Ong Jozarino, Leonardi Mathew, Espada Mercedes, Stamatopoulos Nicole, Georgousopoulou Ekavi, Condous George
Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia.
Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
J Ultrasound Med. 2020 Dec;39(12):2365-2372. doi: 10.1002/jum.15345. Epub 2020 May 30.
To evaluate the learning curve of gynecologic surgical fellows (ie, in training) to properly identify the ureters in real time while simultaneously performing and interpreting transvaginal ultrasound (TVUS) examinations.
We performed a prospective study, which took place at 2 centers in Sydney, Australia, from December 2017 to December 2018. Three fellows (F1-F3), of varying prestudy ultrasound (US) experience, were recruited to participate. One hundred fifty predetermined examinations were planned. A TVUS examination was performed by the study reference standard (an expert in gynecologic US). Subsequently, the fellows performed a focused component to identify bilateral ureters, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's evaluations were complete. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used.
A total of 150 examinations were performed on 145 patients. One patient had a single ureter, and 1 patient had US evidence of hydroureter. The cumulative summation test for the learning curve for bilateral ureter identification showed that F1 did not reach competency by 50 TVUS examinations, whereas F2 and F3 required 41 and 31 TVUS examinations to reach competency, respectively.
Contrary to other studies on the topic, this study suggests that although it is feasible for surgical fellows to learn TVUS identification of bilateral ureters, not all fellows can reach competency during a program based on a predefined number of scans. We advocate for an individualized, competency-based medical education model in learning US for identifying the ureters.
评估妇科外科住院医师（即正在接受培训者）在实时进行经阴道超声（TVUS）检查并解读结果的同时正确识别输尿管的学习曲线。
我们于2017年12月至2018年12月在澳大利亚悉尼的2个中心开展了一项前瞻性研究。招募了3名具有不同超声（US）检查前期经验的住院医师（F1 - F3）参与。计划进行150次预先确定的检查。由研究参考标准（一位妇科超声专家）进行TVUS检查。随后，住院医师在不了解患者临床病史和参考标准结果的情况下，进行针对性操作以识别双侧输尿管。在每位住院医师的评估完成后，提供即时反馈和实践指导。为评估获得能力所需的扫描次数，采用了学习曲线的累积总和测试。
对145例患者共进行了150次检查。1例患者有单条输尿管，1例患者有输尿管积水的超声证据。双侧输尿管识别学习曲线的累积总和测试表明，F1在进行50次TVUS检查后未达到能力标准，而F2和F3分别需要41次和31次TVUS检查才能达到能力标准。
与该主题的其他研究相反，本研究表明，虽然外科住院医师学习通过TVUS识别双侧输尿管是可行的，但并非所有住院医师都能在基于预定义扫描次数的培训计划中达到能力标准。我们提倡在学习超声识别输尿管时采用个性化的、基于能力的医学教育模式。
