Special ReportProceedings: Beyond Ultrasound First Forum on improving the quality of ultrasound imaging in obstetrics and gynecology
Introduction
Beyond Ultrasound First is an initiative that focuses on improving the quality and standardization of ultrasound in obstetrics and gynecology (Ob/Gyn) to ensure that the full potential of ultrasound is achieved in clinical practice. While most Ob/Gyn clinical providers agree that ultrasound should be the first line of imaging for their patients, the use of ultrasound as a first-choice imaging modality has remained quite variable throughout the country, probably related to suboptimal training and competency of some ultrasound providers and variable quality of ultrasound throughout the country. The improvement in performance of practitioners who are trained to measure the nuchal translucency vs those who do not have the additional training is only 1 example of the variability of ultrasound skills.1, 2 Ultrasound is unique in that image acquisition is not standardized like computed tomography (CT) and magnetic resonance imaging (MRI), so obtaining a high-quality and informative image requires substantial expertise in image acquisition, a skill traditionally acquired over several years through an apprenticeship with an expert. Ultrasound is one of the few imaging modalities (noninvasive) that requires a skilled professional to obtain 1 image at a time by the bedside. CT and MRI are automated and the images are produced by the scanner in a standard way. There are standards for the content of ultrasound examination, but those standards may be applied by different physicians with variable skill sets. Data for this are available from the simulation literature.3, 4
There is currently lack of consistency in ultrasound training and competency assessment in residency programs in North America.5, 6, 7 The Beyond Ultrasound First Forum was intended to develop solutions on how to standardize and improve ultrasound training, and to introduce competency assessment tools and performance measures of ultrasound in clinical practice. The aim is to raise and unify the quality of ultrasound examinations in Ob/Gyn with the ultimate goal of improving patient safety and quality of clinical care. Misinterpretation, missing a diagnosis, or false-positive findings exemplify some of the ways that poor ultrasound training can harm the population.
This report presents the proceedings of the Beyond Ultrasound First Forum. In this forum, a variety of experts provided data and opinions regarding the current quality and training of Ob/Gyn ultrasound in residency programs and proposed solutions to enhance education and competency assessment in the performance and interpretation of ultrasound examinations. This forum brought together many of the delegates and parties interested in improving ultrasound education and competency of ultrasound throughout the country. These include representatives from many professional associations; the imaging community including radiology, Ob/Gyn, and others; government agencies; insurers; industry; and others with common interest in ultrasound in Ob/Gyn.
Section snippets
The Problem
Stating the current problem in ultrasound training and competency assessment is an important first step towards developing strategies to improve the quality of Ob/Gyn ultrasound in clinical practice. The scope of the forum was thus divided into 3 parts: quality and training in Ob/Gyn ultrasound, ultrasound as first modality in Ob/Gyn imaging, and the payer’s perspectives.
Novel techniques for ultrasound training and competency assessment
The combination of simulated teaching and live instruction makes it possible to teach ultrasound to many students; however, it is far more challenging to assess students’ competency and proficiency, which is a critical part of education.
Medical technology has evolved rapidly, from the 200-year-old stethoscope to today’s ultrasound equipment that fits into the palm of your hand. Technologies have enabled all care providers to have a tool in their hand allowing the clinicians to see inside the
Successful models of resident education: what do we need to know?
The following implementation strategies suggested by the panel:
Ultrasound must be incorporated into the currently required didactic time to promote implementation of the curriculum at a local level. Training programs may consider initiation of Ob/Gyn ultrasound training sooner than currently planned, even into the medical school curriculum, by offering a fourth-year Ob/Gyn imaging rotation to interested students. Using ultrasound as a tool for teaching during medical school could play a very
Forum Summary and Conclusions
There was consensus around the fact that ultrasound is a valuable imaging technology that allows for cost-effective diagnosis of various pathologies in all human organs. It is relatively inexpensive, portable, and safe when used appropriately. In skilled hands, ultrasound performs equally, if not better than, CT and MRI, in a number of anatomic regions. Ultrasound does have some limitations, with the most significant being its operator dependency, which results in variable quality across the
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Cited by (0)
Supported by a grant from GE Healthcare.
W.L. received honoraria from GE Healthcare as a faculty speaker, and limited research funding from Samsung. S.H.M. received compensation from Imorgon Medical LLC as an investor and member of the LLC. E.S. received founders stock from SonoSim as chief executive officer and founding member. The remaining authors report no conflicts of interest.