1) Main findings
In this study, we assessed the effect of ISUOG basic training course in Chinese version based on the trainees’ feedback. As the difference of correct-answer-number between before and after course was with statistical significance (all P-values <0.05), our results indicated that ISUOG basic training course in Chinese version could improve the Chinese sonographers’ theoretical knowledge in some degree. Besides, the numbers of the trainees who evaluated the training as “very useful” were 220(80.3%) in the fist day, 83(88.3%) in second and 103(91.2%) in the last, while the trainees who chose ‘very satisfied’ were 223(81.4%), 82(87.2%) and 103(91.1%) respectively. This indicated the basic training course was highly accepted by the trainees.
However, changes of scores were without significant difference within doctors of different titles (all P-values >0.05) which may be related to the limited sample size. After the first two day’s training, the primary trainees seemed to have more improvement than the middle and high levels, but in the last day’s training was lower. The rate of trainees of primary title who evaluated the training as “very useful” was higher than that of high title, which indicated the basic training course maybe more useful to the young and middle-aged sonographers.
2) Comparison with previous studies
Hillerup et al6examined the validity and reliability of the ISUOG basic training test by assessing 92 participants, including 32 medical students, 45 residents, 12 consultants and 3 fetal medicine specialists. Their study showed clinical experience did not predict theoretical test scores. Our study also showed that there was no statistically significant difference of theoretical test scores in trainees of different titles before the training as well as the changes of the scores (all P-values >0.05). As far as we know, most sonographers in Chinese mainland could do ultrasound scan by themselves only after obtaining their medical qualification. They are doctors, not just technicians. Some part of sonographers preform Ob/Gyn ultrasound used to be a obstetrician or a gynecologist, especially in the elders or with high title. Vrachnis et al4 test twenty-eight participants to evaluate effectiveness of ISUOG Outreach Teaching and Training Program delivered in Muscat, Oman and showed that it improved the theoretical knowledge and practical skills of local health personnel. Our results also showed ISUOG basic training course could improve the theoretical knowledge of Chinese trainees.
3) Quality control
A quality control team was set up during the project implementation. The questionnaire was designed under discussion with professionals related to epidemiology, statistics and ultrasound. Besides ,we selected 7 postgraduate to do the pretest to ensure the feasibility of the content of the questionnaires. Also, paper answer sheets were prepared in case of network problems. In addition, we changed the orders of the questions in post-training tests as well as limited the test time to reduce the response bias. Furthermore, we informed all the participants both the advantages and disadvantages of participating in the study (passing the test could get the continuing education credit score as well as training certificate) and the disadvantages (time taken for questionnaire) to obtain the understanding and cooperation of the participants. Finally, in order to get an honest course assessment, we set the options into five levels, for example, for satisfaction assessment, they are “very satisfied”, “satisfied”, “general”, “not satisfied” and “very dissatisfied”. Statistically, only “very satisfied” would be included as “satisfied for the course” for our final results.
4) Limitations of the study
This was a cross-sectional study based on real world data and we did not select the participants randomly, which could affect the data representation. Besides, although we changed the orders of the questions for the tests, there was still response bias. Furthermore, we did not apply operational test to evaluate their practical skills because of the limitation of lacking financial and operational feasibility. In one published consensus report, the use of ultrasound simulation in residency training should be encouraged12. Further research is needed to evaluate the trainee’s practical skills.