Fellowship Curriculum for Training in MFM Ultrasound Neda

Fellowship Curriculum for Training in MFM Ultrasound Neda Ghaffari, MD Assistant Professor, Maternal Fetal Medicine Department of OB/gyn & RS

Problem Identification § ACGME Annual Program Evaluation 2019 -2020 year: - Ultrasound training was identified as an area for improvement - This had also been identified as an area for improvement in 2018 -2019 - Fellows & attending feedback 2 Fellowship Curriculum for Training in MFM Ultrasound

Problem Identification & Needs Assessment 3 § AIUM publishes lists of required views for the certification of any MFM ultrasound unit (AIUM. org) § There is no formalized national curriculum to train fellows in mastering imaging & interpretation of these views § Programs such as UCSF, UPenn, USC-Keck, Stanford lack a formal curriculum Fellowship Curriculum for Training in MFM Ultrasound

Problem Identification & Needs Assessment Current approach § Apprenticeship model § § Expectations and roles vary by attending and work flow University of WI published a local fellowship curriculum § Not widely adopted § Anthony et al, Am J Perinatol Rep, 2018 § 4 Ideal approach Competence/comfort varies by fellow Fellowship Curriculum for Training in MFM Ultrasound

UW Curriculum 2018 Anthony et al, Am J Perinatol Rep, 2018 § Phase I: 8 -week rotation with RDMS to teach the fellow how to perform a fetal ultrasound examination independently - In phase I, fellow is exempt from clinical duties except for 4 hours of high-risk obstetric continuity clinic (ABOG guidelines) § The fellow spends the majority of his or her time in the ultrasound unit with the RDMS educator § “it is essential for the academic department to protect the RDMS educator at 50% full time equivalent for educational activities. ”* *May not be possible with our current staffing 5 Fellowship Curriculum for Training in MFM Ultrasound

UW Curriculum 2018 Anthony et al, Am J Perinatol Rep, 2018 Phase II § Fellow reviews images acquired by perinatal sonographers § Fellow independently directly scans the patient to confirm normal/abnormal* § During the scanning period, fellow discusses the finding with the patient as previously role-modeled by the attending physician* § The fellow is expected to complete the report before attending to the next patient** § Both the images and the report are reviewed by the attending physician and direct feedback is provided contemporaneously on a case-by-case basis *Needs active attending supervision in our unit and may impact patient satisfaction scores 6 Fellowship Curriculum for Training in MFM Ultrasound

Targeted Needs Assessment § ACGME Annual Program Evaluation 2019 -2020 year § Describe the program weaknesses (maximum 250 words): - An opportunity for growth in the MFM program is the development of formal and structured obstetrical ultrasound teaching 7 Fellowship Curriculum for Training in MFM Ultrasound

Goals & Objectives Broad 8 § Establish a clear curriculum with planned proficiencies per year of training § Increase faculty teaching in fellows’ ultrasound experience through didactics and hands‐on training § Identify and establish protected time for a teaching sonographer/Registered Diagnostic Medical Sonographer (RDMS) in Obstetrics to teach the fellows Fellowship Curriculum for Training in MFM Ultrasound

Goals & Objectives Specific § Fellows achieve confidence & mastery in: - Image acquisition - Image interpretation - Counseling patients on findings & management 9 Fellowship Curriculum for Training in MFM Ultrasound

UW Curriculum 2018 Anthony et al, Am J Perinatol Rep, 2018 § Phase II: 8 -week rotation with MFM attending to develop perinatal sonologist skills: acquiring technically adequate images, interpreting them, generating ultrasound reports. - Apprenticeship model of teaching from the MFM faculty member 10 Fellowship Curriculum for Training in MFM Ultrasound

UCSF Educational Strategy Goals for each year: Complete at least 5 of each (AIUM, NTQR, CLEAR) 1 st to 2 nd Year Competencies • • 11 Image optimization Full 3 rd trimester basic (biometry) scans 2 nd trimester scans with basic cardiac views (76805) Transvaginal scans (cervical length, r/o previa ) Fellowship Curriculum for Training in MFM Ultrasound • NT ultrasound • Detailed 2 nd trimester anatomy scans (76811) • Full 3 rd trimester anatomy scans • Doppler evaluations (UA, MCA) • 3 rd trimester on multiple gestations

UCSF Educational Strategy Goals for each year: Complete at least 5 of each (AIUM, NTQR, CLEAR) 3 rd Year Competencies • • Detailed 2 nd trimester scans on multiple gestation Full doppler evaluations (UA, MCA, DV, uterine artery) • 1 st trimester scans with early anatomy Read 10 detailed 2 nd trimester scans • Fetal echocardiogram • NTQR certification* • CLEAR certification* Detailed 2 nd trimester scans w/ fetal anomaly and counseling *Submit formal application 12 Fellowship Curriculum for Training in MFM Ultrasound

Educational Strategy Fellow to keep a log, attending to sign-off 13 Fellowship Curriculum for Training in MFM Ultrasound

Implementation 14 § Create a reasonable ultrasound rotation schedule for the fellows § Outline clear roles & expectations for fellow, RDMS, attending § Request permission for fellows to rotate at at least 1 satellite (with more availability of ultrasound room, time in schedule) § Sonographer mentor paired with each fellow § Buy-in from PDC administration, fellowship leadership Fellowship Curriculum for Training in MFM Ultrasound

Evaluation & Feedback § Pre- and post- test of fellows - Fellow satisfaction (1 -10 scale) - Fellows’ level of comfort with each skill (1 -10 scale) § 15 Yearly ACGME survey (fellows & attendings) Fellowship Curriculum for Training in MFM Ultrasound

Thank YOU! 16 Fellowship Curriculum for Training in MFM Ultrasound