obstetric & gynecologic ultrasound: improve quality ... · obstetric & gynecologic...
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Mul%-SocietyTaskForceon
UltrasoundTrainingCurriculumandCompetencyAssessmentinResidency
Programs
AlfredAbuhamad,MD.EasternVirginiaMedicalSchool
EarlierToday
• ImproveQuality• StandardizeTraining
Obstetric&GynecologicUltrasound:
Program Requirements for Graduate Medical Education in Obstetrics and Gynecology
January 1, 2008 / Revised 2015 Obstetrics
Gynecology
CouncilonResidencyEduca%oninObstetrics&Gynecology
ObstetricSonography
CouncilonResidencyEduca%oninObstetrics&Gynecology
GynecologicSonographyGuidelines
CME
Accredita2on
Simula2onClinical
Competency
Curriculum
PathwaytoQualityInImaging
Obstetrics2013
Guidelines
Gynecologic2014
Guidelines
Guidelines
2011 2013
CME
Accredita%on
1122Obprac%ces
Accredita%on
Guidelines
CME
Accredita2on Competency
Curriculum
Simula2onClinical
PathwaytoQualityInImaging Guidelines
CME
Accredita2on Competency
Curriculum
Simula2onClinical
TaskForcePathwaytoQuality
InImaging
UltrasoundTrainingCurriculum&CompetencyAssessment
• Todevelopaconsensus-baseddetailedcurriculumandcompetencyassessmenttoolsforultrasoundtraininginobstetrics&gynecology.
Mission
Cogni2veCurriculum
CompetencyCurriculum
UltrasoundTrainingCurriculum&CompetencyAssessment
• Ob/Gynresidents• Radiologyresidents• Sonographystudents• Other:
– Familymedicineresidents– Emergencymedicineresidents– Prac%oners
TargetAudience
UltrasoundTrainingCurriculum&CompetencyAssessment
• ReflectsthebasicOb/Gynultrasoundexamina%ons,definedbyguidelines
• RepresentsminimumrequirementsforthebasicOb/Gynultrasound
• Arrangedbyyear/leveloftraining• Requirestraineestoindividuallyobtaintherespec%veimagesforcompetencyassessment
Founda%on
UltrasoundTrainingCurriculum&CompetencyAssessment
• Forspecial%es&prac%ceswhereprimarymodeofultrasoundimagingisbasedonimageinterpreta%on,competenciescanbeadaptedtoreflectthat.
• Programsmayreorganizethelevelsoftrainingasitfitsintoclinicalprac%cerequirements
Flexibility
TaskForceMembers• AlfredAbuhamad,MD.–Chair• BerylBenacerraf,MD.• CarolBenson,MD.• TrishChudleigh,PhD.DMU• LoriCrites,BS.RDMS.• PeterDoubilet,PhD.MD.• RitaDriggers,MD.• WesleyLee,MD.• KarenMann,PhD.• JamesPerez,DO.• NancyRose,MD.• LynnSimpson,MD.• AnnTabor,MD.
ASpecialThankYou
KathiKMinton,MA,RDMS,RDCS,FAIUMAIUMClinicalEduca%onCoordinator
TaskForceMee%ngs
• August10,2015• October28,2015• November2,2015• February8,2016• February9,2016• March18,2016(face-to-face)
Cogni%veCurriculumTaskForceMembers
• AlfredAbuhamad,MD.–Chair• TrishChudleigh,PhD.DMU• PeterDoubilet,PhD.MD.• RitaDriggers,MD.• WesleyLee,MD.• LynnSimpson,MD.
Cogni2veCurriculum
• AlfredAbuhamad,MD.–Chair• BerylBenacerraf,MD.• CarolBenson,MD.• LoriCrites,BS.RDMS.• KarenMann,PhD.• JamesPerez,DO.• NancyRose,MD.• AnnTabor,MD.
CompetencyCurriculumTaskForceMembers
CompetencyCurriculum
Cogni%veCurriculum-Obstetrics
• Basicprinciplesofmedicalultrasound• Basiccharacteris%csoftheultrasoundequipment• Aspectsoftheultrasoundexamina%on• Ultrasoundinfirsttrimester• Ultrasoundinsecond&thirdtrimester• Ultrasoundevalua%onoftwins• Placentalabnormali%es• Amnio%cfluidassessment
Level1/Year1
Cogni%veCurriculum-Obstetrics
• Ultrasoundevalua%onoftwins
Level1/Year1
• Recognizeanddescribeindica%onsforpelvicsonography
• Recognizeanddescribesonographicfeaturesofthenormaluterus
Level1/Year1
Cogni%veCurriculum-Gynecology
• Ultrasoundinthefirsttrimester• Ultrasoundevalua%onoftwingesta%ons
• Placentalabnormali%es• Amnio%cfluidassessment
Level2/Year2
Cogni%veCurriculum-Obstetrics• Ultrasoundevalua%onoftwingesta%ons
Level2/Year2
Cogni%veCurriculum-Obstetrics
• Recognizeanddescribeultrasoundevalua%onofanatomicloca%onsofleiomyomas
• Recognizeanddescribeendometrialabnormali%es(leiomyomas,polyps,..)
