Most of my energies have focused on writing lectures and running the USS course over the last 4 weeks. Over the next week, I am meeting the other obstetricians and finalising the protocols.
The first batch of 5 (1 could not attend) Xray technicians arrived on 17th April. In the days preceding this, the course was put together by Dave Parry, Emma Parry and Phurb Dorji. Two ultrasound machines had been made available from 10.30 am each day so that after this the students were scanning patients with Emma providing hands on feedback. A copy of the course outline is attached.
Course materials were photocopied and an MCQ and logbook prepared.
On the Monday morning the course was officially opened by Dr Uygen Dophu and Dr Phurb Dorji. Thanks was expressed to the Magee family and the Parry family for their support and help in bringing the course together. Initially all got to know each other and levels of experience ascertained. Students had come from far and wide: Punakha, Gelegphu, Yebilaptsa and Thimphu.
Over the next four weeks the lectures continued each morning (often written the day before!) as outlined in the course outline. The students were split between the two USS sites (general and maternity) on a rotating basis to allow exposure to obstetric and gynaecological scanning and to maintain the service requirements of the hospital. The portable USS machine was invaluable as it resulted in two machines being available at the naternity unit, so there were four machines in total and nearly all the students could scan at one. It also meant that the supervisor could monitor the progress of two students at each site. Emma and Phurb were available to provide hands-on supervision for most of the day until 3pm when scanning finished. This was intensive during the first 2 weeks to get the students scanning better. In particular, issues regarding depth of field of view, focal point, correct plane for image were corrected. Following this, students scanned with less direct supervision so that they could confirm that they could continue at a higher standard without supervision.
On Tuesday and Thursday afternoons, the students attended the high risk USS clinic where they watched Emma scan and demonstrate best practice and some antenatal complexities such as fetal abnormalities and twin pregnancies.
Each Friday logbooks were examined and feedback obtained. In general this was good and the students felt they were improving. Each student presented a case demonstrating good/ bad points. Part of the aim of the course was to develop techniques of self- criticism as most technicians are working in isolation.
In the third week the students had a practical exam where they were observed performing a growth scan. This was a formative test with feedback provided. At the end of the 4th week a second exam was performed and the same MCQ done again.
The marks showed that all students had improved a great deal with the MCQ improvement ranging from 60% to over 200%. All five students passed with grades ranging from C+ to A.
A feedback questionnaire was given to the students to fill in anonymously and the results will soon be available.
The second group of students will start their four week course on 18th May.
During the third week of the USS course I made time to visit the maternity unit and spend some time with the midwives. We talked about a number of areas where I might be able to help improve the situation. It was agreed that I would do some CTG teaching and surce some midwifery based protocols. I also ended up delivering a baby as I was in the unit and the other doctors were busy!
The Perinatal database will be adapted from the NIFTY database. This runs on the web, using open-source (i.e. free) software – PHP and MySQL. A plan has been produced and after this is accepted Dave will implement a local version running on Sr. Pema’s machine and then port it to the hospital web server. Training is obviously very important so the plan includes training for users and the support staff in the hospital. Dave is contacting the Institute of Electrical and Electronic Engineers (IEEE) and the Association of Computing Machinery (ACM) to see if there are any support arrangements for less developed nations. Students have been trained on two Ultrasound CD’s and are being contacted via email.