One-Size-Fits-All Approach Does Not Work for Gynecology Trainees Learning Endometriosis Ultrasound Skills

Mathew Leonardi, Jozarino Ong, Mercedes Espada, Nicole Stamatopoulos, Ekavi Georgousopoulou, Gernot Hudelist, George Condous

Research output: Contribution to journalReview articlepeer-review

20 Citations (Scopus)


Objectives: To evaluate whether gynecologic surgical trainees (fellows) can become competent in the real-time classification of the pouch of Douglas (POD) obliteration state and direct visualization of bowel deep endometriosis (DE) during a program with a prespecified number of transvaginal ultrasound (TVUS) examinations. Methods: We performed a prospective study between December 2017 and December 2018. Three fellows (F1–F3) performed 50 scans each, which were all supervised by an expert sonologist, who performed the reference standard TVUS examination. The fellows performed a focused TVUS examination to assess the bowel and POD state, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's official classifications. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. Results: A total of 150 examinations were performed on 145 patients. Twenty-six (17.9%) patients had a diagnosis of bowel DE, and 34 (23.4%) were classified as having a negative sliding sign by the reference standard. The overall accuracy of the presence/absence of bowel DE was 90% (range, 82%–94%). The overall accuracy of POD state classification was 93% (range, 90%–96%). The cumulative summation test for the learning curve for bowel DE showed that F1 did not reach competency by 50 scans, whereas F2 and F3 required 21 and 25 scans, respectively. For POD obliteration, F2 did not reach competency, whereas F1 and F3 required 40 and 22 scans. Conclusions: Not all trainees can reach competency for TVUS evaluations of POD obliteration and bowel DE in a predefined number of scans.

Original languageEnglish
Pages (from-to)2295-2303
Number of pages9
JournalJournal of Ultrasound in Medicine
Issue number12
Publication statusPublished - Dec 2020
Externally publishedYes


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