Obstetric & Gynecologic Ultrasound: Improve Quality ... · Obstetric & Gynecologic Ultrasound:...

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


Curriculum

Simula2onClinical

TaskForcePathwaytoQuality

InImaging

UltrasoundTrainingCurriculum&CompetencyAssessment

•  Todevelopaconsensus-baseddetailedcurriculumandcompetencyassessmenttoolsforultrasoundtraininginobstetrics&gynecology.

Mission

Cogni2veCurriculum

CompetencyCurriculum


• Ob/Gynresidents•  Radiologyresidents•  Sonographystudents• Other:

– Familymedicineresidents– Emergencymedicineresidents– Prac%oners

TargetAudience


•  ReflectsthebasicOb/Gynultrasoundexamina%ons,definedbyguidelines

•  RepresentsminimumrequirementsforthebasicOb/Gynultrasound

•  Arrangedbyyear/leveloftraining•  Requirestraineestoindividuallyobtaintherespec%veimagesforcompetencyassessment

Founda%on


•  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


Cogni%veCurriculum-Obstetrics

•  Basicprinciplesofmedicalultrasound•  Basiccharacteris%csoftheultrasoundequipment•  Aspectsoftheultrasoundexamina%on•  Ultrasoundinfirsttrimester•  Ultrasoundinsecond&thirdtrimester•  Ultrasoundevalua%onoftwins•  Placentalabnormali%es•  Amnio%cfluidassessment

Level1/Year1


•  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


•  Recognizeanddescribeultrasoundevalua%onofanatomicloca%onsofleiomyomas

•  Recognizeanddescribeendometrialabnormali%es(leiomyomas,polyps,..)

Level2/Year2


• Ultrasoundinthesecondandthirdtrimesters(fetalmorphology)

Level3/Year3


•  Recognizeanddescribesonographicfeaturesofadenomyosis.

•  Explainclassifica%onofcongenitaluterinemalforma%ons(2D&3Dultrasound).

•  Recognizeanddescribeintrauterinecontracep%vedevices(2D&3Dultrasound).

Level3/Year3


• 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


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


•  1hourclassonOb/Gynultrasoundbyexpert

• Wrioenstandardizedimagingprotocol

AllresidentsReceived:


•  Submissionof5completeUSexamina%ons

•  Feedback&reviewprovidedfromUSexpertusingasonographyscore

Accredita<onTrainingGroup:


ComparingPreandPostAccredita%onPerformance

IsthereEvidencethatUltrasoundSimula%onEnhancesTraining?

Simula%on

Simula%on


•  Randomizedstudy,transvaginalultrasound•  33residentswithnopriorUSexperience•  Controls:clinicaltrainingalone(15)•  Cases:clinicaltraining+simula%on-basedtraining(18)

•  Outcomeisclinicalperformanceonpa%entsassessed2monthspoststudy


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


Curriculum

Simula2onClinical

ThankYou

PathwaytoQualityInImaging

Obstetric & Gynecologic Ultrasound: Improve Quality ... · Obstetric & Gynecologic Ultrasound:...

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