Rationale and Objectives
To determine the effectiveness of a comprehensive educational program that trained a group of physicians in diagnostic ultrasound (US), so that they would return to their respective countries to train others with the intent of helping to standardize knowledge and improve the quality of US in Africa. Additionally, to compare the effectiveness of this program to that of a similar, but larger, program.
Materials and Methods
Twelve physicians from sub-Saharan Africa were selected for an intensive 3-month training program sponsored by Radiological Society of North America Research and Education Foundation Grant in all aspects of diagnostic US. A 100-item open-ended test was used to assess learning and retention of knowledge by administration of the same test at three points: at entry into the program, at completion, and 6-month follow-up. Findings were compared with the previously published results of a larger study.
Results
Mean test scores increased significantly from a mean of 58.4% at entry to 76.8% at end-of-program. The mean 6-month follow-up test score (79.1%) was slightly higher than posttest and approached significance, similar to the larger group. Nine of the 12 physicians were selected to establish affiliated ultrasound training programs.
Conclusion
The results of this testing process are both statistically and clinically significant, because they document an increase in knowledge at the end of an intensive 3-month training program, similar to the results reported for a larger group. There was retention and even slight improvement in the physicians’ knowledge at 6-month follow-up, a time during which they were teaching others in their home countries in Africa.
Ultrasound is a safe, noninvasive, cost-effective, and ubiquitous imaging technology that has proven diagnostic capabilities and applications. As compared to other imaging technologies, it is a practical and affordable medical imaging modality for developing and impoverished nations seeking to improve the standard of health care in their countries. Ultrasound is known to be more operator-dependent than most other diagnostic modalities; therefore, training is required not only in image interpretation, but also in the use of this technology, which becomes highly effective in the hands of trained operators. Training in all aspects of ultrasound of a small group of radiologists, who would return to their countries to train others, would multiply the efforts needed to meet the needs of these countries. This concept of “Teaching the Teachers” has been implemented into a formal training program at our institute for nearly two decades. Since the implementation of this program, more than 500 physicians from foreign countries have been trained in virtually all aspects of ultrasound. They have subsequently returned to their native countries, resulting in the establishment of over 70 Ultrasound Training Centers affiliated with our institute. The purpose of this report is to determine the effectiveness of a comprehensive educational program entitled “Teaching the Teachers Initiative for Ultrasound Training in Africa” by means of objective measurement of change in knowledge in a group of African physicians by comparing testing results before and after completion of such a program.
Materials and methods
Selection Process
This program was made possible by a 3-year $300,000 Radiological Society of North America Research and Education Foundation International Radiology Education Program Grant entitled “Teaching the Teachers Initiative for Ultrasound Training in Africa.” An African Advisory Committee was established with recognized leaders in ultrasound, including several from Africa to help in the advertisement, selection process, and long-term oversight of the program. We worked with the committee in announcing the program, soliciting applications, assisting in the selection of candidates and, finally, assisting in the selection of sub-Saharan African sites that demonstrated potential for the successful establishment of an ultrasound education center. The recruitment of physicians was accomplished through the process of advertising on our website, Radiological Society of North America website, by the World Health Organization, and with the local radiological societies and organizations recommended by members of the African Advisory Committee. Applications were available online.
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The Comprehensive Program
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Testing Method
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Results
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Table 1
Percentage Correct Scores on Entry Examination and End-of-Program Examination for 12 Participants in African Grant Ultrasound Training Program
Entry Exam End-of-Program Exam Number of Questions Mean ∗ SD Mean ∗ SD_t__P_ Value Change Total test 100 58.4 9.7 76.8 9.6 13.41 <.001 18.4 Subtest Physics 21 46.4 13.2 77.0 10.6 8.73 <.001 30.6 Abdomen 35 67.8 13.0 82.9 9.8 6.72 <.001 15.1 Obstetrics 20 53.8 14.2 70.0 10.9 4.98 <.001 16.2 Gynecology 18 60.2 15.8 73.0 17.7 5.49 <.001 12.8 Other † 6 55.7 17.9 75.0 13.1 3.6 <.01 19.3
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Table 2
Percentage Correct Scores on End-of-Program Examination and 6-Month Follow-up Examination for 12 Participants in African Grant Ultrasound Training Program
End-of-Program Exam 6-month F/U Exam Number of Questions Mean ∗ SD Mean ∗ SD_t__P_ Value Change Total test 100 76.8 9.6 79.1 6 1.12 .29 2.3 Subtest Physics 21 77.0 10.6 80.0 6.6 1.32 .21 3 Abdomen 35 82.9 9.8 84.0 7.6 0.32 .75 1.1 Obstetrics 20 70.0 10.9 75.0 10.0 2.71 <.05 5 Gynecology 18 73.0 17.7 73.6 12.4 0.15 .88 0.6 Other † 6 75.0 13.1 77.7 12.8 0.77 .46 2.7
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Discussion
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