Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study

Abstract

Background There is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically. Methods This prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees’ knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians . The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees’ clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees. Results Pre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8, P < 0.0001). At 6 months, 62% of trainees were performing PoCUS that had assisted in patient management and clinical diagnosis, and 46% reported earlier diagnosis and changes to patient management. 74% of trainees had increased scanning frequency and 93% reported improved scanning confidence. Conclusion This study demonstrated intensive 2-day workshops can equip clinicians with valuable antenatal PoCUS skills, offering a viable solution to assist in the assessment and management of pregnant women in the rural/resource-poor setting where access to ultrasound services is limited or non-existent. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the continuing professional development of remote trainees and the implementation of PoCUS.

Shaping ultrasound in midwifery: towards an evidence-based training framework for enhanced prenatal care

“…For midwives, participation in continuing education courses on ultrasound diagnostics represents a significant enhancement of their ultrasonographic skills and knowledge, augmenting their existing clinical competencies [ 19 ]. Throughout the duration of these training courses, midwives are either relieved from their clinical responsibilities or they undertake the training concurrently with their standard duties [ 17 , 20 ].…”

“…Geographic challenges, including extensive distances and inadequate transportation infrastructure, compound the difficulty of accessing obstetric care, imposing economic burdens [ 17 ]. These regions are further characterized by a significant dearth of trained personnel and insufficient resources for hospitalization, alongside deficiencies in antenatal care and elevated rates of maternal and fetal mortality [ 17 , 20 ]. In LMICs, congenital anomalies account for approximately 5–7% of perinatal mortality rates, suggesting that improved access to obstetric ultrasound could enhance the detection of high-risk conditions and improve maternal and neonatal outcomes [ 22 , 23 ].…”

“…The introduction of point-of-care ultrasound (POCUS) training programmes addresses the specific needs of patients in rural settings through the use of portable equipment and the capability for bedside examinations. This strategy enables prompt and appropriate prenatal care planning and referrals for urgent cases [ 20 ].…”

“…Despite variations in the emphasis and allocation of these components across different programs, a predominant focus on hands-on experience is noted. [ 17 , 20 ].

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Point of care obstetric ultrasound knowledge retention among mid-wives following a training program: a prospective cohort pilot study

“…The goal of POCUS is to transfer some of the basic ultrasound skills to non-imaging health professionals such that these skills assist them in making clinical decisions to manage their patients. This also addresses the critical shortage of imaging professionals in many settings especially low income settings [ 4 ]. In this study, the midwives demonstrated minimal decrease in knowledge even at 6 months follow up as can be evidenced in the exam scores.…”