Training Nonradiologist Clinicians in Diagnostic Breast Ultrasound in Rural Rwanda: Impact on Knowledge and Skills

Area of Science:

• Medical Education
• Global Health
• Diagnostic Imaging

Background:

• Limited access to specialized diagnostic skills in rural sub-Saharan Africa.
• Need for enhanced breast cancer screening capabilities in resource-limited settings.

Purpose of the Study:

• To evaluate the effectiveness of a combined in-person and remote mentorship program for diagnostic breast ultrasound training.
• To assess skill acquisition in general practitioners and nurses in Rwanda.

Main Methods:

• Radiologists provided 9 weeks of in-person training and 20 months of remote mentorship to Rwandan clinicians.
• Electronic image review with emailed feedback was utilized for ongoing assessment.
• Trainee performance was compared to gold-standard radiologist assessments, analyzing sensitivity and specificity.

Main Results:

• Trainee knowledge assessment scores improved significantly post-training (57.7% to 98.1%).
• Sensitivity for identifying solid breast masses increased from 90.6% to 94.0% (not significant).
• Sensitivity for medium- to high-suspicion masses significantly improved from 79.2% to 96.3% (P=.03). Specificity also improved.

Conclusions:

• Non-radiologist clinicians can develop strong diagnostic breast ultrasound skills through combined training and mentorship.
• Sustained remote mentorship is crucial for improving the accuracy of identifying potentially malignant breast masses.
• Further assessment of patient care impact is underway.