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LETTER TO EDITOR
Year : 2022  |  Volume : 25  |  Issue : 7  |  Page : 1199-1201

How ready are accredited obstetrics and gynaecology training departments to offer ultrasound services and training?


1 Department of Obstetrics and Gynaecology, University of Benin, Benin City, Nigeria
2 Department of Radiology, University of Ibadan, Ekpoma, Nigeria
3 Department of Obstetrics and Gynaecology, St Philomena Catholic Hospital, Benin City, Nigeria
4 Department of Obstetrics and Gynaecology, University of Ilorin, Ekpoma, Nigeria
5 Department of Obstetrics and Gynaecology, Ambrose Alli University, Ekpoma, Nigeria
6 Department of Radiology, Delta State University, Abraka, Nigeria
7 Department of Radiography and Radiation Science, University of Benin, Ekpoma, Nigeria
8 Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria
9 Department of Obstetrics and Gynaecology, Bayero University, Kano, Nigeria

Date of Submission04-May-2021
Date of Acceptance09-Jun-2022
Date of Web Publication20-Jul-2022

Correspondence Address:
Dr. E J Enabudoso
Department of Obstetrics and Gynaecology, University of Benin
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_1359_21

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How to cite this article:
Enabudoso E J, Akinmoladun J A, Igbarumah S, Raji H O, Njoku A I, Ikubor J E, Ogbebor O H, Awowole I, Aliyu L D. How ready are accredited obstetrics and gynaecology training departments to offer ultrasound services and training?. Niger J Clin Pract 2022;25:1199-201

How to cite this URL:
Enabudoso E J, Akinmoladun J A, Igbarumah S, Raji H O, Njoku A I, Ikubor J E, Ogbebor O H, Awowole I, Aliyu L D. How ready are accredited obstetrics and gynaecology training departments to offer ultrasound services and training?. Niger J Clin Pract [serial online] 2022 [cited 2022 Aug 8];25:1199-201. Available from: https://www.njcponline.com/text.asp?2022/25/7/1199/351440




   Introduction Top


Ultrasonography has become a core diagnostic tool in Obstetrics and Gynaecology and it is an indispensable component of modern antenatal care.[1],[2] The need for the Obstetrician/Gynaecologist to play a prime role in providing ultrasound services is a global trend.[3],[4] There is yet no record to determine the level of involvement of Obstetricians and Gynaecologists in Nigeria in the provision of this service, hence this survey. Information gathered may then be used to design programs to improve obstetrics and gynaecology ultrasound scan training towards better service delivery.


   Subjects and Methods Top


This cross-sectional, descriptive questionnaire-based survey of the 56 tertiary hospitals that were accredited by the National Postgraduate Medical College of Nigeria for specialty training in Obstetrics and Gynaecology in 2018 used a purpose-designed, pre-tested self-administered questionnaire. An obstetrician, preferably in maternal-fetal medicine, was contacted in each centre and the questionnaire was mailed to consenting consultants in both electronic format and hard copy.

Relevant information regarding the organization of obstetric services, the availability, utilization, and provision of ultrasound services by the Obstetricians/Gynaecologists in the department, and factors affecting the provision of such service was obtained. Descriptive and inferential analysis was performed on the data obtained.


   Results Top


Fifty-six questionnaires were sent to all the 56 tertiary institutions that were accredited for Obstetrics and Gynaecology fellowship training by the National Postgraduate Medical College of Nigeria. Of these 56, 40 questionnaires were returned and considered appropriately filled, giving a retrieval rate of 71%. The responding centres included 20 Federal Teaching Hospitals, 16 Federal Medical Centres and 4 State Specialist Hospitals. These 40 responding centres spanned the 6 geopolitical regions of the country and included the 6 largest teaching hospitals in the country.

The surveyed centres had annual delivery rates of between 1,500 and 3,500. About a third of the centres had divisions into subspecialty units that included the Maternal-Fetal Medicine unit. Sub-specialization tended to being associated with centres that had a higher delivery rate though this association was found not to be statistically significant [p-value 0.608; CI: 0.374–5.5365]. Regarding the source of obstetric ultrasound reports, only a tenth of the surveyed departments had majority of their obstetric scans being performed through the department-domicile ultrasound service. None of the departments had a wholly self-serving department domicile ultrasound service.

[Figure 1] depicts availability of departmental ultrasound machines at the surveyed centres. Only 17 [42.5%] of the surveyed obstetric units had functioning departmental ultrasound machines. These were the ones that had some form of ultrasound scanning service and allowed residents various degrees of ultrasound practice. Of these 17 centres with functioning ultrasound machines, eight had at least two functioning machines while only five centres had functioning transvaginal probes.
Figure 1: Distribution of tertiary training centres with respect to Obstetric department-domiciled ultrasound machine

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Only four of the centres had a written protocol for antenatal obstetric ultrasound scan. Twenty-four [60%] of the respondents reported not having a consultant or resident doctor with any form of practical ultrasound training in the past. Twenty five (62.5%) respondents were dissatisfied with the present level of obstetric ultrasound service and believe that there was need to progress towards an obstetrician led obstetric ultrasound service.

