H. Benjamin Harvey MD, JD, Presenter: Nothing to Disclose

Daniel Price MD, Abstract Co-Author: Nothing to Disclose

Roy Ahn MPH, Abstract Co-Author: Nothing to Disclose

Garry Choy MD, MS, Abstract Co-Author: Nothing to Disclose

Giles W. Boland MD, Abstract Co-Author: Nothing to Disclose

Thomas Burke MD, Abstract Co-Author: Grant, FUJIFILM Holdings Corporation

Hand-held ultrasound machines have the potential to positively impact infant and maternal mortality in the developing world by identifying patients with high risk conditions that should deliver in a hospital setting. However, due to the paucity of radiologists in the developing world, training of non-radiologist clinicians in point-of-care ultrasound is essential. We trained a select group of nurse midwives in resource-limited areas of Western Kenya and empowered them to implement antenatal ultrasound screening programs in their hospitals and clinics. At least six months after training, we evaluated their retained obstetrical ultrasound skills. 

From February 2011 through August 2012, nine nurse midwives underwent an intensive one-week training course to perform and interpret point-of-care ultrasound examinations followed by a few weeks of supervised on-the-job training. Approximately six months after completion of training, fellowship trained sonographers subjected the providers to an objective structured clinical examination (OSCE) on two patients. The OSCE graded their ability to assess gestational number, gestational age, fetal heart rate, fetal position, placental position, and amniotic fluid index on a 3 point scale (0 = inadequate, 1 = adequate, 2 = excellent). The maximum score for the OSCE was 12.

The ultrasound screening programs were set up in three hospitals and six clinics. The average age of the providers was 36.9 yrs (28-60yrs, stdev 12.9 yrs). The providers performed an average of 9.3 scans per month (4-15, stdev 4.6) in their home clinics and hospitals.  All of the providers achieved at least a score of 1 (adequate) on all the assessed OSCE measures with an average per skill score of 1.6. The average total OSCE score per provider was 9.9 (8-12, stdev 1.3).

The findings suggest that non-physician clinical providers retain basic skills in point-of-care maternal ultrasound after one week of intensive training. Confident with the quality of the service provided, we next hope to begin the process of evaluating the potential longitudinal impact of these maternal ultrasound screening programs on patient management and maternal and infant outcomes.

Non-physician clinical providers can be trained to reliably perform and interpret point-of-care obstetrical ultrasound examinations in resource-limited areas of the developing world. 

Harvey, H, Price, D, Ahn, R, Choy, G, Boland, G, Burke, T, Assessing Competence of Non-physician Providers Trained in Point-of-Care Obstetrical Ultrasound in Under-resourced Settings of Western Kenya.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13024548.html