Evaluation of antenatal Point-of-Care Ultrasound (PoCUS) training: a systematic review

Abstract

Introduction There is limited access to life-saving antenatal ultrasound in rural and low-resource settings largely due to shortages in skilled staff. Studies have shown healthcare practitioners can be upskilled in PoCUS through focused training, offering a viable solution to this deficit. However, standards for training and competency assessment are unclear and regulation surrounding practice is lacking. We aimed to review published literature examining antenatal PoCUS training programs, comparing teaching approaches and study methodologies. Methods A search of electronic databases EMBASE, MEDLINE and Google Scholar was conducted. Original research articles evaluating antenatal PoCUS training of healthcare professionals worldwide were identified for analysis. Articles with limited detail on the PoCUS training intervention and those describing comprehensive diagnostic training programs were excluded. Evaluations were compared against the Kirkpatrick Evaluation Framework (KEF). Results Twenty-seven studies were included from an initial search result of 484 articles. There was considerable heterogeneity between the PoCUS training programs described. Course duration ranged from 3 hours to 2 years, with 11 of the 27 studies delivering obstetric-exclusive content. 44% trained multidisciplinary groups of health professionals. Long-term follow-up training and skills assessments were lacking in over half of the reviewed studies. Study quality and reporting detail varied, but overall beneficial outcomes were reported with 3/4s of the studies reaching upper KEF levels 3 and 4. Conclusion PoCUS performed by upskilled healthcare professionals offers an attractive solution to the problem of inequitable access to antenatal ultrasound. A review of available literature highlighted a paucity of comparable high-quality studies needed to establish a stronger evidence base for antenatal PoCUS, and a need to standardise training and competency assessment. This review may inform educators, researchers and policy-makers on existing training formats and methodologies to assist in establishing best practice antenatal PoCUS training methods for safe service delivery by remote healthcare professionals.

The effect of online point of care ultrasound training coupled with 1:1 sessions on medical learner comfort level and intended use

“…However, the training required for POCUS certi cation can be costly, time consuming, utilizes patient resources and requires time away from the participant's practice (5,6). This is particularly relevant for providers in rural and remote communities, which are typically under-resourced.…”

“…In-person POCUS modules typically cost $1500.00 (CDN) without consideration of costs accrued for the ultrasound machine, compensation to live models, instructor(s), or consumables associated with delivering such a course (e.g., catering, room rental, linens, ultrasound gel, etc.). Shortages in skilled staff, particularly in rural and low-resource areas, results in limited access to POCUS training (5,6). Online training may help overcome these barriers to POCUS education, which could be of special bene t for rural areas.…”

Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study

“…These studies commonly suffer limitations inherent to research conducted in remote settings, including low participant numbers, convenience samples, and loss to follow-up [ 32 ]. Our own systematic review [ 22 ] of PoCUS training evaluations in published literature highlighted a lack of comparable high-quality studies needed to establish a stronger evidence base for antenatal PoCUS. However, findings were generally positive, with improved knowledge and competence being reported despite the varying course durations (3 h to spanning several years).…”

“…Once trained it is challenging to entice professionals to relocate and remain in rural locations [ 18 , 20 , 21 ]. Upskilling the rural workforce in antenatal Point-of-Care ultrasound (PoCUS) is a viable solution to assist with this deficit and can offer substantial benefits to these under-resourced communities [ 22 ].…”

Handheld ultrasound device in the assessment of the uterus and adnexa

“…Particularly in obstetrics, studies have shown improvements in diagnosing complicated pregnancies, such as unfavorable fetal positions, placenta previa, and intrauterine growth restriction. However, there is still a lack of high-quality evidence demonstrating its accuracy compared to conventional high-resolution ultrasound devices [3,5,10,11]. In the evaluation of early pregnancy, authors have also highlighted the usefulness of POCUS in characterizing the intrauterine gestational sac [12][13][14].…”