Viner Alexandra C, Membe-Gadama Gladys, Whyte Sonia, Kayambo Doris, Masamba Martha, Makwakwa Enita, Lissauer David, Stock Sarah J, Norman Jane E, Reynolds Rebecca M, Magowan Brian, Freyne Bridget, Gadama Luis
Medical Research Council (MRC) Centre for Reproductive Health, The University of Edinburgh, Edinburgh, United Kingdom.
Department of Obstetrics and Gynaecology, University of Malawi College of Medicine, Blantyre, Malawi.
Front Glob Womens Health. 2022 Apr 5;3:880615. doi: 10.3389/fgwh.2022.880615. eCollection 2022.
Although ultrasound to determine gestational age is fundamental to the optimum management of pregnancy and is recommended for all women by the World Health Organisation, it remains unavailable to many women in low-income countries where trained practitioners are scarce. This study aimed to evaluate a novel, context-specific education package to teach midwives basic obstetric ultrasound, including the determination of gestational age by measurement of fetal femur length.
The study was conducted across six sites in Malawi in January 2021. Following a virtual "training of the trainers", local teams delivered a 10-day programme encompassing both didactic and "hands on" components. Matched pre and post course tests assessed participants' knowledge of key concepts, with Objective Structured Clinical Examinations used to evaluate practical skills. To achieve a pass, trainees were required to establish the gestational age to within ±7 days of an experienced practitioner and achieve an overall score of >65% on five consecutive occasions. A matched pre and post course survey explored participants' attitudes and confidence in performing ultrasound examinations.
Of the 29 midwives who participated, 28 finished the programme and met the criteria specified to pass. 22 midwives completed the matched knowledge tests, with the mean (SD) score increasing from 10.2 (3.3) to 18 (2.5) after training ( <0.0001). Mean difference 7.9, 95% CI 6.5-9.2. Midwives passed 87% of the Observed Structured Clinical Examinations, establishing the gestational age to within ±7 days of an experienced practitioner in 89% of assessments. Beliefs regarding the importance of antenatal ultrasound increased post course ( = 0.02), as did confidence in performing ultrasound examinations ( <0.0001).
This study demonstrates not only that ultrasound-naive practitioners can be taught to perform basic obstetric ultrasound dating scans, confidently and competently, after 10 days of training, but also that local teams can be orientated to successfully deliver the programme virtually. Previous ultrasound training initiatives, while often more comprehensive in their syllabus, have been of considerably longer duration and this is likely to be a barrier to upscaling opportunities. We propose that this focused training increases the potential for widescale and sustainable implementation.
尽管超声检查确定孕周对于孕期的最佳管理至关重要，且世界卫生组织建议所有孕妇都进行此项检查，但在低收入国家，许多妇女仍无法获得超声检查服务，因为那里缺乏训练有素的从业人员。本研究旨在评估一种针对特定环境的新型教育方案，以教导助产士基本的产科超声检查技能，包括通过测量胎儿股骨长度来确定孕周。
2021年1月，该研究在马拉维的六个地点开展。在进行了一次虚拟的“培训培训员”活动后，当地团队开展了一个为期10天的项目，该项目包括理论教学和“实操”部分。课程前后进行了配对测试，以评估参与者对关键概念的掌握情况，并采用客观结构化临床考试来评估实践技能。为了通过考核，学员需要将孕周确定在经验丰富的从业者±7天的误差范围内，并在连续五次考试中总体得分超过65%。课程前后进行了配对调查，以探究参与者对进行超声检查的态度和信心。
参与的29名助产士中，28名完成了该项目并达到了规定的通过标准。22名助产士完成了配对知识测试，培训后平均（标准差）得分从10.2（3.3）提高到18（2.5）（<0.0001）。平均差值为7.9，95%置信区间为6.5 - 9.2。助产士在87%的客观结构化临床考试中通过，在89%的评估中，将孕周确定在经验丰富的从业者±7天的误差范围内。课程结束后，对产前超声重要性的认识有所提高（P = 0.02），进行超声检查的信心也有所增强（<0.0001）。
本研究不仅表明，未接触过超声检查的从业者在经过10天的培训后，能够自信且熟练地进行基本的产科超声孕周扫描，还表明当地团队可以通过虚拟方式成功开展该项目。以往的超声培训项目虽然教学大纲往往更全面，但持续时间长得多，这可能是扩大推广机会的一个障碍。我们认为，这种有针对性的培训增加了大规模可持续实施的可能性。
