Structured Training for Fetal Diagnostic Skills in a Maternal-Fetal Medicine Fellowship

Abstract

Objective The American Institute of Ultrasound in Medicine has described what constitutes a detailed fetal anatomic examination but what comprises an appropriate physician training program has not been described. The purpose of this paper is to describe a highly-structured program developed by our center to train maternal-fetal medicine fellows in a systematic approach to fetal diagnostic imaging.

Study Design We describe this approach in three phases. Phase I: Development of Skills as a Perinatal Sonographer, Phase II: Mentored Evolution to a Perinatal Sonologist and Phase III: Supervised Independent Practice as Consultant-in-training.

Results This curriculum was implemented in 2006. Of the eight maternal-fetal medicine fellows who completed this program, 100% were capable of following this curriculum and 100% felt comfortable performing and interpreting detailed sonograms including sonograms with significant and uncommon anomalies. Qualitative feedback was also positive. Finally, this structured approach resulted in an increase in the average total number of sonograms interpreted.

Conclusion Our curriculum, by following the explicit guidelines and expectations set out by the American Institute of Ultrasound in Medicine and the American Board of Obstetrics and Gynecology for practicing maternal-fetal medicine fellowship graduates, provides an opportunity to explore national standardization for this component of training.

Keywords

ultrasound training - fetal diagnosis - maternal-fetal medicine fellowship - ultrasound curriculum - medical education - obstetric ultrasound

