Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy.
Department of Obstetrics, Gynecology and Reproduction, Hospital Universitari Dexeus, Barcelona, Spain.
Ultrasound Obstet Gynecol. 2019 Aug;54(2):262-269. doi: 10.1002/uog.20176.
To assess the learning curves of trainees during a structured offline/hands-on training program for the ultrasonographic diagnosis of deep infiltrating endometriosis (DIE).
Four trainees (all Ob/Gyn postgraduates with at least 5 years' experience in ultrasonography in obstetrics and gynecology, but with no experience of sonographic examination of DIE) participated in the study. They underwent a 2-week training program with a single trainer. Day 1 was devoted to theoretical issues and guided offline analysis of 10 three-dimensional ultrasound volumes. During the following days, four sessions of real-time sonographic examinations were performed in a DIE referral center ultrasound unit. In between these sessions, the trainees analyzed four datasets offline, each containing 25 volumes. At the end of each set, misinterpreted volumes were reassessed with the trainer. Presence or absence of DIE at surgery was considered the gold standard. The trainees' learning process was evaluated by learning-curve cumulative summation (LC-CUSUM) and the deviations of the trainees' level of performance at the control stage was assessed by CUSUM (standard CUSUM), for different locations of DIE.
The trainees reached competence after an average of 17 (range, 14-21) evaluations for bladder, 40 (range, 30-60) for rectosigmoid, 25 (range, 14-34) for forniceal, 44 (range, 25-66) for uterosacral ligament (USL) and 21 (range, 14-43) for rectovaginal septum (RVS) locations of DIE, and then kept the process under control, with error levels of less than 4.5% until the end of the test. The overall accuracy for each trainee in diagnosis of DIE at the different locations ranged from 0.91 to 0.98 for bladder DIE, from 0.80 to 0.94 for rectosigmoid DIE, from 0.90 to 0.94 for forniceal DIE, from 0.79 to 0.82 for USL DIE and from 0.89 to 0.98 for RVS DIE.
The suggested 2-week training program, based on a mixture of offline and live scanning sessions, is feasible and apparently provides effective training for the ultrasonographic diagnosis of DIE. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
评估受训者在深度浸润性子宫内膜异位症（DIE）超声诊断的结构化离线/实践培训计划中的学习曲线。
4 名受训者（均为妇产科研究生，在妇产科超声方面至少有 5 年经验，但无 DIE 超声检查经验）参加了研究。他们接受了为期 2 周的培训计划，由一名培训师授课。第 1 天专门用于理论问题和 10 个三维超声体积的指导式离线分析。在接下来的几天里，在 DIE 转诊中心超声科进行了 4 次实时超声检查。在这些检查之间，受训者离线分析了 4 组数据集，每组包含 25 个体积。在每组结束时，受训者用培训师重新评估了误判的体积。手术中是否存在 DIE 被视为金标准。通过学习曲线累积和（LC-CUSUM）评估受训者的学习过程，通过CUSUM（标准 CUSUM）评估受训者在控制阶段的表现水平偏差，用于不同部位的 DIE。
受训者在平均 17 次（范围，14-21 次）膀胱评估、40 次（范围，30-60 次）直肠乙状结肠评估、25 次（范围，14-34 次）穹窿评估、44 次（范围，25-66 次）子宫骶韧带（USL）评估和 21 次（范围，14-43 次）直肠阴道隔（RVS）评估后达到熟练程度，然后在整个测试过程中保持控制状态，错误水平低于 4.5%。每位受训者在不同部位诊断 DIE 的总体准确率范围为膀胱 DIE 的 0.91-0.98、直肠乙状结肠 DIE 的 0.80-0.94、穹窿 DIE 的 0.90-0.94、USL DIE 的 0.79-0.82 和 RVS DIE 的 0.89-0.98。
基于离线和实时扫描会议混合的 2 周培训计划是可行的，显然为 DIE 的超声诊断提供了有效的培训。版权所有©2018 ISUOG。由 John Wiley & Sons Ltd 出版。
