A Curriculum Model for Multidisciplinary Training of Midwife Sonographers in a Low Resource Setting

Figures & data

Figure 1 Location of Centres.

Figure 2 Curriculum Overview.

Figure 3 Quality Control Points.

Table 1 Accuracy of Image Interpretation of Midwives versus Final Report by Radiologists

Women Scanned	Total	Discrepancy	Conformity
Number	271	1	270
Percentage	100	0.37	99.63

Table 2 Outcome of Classified High-Risk Pregnancies (Vinayak et al, 2017)

High-Risk Finding	Number	Outcome Match
Breech	4	4
Low placenta? – 2 cm from os	1	1
Amniotic fluid index <6 cm in third trimester	2	0
Twins	7	7
IUGR	2	2
Wrong dates *	4	4
Total	20	18

Note: *Wrong dates defined as discrepancy of more than two weeks also seen on later scans.

Table 3 Comparisons Shorter versus Longer Training POCUS Training Programs

Four-Week Training Program with Supervision and Extensive Hands-on Practice	Shorter Training Program with Three One Day Workshops and One Day Refresher Option
Testing Participant Competence: The study involved a robust measurement and evaluation framework with follow up of patients to compare in-training ultrasound findings with post-delivery outcome. The correlation was almost 100% Challenging pass marks were required at the end of the training to confirm that a robust theory of knowledge had been imparted. The DOPS assessments over a week confirmed that practical competencies were at a high level and that the trainees were capable of safe practice	Testing Participant Competence: The study involved three intensive one day workshops over a two-month period. No matter how intensive the short training is, the study showed that trainees do not develop confidence to work independently. Authors noted that periods between trainings could result in misdiagnosis. The training approach asserted that while performance of knowledge, skills and theory of knowledge can be tested in the classroom the real test has to be in the field. The study did not include comparison of in-training assessment with post-delivery outcomes.
Evaluation: Evaluation showed this to be a robust training program that gave the trainee midwives confidence to work independently having completed education in direct partnership with radiologists and sonographers at main center.	Evaluation: While the training workshops showed promise in promoting knowledge and practical skills among participants and increases in patient care, results suggested that refresher training is needed to provide additional benefits for some participants.
Study conclusion: Findings highlight the importance of each step of the quality processes and reinforce the need for substantive practice-based 4-week program	Study conclusion: Findings provide a strong rationale for the need to expand the training program and for measuring its clinical impact.
References: Vinayak, S., Sande, S., Nisenbaum, H., & Pállson Nolsøe, C. (2017). Training midwives to perform basic Obstetric PoCUS in rural areas using a tablet platform and mobile phone transmission technology – A WFUMB COE Project. Ultrasound, 43(10), 2125–2132. Vinayak, S., & Brownie, S. (2018). Collaborative task-sharing to enhance the Point-Of-Care Ultrasound (POCUS) access among expectant women in Kenya: The role of midwife sonographers. J Interprof Care, 32(5), 641–644.	References: Bell, G., Wachira, B., & Denning, G. (2016). A pilot training program for point-of-care ultrasound in Kenya. African Journal of Emergency Medicine, 6(3), 132–137. Wanjiku, G. W., Bell, G., & Wachira, B. (2018). Assessing a novel point-of-care ultrasound training program for rural healthcare providers in Kenya. BMC Health Serv Res, 18(1), 607.