaningful information about user behaviour can be captured. Initial feedback is encouraging and shows improved user assessment where AR guidance is provided.

Validated, Consensus-Based Second- and Third-Trimester Sonographic Learning Objectives for the Obstetrics Clerkship.

Currently, there are no established guidelines for obstetric ultrasound training at the core medical student clerkship level. Our objective was to develop practical, consensus-based learning objectives in second- and third-trimester ultrasound and assess the feasibility of implementing these objectives into a clinical curriculum. Using the modified Delphi approach, a panel of expert stakeholders (n = 23) was assembled to reach consensus on the proposed learning objectives. A model curriculum was created consisting of a video tutorial, in-person training, and an optional tracker and piloted at two academic medical centers. Participant perception of acquired ultrasound skills and the program were assessed using a modified, previously validated survey. Pre- and postprogram survey responses were compared using the Chi-squared test of association. A p-value of <0.05 was considered statistically significant. The expert panel reached consensus on five learning objectives to include determination of fetal number and presentation, assessment of fetal heart rate, determination of placental location, assessment of amniotic fluid volume, and a general understanding of the biophysical profile and its indications. A total of 26 students participated in the piloted curriculum. On completion, a majority of participants reported improved confidence in understanding and performing prenatal ultrasound in the second and third trimesters (p < 0.05). The majority of participants valued a hands-on ultrasound curriculum. We propose practical, consensus-based learning objectives for second- and third-trimester sonography during the core clerkship with demonstrated feasibility in a two-center pilot program. · Ultrasound is a valuable skill for medical students.. · Specific learning objectives in obstetric ultrasound are currently lacking.. · We propose consensus-based objectives and a model curriculum.. · A two-center pilot study demonstrated efficacy..

Does group size matter during collaborative skills learning? A randomised study.

BackgroundCollaborative skills learning in the form of dyad learning compared with individual learning has been shown to lead to non‐inferior skills retention and transfer. However, we have limited knowledge on which learning activities improve collaborative skills training and how the number of collaborators may impact skills transfer. We explored the effects of skills training individually, in dyads, triads or tetrads on learning activities during training and on subsequent skills transfer.MethodsIn a randomised, controlled study, participants completed a pre‐post‐transfer‐test set‐up in groups of one to four. Participants completed 2 hours of obstetric ultrasound training. In the dyad, triad and tetrad group participants took turns actively handling the ultrasound probe. All performances were rated by two blinded experts using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale and a Global Rating Scale (GRS). All training was video recorded, and learning activities were analysed using the Interactive‐Constructive‐Active‐Passive (ICAP) framework.ResultsOne hundred one participants completed the simulation‐based training, and ninety‐seven completed the transfer test. Performance scores improved significantly from pre‐ to post‐test for all groups (p < 0.001, ηp2 = 0.55). However, group size did not affect transfer test performance on OSAUS scores (p = 0.13, ηp2 = 0.06) or GRS scores (p = 0.23, ηp2 = 0.05). ICAP analyses of training activities showed that time spent on non‐learning and passive learning activities increased with group size (p < 0.001, ηp2 = 0.31), whereas time spent on constructive and interactive learning activities was constant between groups compared with singles (p < 0.001, ηp2 = 0.72).ConclusionCollaborative skills learning in groups of up to four did not impair skills transfer despite less hands‐on time. This may be explained by a compensatory shift towards constructive and interactive learning activities that outweigh the effect of shorter hands‐on time.

A Study to Evaluate the Practice and Training in Obstetric Ultrasound at Accredited Obstetrics and Gynaecology Training Institutions in Nigeria.

There is a global trend towards domiciling Obstetric and Gynaecologic ultrasound scan services and training within the Obstetrics and Gynaecology Department. This requires readiness on the part of the Obstetrics and Gynaecology residency programmes to offer hands-on training and mentorship to its trainees. This study aims to assess the services and training potential of these centres in Obstetrics and Gynaecology ultrasound in Nigeria. A cross-sectional descriptive questionnaire-based survey among the various tertiary health facilities which offer post graduate fellowship training in Obstetrics and Gynaecology in Nigeria was conducted. A list of all the centres accredited for obstetrics and gynaecology residency training by the National Postgraduate Medical College of Nigeria was obtained. An obstetrician was identified, and a pretested self-administered questionnaire was mailed to him as a hard copy and an electronic copy was forwarded as well. The questionnaire was filled by the Obstetrician and returned for collation. The completed forms were populated into an excel spreadsheet and summary and descriptive statistics carried out. There was a valid 71% response rate from the 56 accredited centres. Thirty five percent of the centres had established subspecialty units. Only 10% had fully functional ultrasound service that catered for over half of their clients. Half of the responding centres did not have any ultrasound scan machines, and these too lacked any trained personnel in ultrasound within the department. Nearly all respondents supported the drive towards an obstetrician led ultrasound scan service but majority cited lack of protocols, trained personnel and dedicated time as major impediments to achieving this ideal. There is a lack of preparedness for domestication of obstetric ultrasound service and training in the obstetrics and gynaecology Department in Nigeria. There is the need to address the acute shortage of personnel to expand the frontiers of ultrasound service and training.