• References

• 1 Wax J, Minkoff H, Johnson A. , et al. Consensus report on the detailed fetal anatomic ultrasound examination: indications, components, and qualifications. J Ultrasound Med 2014; 33 (02) 189-195
• 2 Calhoun BC, Hume RF. Integrated Obstetric Curriculum for Obstetrics and Gynecology Residency, Radiology Residency and Maternal-Fetal Medicine Fellowship program at an accredited American Institute of Ultrasound in Medicine Diagnostic Ultrasound Center. Ultrasound Obstet Gynecol 2000; 16 (01) 68-71
• 3 Lee W, Hodges AN, Williams S, Vettraino IM, McNie B. Fetal ultrasound training for obstetrics and gynecology residents. Obstet Gynecol 2004; 103 (02) 333-338
• 4 Wiggins G, McTighe J. Understanding by Design. 2nd ed. Alexandria, VA: Association for Supervision and Curriculum Development; 2005
• 5 Accreditation Council for Graduate Medical Education, The American Board of Obstetrics and Gynecology, The American College of Obstetricians and Gynecologists. The maternal-fetal medicine milestones project. 2016 ; available from: http://www.acgme.org/Portals/0/PDFs/Milestones/MaternalFetalMedicineMilestones.pdf . Accessed on September 27, 2018
• 6 Suneja A, Suneja C. The Lean Doctors Workbook: An Application Guide for Transforming Outpatient Clinic Systems with Lean. Milwaukee, WI: American Society for Quality, Quality Press; 2011
• 7 Knowles MS, Holton EF, Holton Ed, Swanson RA. The Adult Learner: The Definitive Classic in Adult Education and Human Resource Development. 6th ed. Burlington, MD: Elsevier; 2005
• 8 Gilstrap LC. American Board of Obstetrics and Gynecology. General requirements for gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility and special requirements for maternal-fetal medicined [Internet]. Vol. September, ABOG program requirements for fellowship graudate medical education. 2014 . Available from: https://www.abog.org/docs/default-source/default-document-library/guide-to-learning-mfm-2018.pdf . Accessed October 18, 2018
• 9 American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of obstetric ultrasound examinations. J Ultrasound Med 2013; 32 (06) 1083-1101
• 10 International Society of Ultrasound in Obstetrics and Gynecology. ISUOG Education Committee recommendations for basic training in obstetric and gynecological ultrasound. Ultrasound Obstet Gynecol 2014; 43 (01) 113-116
• 11 Perinatal Quality Foundation. Cervical length education and review. Available from: https://clear.perinatalquality.org/ 2016 ; accessed on September 27, 2018
• 12 Khurshid N, Trampe B, Heiser T. , et al. Abstract 420: Impact of an amniocentesis simulation curriculum for training in MFM fellowship program. Am J Obstet Gynecol 2014; 210 (1, Supplement): S212-S213
• 13 Iruretagoyena JI, Shah D, Malinger G. Dedicated fetal neurosonographic evaluation improves patient care and maternal fetal medicine fellow training. J Matern Fetal Neonatal Med 2016; 29 (03) 482-486
• 14 Iruretagoyena JI, Trampe B, Stewart K, Droste S. A transcervical chorionic villus sampling model for teaching. J Ultrasound Med 2013; 32 (08) 1489-1492
• 15 Bahner DP, Royall NA. Advanced ultrasound training for fourth-year medical students: a novel training program at The Ohio State University College of Medicine. Acad Med 2013; 88 (02) 206-213
• 16 Bahner DP, Adkins EJ, Hughes D, Barrie M, Boulger CT, Royall NA. Integrated medical school ultrasound: development of an ultrasound vertical curriculum. Crit Ultrasound J 2013; 5 (01) 6-15
• 17 Kissin EY, Niu J, Balint P. , et al. Musculoskeletal ultrasound training and competency assessment program for rheumatology fellows. J Ultrasound Med 2013; 32 (10) 1735-1743
• 18 Srivastava S, Printz BF, Geva T. , et al; Society of Pediatric Cardiology Training Program Directors; American College of Cardiology; American Academy of Pediatrics; American Heart Association. Task force 2: pediatric cardiology fellowship training in noninvasive cardiac imaging. SPCTPD/ACC/AAP/AHA. Circulation 2015; 132 (06) e57 –e67
• 19 Tsai PJ, Wong S, Zalud I. Ultrasound education in obstetrics and gynecology: Hawai'i experience. Hawaii J Med Public Health 2013; 72 (05) 172-174
• 20 Kasales CJ, Coulson CC, Mauger D, Chertoff JD, Matthews A. Training in obstetric sonography for radiology residents and fellows in the United States. AJR Am J Roentgenol 2001; 177 (04) 763-767
• 21 Shaw-Battista J, Young-Lin N, Bearman S, Dau K, Vargas J. Interprofessional obstetric ultrasound education: successful development of online learning modules; case-based seminars; and skills labs for registered and advanced practice nurses, midwives, physicians, and trainees. J Midwifery Womens Health 2015; 60 (06) 727-734
• 22 Bruner JS. Organization of early skilled action. Child Dev 1973; 44 (01) 1-11
• 23 Wood D, Bruner JS, Ross G. The role of tutoring in problem solving. . J Child Psychol Psychiatry 1976; 17 (02) 89-100
• 24 Benner P. Using the dreyfus model of skill acquisition to describe the interpret skill acquisition and clinical judgment in nursing practice and education. Bull Sci Technol Soc 2004; 24 (03) 188-199
• 25 Green ML, Aagaard EM, Caverzagie KJ. , et al. Charting the road to competence: developmental milestones for internal medicine residency training. J Grad Med Educ 2009; 1 (01) 5-20
• 26 Committee on Obstetric Practice, the American Institute of Ultrasound in Medicine, and the Society for Maternal-Fetal Medicine. Committee opinion no 700: methods for estimating the due date. Obstet Gynecol 2017; 129 (05) e150-e154
• 27 Reddy UM, Abuhamad AZ, Levine D, Saade GR. ; Fetal Imaging Workshop Invited Participants. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2014; 123 (05) 1070-1082
• 28 The Association for Medical Ultrasound: American Institute of Ultrasound in Medicine. AIUM practice parameter for documentation of an ultrasound examination. 2015 ; cited January 1, 2017. Available from: http://www.aium.org/resources/guidelines/documentation.pdf ; accessed on September 27, 2018
• 29 Winter TC, Kennedy AM, Byrne J, Woodward PJ. The cavum septi pellucidi: why is it important?. J Ultrasound Med 2010; 29 (03) 427-444
• 30 Callen PW, Callen AL, Glenn OA, Toi A. Columns of the fornix, not to be mistaken for the cavum septi pellucidi on prenatal sonography. J Ultrasound Med 2008; 27 (01) 25-31
• 31 Viñals F, Heredia F, Giuliano A. The role of the three vessels and trachea view (3VT) in the diagnosis of congenital heart defects. Ultrasound Obstet Gynecol 2003; 22 (04) 358-367
• 32 The Association for Medical Ultrasound: American Institute of Ultrasound in Medicine. Practice Parameter for the Performance of Fetal Echocardiography 2013 ; available from: http://www.aium.org/resources/guidelines/fetalecho.pdf ; accessed on September 27, 2018
• 33 Nelson TR, Fowlkes JB, Abramowicz JS, Church CC. Ultrasound biosafety considerations for the practicing sonographer and sonologist. J Ultrasound Med 2009; 28 (02) 139-150
• 34 Bergland C. . Curiosity and conscientiousness more Important than Intelligence: how to beat the “been-there-done-that” doldrums Psychology Today. 2011 ; cited April 24, 2017; available from: https://www.psychologytoday.com/blog/the-athletes-way/201112/curiosity-and-conscientiousness-more-important-intelligence ; accessed on September 27, 2018