Teaching Family Physicians the Art of Prenatal Ultrasound

For many pregnant women, fetal ultrasound scans are a routine—and usually joyous—part of prenatal care.

Most of the time, these scans are performed by sonographers and the results read by radiologists. However, a small percentage of family physicians are getting the necessary training to perform prenatal ultrasounds themselves—a choice that can offer unique benefits to patient and doctor alike.

Continuing its support of this trend, the Department of Family Medicine (DFM), in collaboration with the Medical College of Wisconsin's (MCOW) Department of Family and Community Medicine, recently offered its fourth prenatal ultrasound course.

The course, one of only a few of its kind in the nation, was held May 14-16 at the Northeast Family Medical Center in Madison. It provided nine residents and three practicing physicians with the basics of prenatal ultrasound, giving them a jump start for future training in this challenging but useful skill.

Structured For Hands-on Learning

Before the workshop began, course director Lee Dresang, MD, distributed CD-ROMs with didactic information for review ahead of time. "This way, participants can start getting the cognitive framework down beforehand," he said.

For the first two days of the course, each morning and afternoon started with a lecture to review topics first introduced on the CD-ROM. Each lecture was then followed by lengthy scanning sessions using patient volunteers, under the supervision of Dr. Dresang and six other course instructors.

The third day of the course consisted of a Jeopardy-style game to review material learned so far, several additional lectures, a written test, and a final comprehensive ultrasound examination.

The Path to Proficiency

By the end of the course, each participant was able to perform a limited prenatal ultrasound scan. A limited scan, according to Dr. Dresang, is one that simply detects whether the fetus is alive—it does not include fetal measurements or detection of any anomalies. "Limited ultrasound examinations, however, are useful in emergent or remote settings," he said.

But skills increase with experience, Dr. Dresang said. "Each participant was able to perform 19 complete scans during the course. Studies show that new ultrasound learners can get the skills needed for biometry (measuring a fetus) within as few as 25 to 40 scans."

Dr. Dresang emphasized, however, that all participants will need additional training beyond this course—and their family medicine residency—to become truly proficient in prenatal ultrasound.

"Prenatal ultrasound is a more difficult skill to acquire than some other family medicine procedures," he said. "It can take up to 200 scans to learn how to detect fetal anomalies through ultrasound. Our goal with this course was to give participants the framework for future fellowships or mentorships, not to make them competent sonographers right now."

The Benefits for Family Practice

According to Dr. Dresang, when family physicians can perform prenatal ultrasounds right in the clinic, patients and doctors both benefit. Advantages include:

• Patients don't need to travel to another facility for an ultrasound, which can be especially beneficial in rural and urban settings;
• Results are available right away, so the physician can take immediate action if necessary;
• Patient-doctor relationships are enhanced by the emotional impact of the experience; and
• The family physician knows the clinical context of the scan and can make appropriate recommendations.

Dr. Dresang hopes that through this workshop—and the new collaboration with MCOW, who will be hosting next year's course—more family medicine residents statewide will have the chance to learn basic prenatal ultrasound skills.

And although no one knows for sure whether family physicians will more universally adopt prenatal ultrasound into their practice, "the technology is getting better, cheaper, and smaller," Dr. Dresang said. "Some even say that ultrasound may be the stethoscope of the 21st century. Whether that turns out to be true or not, ultrasound is an extremely useful—and attainable—skill for family physicians."

The DFM/MCOW prenatal ultrasound course was modeled after similar courses developed by family medicine faculty at the University of Colorado Health Sciences Center, University of Southern California, and in Memphis, Tennessee. Existing course models were streamlined to fit in three days and focus more on hands-on scanning.