[Table 1] shows the respondents perception of the impediments to the implementation of an obstetric department-domicile ultrasound service. The lack of protocols guiding the practice of obstetric ultrasound scan ranked as the highest of these. Other reported major contributors were lack of self-confidence, lack of training, and absence of dedicated time for ultrasound.
Table 1: Most important factor impeding the availability of obstetric department-domiciled ultrasound services in Nigerian training institutions (n=40)

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   Discussion Top


The results of this survey revealed that majority of the accredited tertiary training institutions in Nigeria have sub-optimal capacity for Obstetrician-led Obstetrics and Gynaecology ultrasound services and training. These results are definitely not in tune with the global trend for improved training and ultrasound service delivery by obstetric department personnel.[5] Salvesen et al.[5] stressed the importance of obstetrician-led ultrasound services. Djokovic et al.[6] also reported challenges with endometriosis diagnosis in gynaecology and highlighted attempts to improve management through accuracy in performance and reporting of ultrasound finding. This service is also an essential component of the point of care service to which ultrasound evaluation is often called.[7] This view has been corroborated by the guidelines and curricula on ultrasound training for obstetric residents from other countries.[8],[9] Acquisition of proficiency in obstetric ultrasound scan has also become a mandatory competence that must be achieved in the postgraduate training curriculum in those countries. Availability of competent trainers is essential to achieving this.[2],[3]

Sub-specialty training in Obstetrics and Gynaecology, availability of ultrasound scan machines and appropriately trained personnel are essential in achieving the goal of the obstetrician-led obstetric ultrasound training and clinical service. However, this study shows these essential prerequisites are not available in most of the centres accredited for Obstetric training in Nigeria. This therefore creates significant impediments to the achievement of the global trend. This behoves on the postgraduate colleges to appreciate this deficit and address it effectively. One strategy to address the unavailability of appropriately trained personnel may be to commission indigenous, accessible centres of excellence to champion the training in obstetric and gynaecology ultrasound scans, especially in training institutions where the skills are already available.[2] Enabudoso et al.[10] had reported their positive experience on skill acquisition after an indigenous but internationally accredited standard obstetric ultrasound training programme.

The absence of protocols and lack of dedicated time for an ultrasound service are also of genuine concerns. This observation is similar to a previous report by Leonardi et al.[11] in a survey of the ultrasound training for obstetric residents in Canada. With the expansion of knowledge and practice, including further sub-specialization requirement in Obstetrics and Gynaecology training, postgraduate trainees have become even more engaged. Time has to be specifically allotted for skill acquisition and practice for the trainees to achieve proficiency.[3] This is in addition to improving the training climate including the use of simulation and specialty tutors in delivering training.[12]

This study may represent one of the first steps in Nigeria to formally address the perennial issue of sub-optimal preparedness of Obstetrics and Gynaecology Departments at provision of ultrasound scan services to their clients.


   Conclusion Top


There is sub-optimal capacity for the provision of obstetrician-led ultrasound services in Nigeria. The need for ultrasound machines, protocols, sub-specialization, and protected training periods are essential for success implementation of this service and training in Obstetrics and Gynaecology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ross AB, DeStigter KK, Coutinho A, Souza S, Mwatha S, Matovu A, et al. Ancillary benefits of antenatal ultrasound: An association between the introduction of a low-cost ultrasound program and an increase in the numbers of women receiving recommended antenatal treatments. BMC Pregnancy Childbirth 2014;14:424.  Back to cited text no. 1
    
2.
Stanton K, Mwanri L. Global maternal and child health outcomes: The role of obstetric ultrasound in low resource settings. World J Prev Med 2013;1:22-9.  Back to cited text no. 2
    
3.
Nora D. Ultrasound training in obstetrics and gynecology residency: A national portrait. Obstet Gynecol 2018;132:45S.  Back to cited text no. 3
    
4.
Green J, Kahan M, Wong S. Obstetric and gynecologic resident ultrasound education project: Is the current level of gynecologic ultrasound training in Canada meeting the needs of residents and faculty? J Ultrasound Med 2015;34:1583-9.  Back to cited text no. 4
    
5.
Salvesen KA, Lees C, Tutschek B. Basic European ultrasound training in obstetrics and gynecology: Where are we and where do we go from here? Ultrasound Obstet Gynecol 2010;36:525–9.  Back to cited text no. 5
    
6.
Djokovic D, Pinto P, van Herendael BJ, Laganà AS, Thomas V, Keckstein J. Structured report for dynamic ultrasonography in patients with suspected or known endometriosis: Recommendations of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 2021;263:252–60.  Back to cited text no. 6
    
7.
Seffah JD, Adanu RM. Obstetric ultrasonography in low-income countries. Clin Obstet Gynecol 2009;52:250-5.  Back to cited text no. 7
    
8.
Heinzow HS, Friedrichs H, Lenz P, Schmedt A, Becker JC, Hengst K, et al. Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: A prospective study. BMC Med Educ 2013;13:84.  Back to cited text no. 8
    
9.
Abuhamad A, Minton KK, Benson CB, Chudleigh T, Crites L, Doubilet PM, et al. Obstetric and gynecologic ultrasound curriculum and competency assessment in residency training programs: Consensus report. Ultrasound Obstet Gynecol 2018;51:150–5.  Back to cited text no. 9
    
10.
Enabudoso E, Adams OH. An international standard fetal ultrasound training programme organized in a low resource setting: The ISUOG-Benin city experience. Trop J Obstet Gynaecol 2016;33:292-6.  Back to cited text no. 10
  [Full text]  
11.
Leonardi M, Luketic L, Sobel ML, Toor K, D'Souza R, Murji A. Evaluation of obstetrics & gynecology ultrasound curriculum and self-reported competency of final-year Canadian residents. J Obstet Gynaecol Can 2018;40:1580-5.  Back to cited text no. 11
    
12.
Sartori E, Ghezzi F, Cromi A, Laganà A, Garzon S, Raffaelli R, et al. Learning climate and quality of Italian training courses in gynecology and obstetrics. Eur J Obstet Gynecol Reprod Biol 2019;241:13–8.  Back to cited text no. 12
    


    Figures

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    Tables

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  In this article
   Introduction
   Subjects and Methods
   Results
   Discussion
   Conclusion
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