Simulation-Based Ultrasound Training in Obstetrics and Gynecology: A Systematic Review and Meta-Analysis.

The purpose of this systematic review and meta-analysis was to examine the effects of simulation-based ultrasound training (SIM-UT) in obstetrics and gynecology compared to non-SIM-UT on trainee learning, clinical performance, patient-relevant outcomes, and cost of training. A systematic search was performed in June 2019 in PubMed, Embase, and Scopus using search terms for the topic and the intervention as well as certain MESH terms. Inclusion criteria were defined in accordance with the PICO question. Studies published in any language involving SIM-UT in obstetrics and gynecology compared to non-SIM-UT or no training were included. The outcomes included effects on health care provider learning and clinical performance, patient-relevant outcomes, and cost of training. Two authors evaluated the study quality with the MERSQI instrument and the Oxford Quality Scoring System. A meta-analysis was planned for the included randomized controlled trials. 15 studies were included, and 11 studies were eligible for meta-analysis. SIM-UT was significantly superior to clinical training only and theoretical teaching with standard mean differences (SMD) of 0.84 (0.08-1.61) and 1.20 (0.37-2.04), respectively. However, SIM-UT was not superior to live model training; SMD of 0.65 (-3.25-4.55). Of all studies included in the meta-analysis, 91 % favored SIM-UT over clinical training alone, theoretical teaching, or in some cases live model training. In the field of obstetrics and gynecology, SIM-UT in addition to clinical training markedly improves trainee learning, clinical performance, as well as patient-perceived quality of care.

Rethinking Prenatal Screening for Anomalies of Placental and Umbilical Cord Implantation.

The most common anomalies of implantation of the placenta and umbilical cord include placenta previa, placenta accreta spectrum, and vasa previa, and are associated with considerable perinatal and maternal morbidity and mortality. There is moderate quality evidence that prenatal diagnosis of these conditions improves perinatal outcomes and the performance of ultrasound imaging in diagnosing them is considered excellent. The epidemiology of placenta previa is well known, and it is standard clinical practice to assess placental location at the routine screening second-trimester detailed fetal anatomy ultrasound examination. In contrast, the prevalence of placenta accreta spectrum and vasa previa in the general population is more difficult to evaluate because detailed confirmatory histopathologic data are not available in most studies. The sensitivity and specificity of ultrasonography for the diagnosis of these anomalies is also difficult to assess. Recent epidemiologic studies show an increase in the incidence of placental and umbilical cord implantation anomalies, which may be the result of increased use of assisted reproductive technology and cesarean delivery. There is good evidence to support targeted standardized protocols for women at high risk and that screening and diagnosing placenta accreta spectrum and vasa previa should be integrated into obstetric ultrasound training programs.

Impact of Physician Expertise on Probe Trajectory During Obstetric Ultrasound: A Quantitative Approach for Skill Assessment.

The objective of the study was to identify objective metrics to evaluate the significance of a sonographer's expertise on trajectories of ultrasound probe during obstetric ultrasound training procedures. This prospective observational study was conducted at Rennes University Hospital, Department of Obstetrics and Gynecology. We evaluated a panel of sonographers (expert, intermediate, and novice) in performing 3 tasks (brain, heart, and spine) with an obstetric ultrasound simulator (Scantrainer; Medaphor, Cardiff, UK). The trajectories of the probe were logged and recorded by a custom data acquisition software. We computed metrics on the trajectories (duration, path length, average velocity, average acceleration, jerk, working volume) to compare the 3 groups and identify discriminating metrics. A total of 33 participants were enrolled: 5 experts, 12 intermediates, and 16 novices. Discriminatory metrics were observed among the 3 levels of expertise for duration, velocity, acceleration, and jerk for brain and spine tasks. Working volume was discriminatory for the brain and the heart task. Path length was discriminatory for the brain task. Our results suggest a relationship between the sonographer's level of expertise and probe trajectory metrics. Such measurements could be used as an indicator of sonographer proficiency and contribute to automatic analysis of probe trajectory to evaluate the quality of sonography and the sonographer.

