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Ultrasound feedback training increases trainee accuracy and confidence in vaginal assessment of fetal head position in labor

Jennifer Goldkamp, Laura Vricella, Dorothea Mostello, Tracy Tomlinson
Ultrasound in Obstetrics & Gynecology 2019 April 11

OBJECTIVE: To evaluate the impact of an immediate ultrasound feedback intervention on trainee accuracy in vaginal examination-based assessment of fetal head position.

METHODS: This was a prospective cohort study conducted at a single tertiary care center. Six third year and six fourth year residents were the study subjects. The third-year residents underwent a training intervention in which fetal head position was first assessed by resident transvaginal digital exam, then by ultrasound. All exams were performed on women with singleton gestations ≥ 35 weeks and cervical dilation ≥ 8 cm, following rupture of membranes. Comparison groups were third year residents before training, third year residents after training, and fourth year residents without training. The primary outcome was the difference in third year resident exam accuracy before and after ultrasound feedback training. Univariate and multivariate analyses were performed to identify factors associated with digital exam accuracy.

RESULTS: Three hundred and ninety exams were performed. The accuracy of third year resident exams was 55% before training, 65% during training, and 70% after training, while that of fourth-year residents who did not undergo training was 52% (P = 0.04). Multivariable analysis revealed a positive correlation between ultrasound feedback training and ability to accurately assess fetal head position. After adjusting for the variables included in the final model, third year pre-training exams and fourth year exams were less likely to be accurate than third year post-training exams (OR 0.50, CI 0.26-0.93 and OR 0.43, CI 0.22-0.81, respectively). The fourth year residents who did not undergo ultrasound training demonstrated similar baseline accuracy to the third year residents pre-training [52% (47/90) vs. 55% (53/96), P =0.68], but significantly lower accuracy than the third year residents post-training (P = 0.01).

CONCLUSION: Immediate ultrasound feedback training increased trainee accuracy in vaginal assessment of fetal head position in labor. Its integration into obstetric training programs should be considered. This article is protected by copyright. All rights reserved.


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