Training Nonradiologist Clinicians in Diagnostic Breast Ultrasound in Rural Rwanda: Impact on Knowledge and Skills
| Autor: | Vedaste Hategekimana, Chuan-Chin Huang, Kassim Shabani, Vestine Rugema, Sughra Raza, Elisabeth P. Frost, Cyprien Shyirambere, Michyla Bowerson, Aline Umwizerwa, Tharcisse Mpunga, Lydia E. Pace, Yeonsoo Sara Lee, Dylan C. Kwait, Lawrence N. Shulman, Jean-Marie Vianney Dusengimana |
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| Rok vydání: | 2021 |
| Předmět: |
Rural Population
medicine.medical_specialty education Patient care 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Breast cancer Mentorship Physicians medicine Humans Radiology Nuclear Medicine and imaging Breast ultrasound Ultrasonography medicine.diagnostic_test business.industry Mentors Gold standard Rwanda Solid mass medicine.disease 030220 oncology & carcinogenesis Physical therapy Female business |
| Zdroj: | Journal of the American College of Radiology. 18:121-127 |
| ISSN: | 1546-1440 |
| Popis: | Objective To assess the effectiveness of diagnostic breast ultrasound training provided for general practitioners and nurses in Rwanda via intensive in-person and subsequent online supervision and mentorship. Methods Four breast radiologists from Brigham and Women’s Hospital trained two general practitioner physicians and five nurses in Rwanda over 9 total weeks of in-person training and 20 months of remote mentorship using electronic image review with emailed feedback. Independently recorded assessments were compared to calculate the sensitivity and specificity of trainee assessments, with radiologist assessments as the gold standard. We compared performance in the first versus second half of the training. Results Trainees’ performance on written knowledge assessments improved after training (57.7% versus 98.1% correct, P = .03). Mean sensitivity of trainee-performed ultrasound for identifying a solid breast mass was 90.6% (SD 4.2%) in the first half of the training (period 1) and 94.0% (SD 6.7%) in period 2 (P = .32). Mean specificity was 94.7% (SD 5.4%) in period 1 and 100.0% (SD 0) in period 2 (P = .10). Mean sensitivity for identifying a medium- or high-suspicion solid mass increased from 79.2% (SD 11.0%) in period 1 to 96.3% (SD 6.4%) in period 2 (P = .03). Specificity was 84.4% (SD 15.0%) in period 1 and 96.7% (SD 5.8%) in period 2 (P = .31). Discussion Nonradiologist clinicians (doctors and nurses) in a rural sub-Saharan African hospital built strong skills in diagnostic breast ultrasound over 23 months of combined in-person training and remote mentorship. The sensitivity of trainees’ assessments in identifying masses concerning for malignancy improved after sustained mentorship. Assessment of impact on patient care and outcomes is ongoing. |
| Databáze: | OpenAIRE |
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