Development of a training program for the ultrasound screening of placenta accreta spectrum disorders.

To evaluate the impact of a training program using a systematic protocol on ultrasound signs of placenta accreta spectrum (PAS). Intra- and inter-observer variability rates and sensitivity were tested, before and after additional training, by two research fellows with a prior basic training in obstetric ultrasound using digitally recorded second-trimester ultrasound images from cases of anterior placenta previa with and without PAS. Fifty-two cases of anterior placenta previa with PAS (n=26) and without PAS (n=26) were included in the study. The highest level of inter-observer agreement for ultrasound signs was found for the absence of placental bulge and/or focal exophytic mass on gray-scale imaging and the absence of subplacental hypervascularity, bridging vessels and lacunar feeder vessels on color Doppler imaging. The level of inter-observer agreement increased from 39% before training to 40% after training; the numbers agreed as PAS by both trainees increased from four to 20. No cases were classified as inconclusive after training. There was a significant (P<0.001) change in sensitivity for both trainees after training. Additional training in detecting the ultrasound signs associated with PAS using a standardized protocol improves the diagnostic accuracy of operators with only a basic obstetric ultrasound training.

Ultrasound Training in Obstetrics and Gynecology Residency: A National Portrait

PURPOSE: To understand current training in obstetric and gynecologic ultrasound. BACKGROUND: Modern obstetrics and gynecology practice requires the frequent use of ultrasound (US) and therefore US training has become an important part of resident education. We sought to understand how residents are currently being trained in obstetric and gynecologic US by surveying residency program directors. METHODS: We developed a 36 item self-administered questionnaire targeted for residency program directors (PD). PD from all 261 accredited programs were invited to participate. We inquired about US curriculums, time spent in US training, types of US taught, learning environments and instructors, feedback regarding resident competence and resident input of the learning experience. IRB approval was obtained prior to study onset. RESULTS: We received 108 completed responses. PD from all geographical US areas and Canada responded. PD self-described their programs as 52% university based, 28% community based, 18% combination of university/community based and 2% military. Over 65% reported US education was built into the curriculum as a distinct rotation. Of the US rotations &gt;50% were described as a one month separate block. 40% stated 1–4 hours week devoted to US education. 99% said supervised instruction was the norm with the majority of teachers being MFM physicians/sonographers. A mixture of observational and hands-on ultrasound experience is the norm for most programs. Over 76% PD gave residents US reading assignments and have formal lectures, mostly by MFM and REI faculty. Less than 20% of programs supported any experience with ultrasound simulator training. 90% of PD give formal feedback to the residents about their skills. Only 69% state that their residents can evaluate the learning experience. DISCUSSION: We recount details of the current status of US education in OB/Gyn residency programs as reported by PD across the country. Our questions were designed to understand the amount of time actually committed to ultrasound education. With the inception of widespread US need in the daily life of obstetrics and gynecology the challenge of ensuring adequate resident training exists. More structure and protected learning time may assist in resident training. Simulator training for US education seems underutilized.

The Current State of Ultrasound Training in Obstetrics and Gynecology Residency Programs.

We evaluated the current state of ultrasound training in obstetrics and gynecology (OB-GYN) residency programs across the United States. An electronic survey was sent to OB-GYN residency program directors and OB-GYN residents. Responses were obtained in September 2016. Program directors and residents were asked to reflect on their current ultrasound curriculum. A total of 93 program directors and 437 residents responded. Respondents were mostly from university programs located in tertiary centers. Ultrasound curricula varied: 11% of program directors and 23% of residents did not have any ultrasound-related didactics; of those who did, 27% of program directors and 40% of residents had it yearly or less. Three-quarters had mandatory ultrasound rotations, and few offered ultrasound electives (program directors, 52%; residents, 28%). Most residents were required to perform ultrasound examinations daily or weekly (98%). Most stated that the main focus of the rotation was OB only. Skill was evaluated mainly subjectively by direct observation. Although most program directors stated that residents were satisfactory/excellent in ultrasound, 22% would not treat patients on the basis of ultrasound examinations performed by their senior residents. Similarly, of all postgraduate year 4 respondents (n = 86), 76% stated that they will require additional training to be able to perform or read ultrasound examinations independently, and 43% would not treat a patient on the basis of their own ultrasound examinations without further confirmation. Residents believed that the biggest obstacle in ultrasound training is lack of dedicated faculty time (41%). Recognizing the lack of clearly defined milestones in ultrasound training in OB-GYN residency, this study confirms the substantial heterogeneity in curricula between programs, highlighting a need for a standardized ultrasound curriculum.