Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program
Por:
Guerriero, S, Pascual, MA, Ajossa, S, Rodriguez, I, Zajicek, M, Rolla, M, Llop, NR, Yulzari, V, Bardin, R, Buonomo, F, Comparetto, O, Perniciano, M, Saba, L, Mais, V, Alcazar, JL
Publicada:
1 ago 2019
Resumen:
Objective To assess the learning curves of trainees during a structured offline/hands-on training program for the ultrasonographic diagnosis of deep infiltrating endometriosis (DIE).
Methods Four trainees (all Ob/Gyn postgraduates with at least 5 years' experience in ultrasonography in obstetrics and gynecology, but with no experience of sonographic examination of DIE) participated in the study. They underwent a 2-week training program with a single trainer. Day 1 was devoted to theoretical issues and guided offline analysis of 10 three-dimensional ultrasound volumes. During the following days, four sessions of real-time sonographic examinations were performed in a DIE referral center ultrasound unit. In between these sessions, the trainees analyzed four datasets offline, each containing 25 volumes. At the end of each set, misinterpreted volumes were reassessed with the trainer. Presence or absence of DIE at surgery was considered the gold standard. The trainees' learning process was evaluated by learning-curve cumulative summation (LC-CUSUM) and the deviations of the trainees' level of performance at the control stage was assessed by CUSUM (standard CUSUM), for different locations of DIE.
Results The trainees reached competence after an average of 17 (range, 14-21) evaluations for bladder, 40 (range, 30-60) for rectosigmoid, 25 (range, 14-34) for forniceal, 44 (range, 25-66) for uterosacral ligament (USL) and 21 (range, 14-43) for rectovaginal septum (RVS) locations of DIE, and then kept the process under control, with error levels of less than 4.5% until the end of the test. The overall accuracy for each trainee in diagnosis of DIE at the different locations ranged from 0.91 to 0.98 for bladder DIE, from 0.80 to 0.94 for rectosigmoid DIE, from 0.90 to 0.94 for forniceal DIE, from 0.79 to 0.82 for USL DIE and from 0.89 to 0.98 for RVS DIE.
Conclusions The suggested 2-week training program, based on a mixture of offline and live scanning sessions, is feasible and apparently provides effective training for the ultrasonographic diagnosis of DIE. Copyright (c) 2018 ISUOG. Published by John Wiley & Sons Ltd.
Filiaciones:
Guerriero, S:
Univ Cagliari, Policlin Univ Duilio Casula, Dept Obstet & Gynecol, Cagliari, Italy
Pascual, MA:
Hosp Univ Dexeus, Dept Obstet Gynecol & Reprod, Barcelona, Spain
Ajossa, S:
Univ Cagliari, Policlin Univ Duilio Casula, Dept Obstet & Gynecol, Cagliari, Italy
Rodriguez, I:
Hosp Univ Quiron Dexeus, Dept Obstet Ginecol & Reprod, Unidad Epidemiol & Estadist, Barcelona, Spain
Zajicek, M:
Tel Aviv Univ, Chaim Sheba Med Ctr, Obstet & Gynecol Ultrasound Unit, Tel Hashomer, Israel
Rolla, M:
Univ Parma, Dept Surg Sci, Obstet & Gynecol Unit, Parma, Italy
Llop, NR:
Hosp Santa Creu & Sant Pau, Seccio Ecog, Serv Ginecol & Obstet, Barcelona, Spain
Yulzari, V:
Sheba Med Ctr, Ob Gyn Ultrason Imaging Unit, Tel Hashomer, Israel
Bardin, R:
Hellen Schneider Hosp Women, Rabin Med Ctr, Petah Tiqwa, Israel
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Buonomo, F:
IRCCS Burlo Garofolo, Inst Maternal & Child Hlth, Trieste, Italy
Comparetto, O:
Univ Parma, Dept Surg Sci, Obstet & Gynecol Unit, Parma, Italy
Perniciano, M:
Univ Cagliari, Policlin Univ Duilio Casula, Dept Obstet & Gynecol, Cagliari, Italy
Saba, L:
Azienda Osped Univ Cagliari, Dept Radiol, Cagliari, Italy
Mais, V:
Univ Cagliari, Policlin Univ Duilio Casula, Dept Obstet & Gynecol, Cagliari, Italy
Alcazar, JL:
Univ Navarra, Sch Med, Clin Univ Navarra, Dept Obstet & Gynecol, Pamplona, Spain
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