ABSTRACT
Introduction The maternity care curriculum guidelines of the American Academy of Family Physicians (AAFP) state that family medicine residents (FMRs) should demonstrate the ability to independently perform limited obstetric ultrasound (OBUS) examinations as a core skill. This study's purpose is to examine whether basic OBUS training enhances the knowledge and confidence of FMRs in performing OBUS. Methods This is a Sparrow Institutional Review Board (IRB)-exempt prospective study that was completed at the Sparrow/Michigan State University (MSU) Family Medicine Residency Program (FMRP) in Michigan between December 2020 and December 2021, involving 40 residents. Assessment of knowledge and confidence in performing OBUS was completed prior to and following the training sessions. For training, an online lecture and two separate hands-on sessions with a pregnant patient were completed. Training materials by Prof. Dr. Mark Deutchman and the University of Washington (UoW) were used. Paired T-test was used for statistical analysis, and a p-value of <0.05 was used to determine statistical significance. Results Thirty-two pre- and 25 post-training questionnaires were collected from the target group. Of the respondents, 92% (n=23) indicated that training increased their confidence levels in performing OBUS. The percentage of reported confidence level of 1 or 2 in performing OBUS (on a Likert scale of 5, with 5 as the highest confidence level) decreased by 60% post-training (p<0.001). Levels 3, 4, and 5 in confidence level were increased. According to the respondents, an increased confidence level in OBUS is helpful for improving trust and rapport between the provider and the patient (92%, n=23), boosting the provider's diagnostic abilities (80%, n=20), improving patient satisfaction (76%, n=19), and decreasing healthcare costs (44%, n=11). Conclusion The basic OBUS training sessions improved the knowledge and confidence of residents in interpreting and performing OBUS; therefore, more OBUS training is needed during the residency.
ABSTRACT
OBJECTIVE: The aim of this study was to compare the diagnostic effectiveness of transvaginal sonography (TVS), saline infusion sonohysterography (SIS), and diagnostic hysteroscopy (HS), with the pathologic specimen as a gold standard diagnostic method, in detecting endometrial pathology in premenopausal women with abnormal uterine bleeding. STUDY DESIGN: This prospective cohort study was conducted at Zeynep Kamil Education and Training Hospital, Istanbul, Turkey, and included 89 premenopausal women. All participants were examined first by TVS, further investigated with SIS and HS, and finally dilatation and curettage was performed when needed. The results obtained from these three methods were compared with the pathologic diagnoses. The positive and negative likelihood ratios (LR+ and LR-) of TVS, SIS and HS were calculated by comparison with the final pathological diagnosis. In addition, area under the curve (AUC) values were also calculated. RESULTS: Polypoid lesion was the most common abnormal pathology. LR+ and LR- of TVS, SIS, and HS were 3.13 and 0.15, 9.83 and 0.07, 13.7 and 0.02 respectively in detection of any abnormal pathology, and the AUCs of TVS, SIS, and HS were 0.804, 0.920, and 0.954 respectively. When the three procedures were compared with each other separately, HS had the best diagnostic accuracy, and the diagnostic accuracy of HS and SIS was superior to TVS (p(1)=0.000, p(2)=0.000). For the detection of polypoid lesions, HS was the most accurate diagnostic procedure (AUC=0.947), followed by SIS (AUC=0.894) and TVS (AUC=0.778). CONCLUSION: HS provides the most accurate diagnosis and allows treatment in the same session in premenopausal women with abnormal uterine bleeding.