Level2/Year2
Cogni%veCurriculum-Gynecology
• Ultrasoundinthesecondandthirdtrimesters(fetalmorphology)
Level3/Year3
Cogni%veCurriculum-Obstetrics
• Recognizeanddescribesonographicfeaturesofadenomyosis.
• Explainclassifica%onofcongenitaluterinemalforma%ons(2D&3Dultrasound).
• Recognizeanddescribeintrauterinecontracep%vedevices(2D&3Dultrasound).
Level3/Year3
Cogni%veCurriculum-Gynecology
• Ultrasoundevalua%onoftwingesta%ons
Level4/Year4
Cogni%veCurriculum
• Thereare37competenciesspreadover4levels/yearsasfollows:
CompetencyCurriculum CompetencyCurriculumLevel1/Year1
BasicBiometryBiophysicalProfile
CompetencyCurriculumLevel2/Year2
CervicalLengthBasicGynecology
CompetencyCurriculumLevel3/Year3 BasicFetalAnatomy
Wri%ngaReport
CompetencyCurriculumLevel3/Year3
BasicFetalAnatomyWri%ngaReport
CompetencyCurriculum
Level4/Year4 FetalFaceAmniocentesis
Addi%onalCompetencies CompetencyforFemurLength
Representa%veultrasoundimage
Howisitdone?
CompetencyforFemurLength
7criteria
Representa%veultrasoundimage
Howisitdone?FemurLength
Howisitdone? Passinggradeissetataround70%forall
FemurLengthHowisitdone? Criteriondeemedessen%alforimage
FemurLengthHowisitdone? 5passingimagesestablishescompetency
Why5images?
• Consensusofpanelmembers• Notalotofdataonthissubject• Somesuppor%ngdatafromsimula%on
UltrasoundObstetGynecol2014;44:693
Ini%alscoresfromfirst2itera%ons
UltrasoundObstetGynecol2014;44:693
Novicesreachedtheexpertlevelwithamedianof5
itera%ons.
UltrasoundObstetGynecol2013;42:213–217
PLoSOne2013;8:e57687. PLoSOne2013;8:e57687.
IsthereEvidencethatStandardiza%onofTraining&Evalua%onImproves
Outcome?
JUltrasoundMed2015;34:829–835
• Prospec%vebeforeandamerstudy• Ob/Gynresidents• Largeter%aryhospitalinFrance• Gynecologicemergencysenng
JUltrasoundMed2015;34:829–835
• 1hourclassonOb/Gynultrasoundbyexpert
• Wrioenstandardizedimagingprotocol
AllresidentsReceived:
JUltrasoundMed2015;34:829–835
• Submissionof5completeUSexamina%ons
• Feedback&reviewprovidedfromUSexpertusingasonographyscore
Accredita<onTrainingGroup:
JUltrasoundMed2015;34:829–835
ComparingPreandPostAccredita%onPerformance
IsthereEvidencethatUltrasoundSimula%onEnhancesTraining?
Simula%on
Simula%on
UltrasoundObstetGynecol2015;46:312–318
• Randomizedstudy,transvaginalultrasound• 33residentswithnopriorUSexperience• Controls:clinicaltrainingalone(15)• Cases:clinicaltraining+simula%on-basedtraining(18)
• Outcomeisclinicalperformanceonpa%entsassessed2monthspoststudy
UltrasoundObstetGynecol2015;46:312–318
Objec%veStructuredAssessment
WhatareNextSteps?
NextSteps
NextSteps
• Seekendorsementfromrepresenta%vesocie%es– Endorsedby:AIUM,SMFM,ISUOG,ACOOG– Supportedby:SRUandACR– Awai%ngofficialno%fica%onfromACOG
• Publishtaskforcedocumentinpeer-reviewedjournals
• Developandshareimplementa%onstrategies• Facilitate&supportresearchonsubject• Monitorprogressover%me
ALotofChallengestoOvercome
Challenges!!
Challenges
• Crowdedcurricula• Busyprac%%oners&sonographers• Lackoffacultyultrasoundexper%se• Lackofequipmentavailability• Lackoffinancialresources
OvercomingChallengesStandardizedcurriculum&competencytools• Endorsements&supportbysocie%es• Standardizedimplementa%ontools• Structuredlectureseries• Simula%on
• Cogni%ve• Competency
• Incorpora%ngultrasoundskillsinboardexamina%ons
OvercomingChallengesStandardizedcurriculum&competencytools
Op<malapproachwillincludecollabora<on
Socie%esImplementa%onTools
Roadmap
ProgramsCommitmentLocalResources
IndustryUSEquipmentSimula%on
Guidelines
CME
Accredita2on Competency
Curriculum
Simula2onClinical
ThankYou
PathwaytoQualityInImaging