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Learning curves and training thresholds for paediatricians performing neonatal hip ultrasound using the Graf method
I Miras Aguilar1,2, L Fidalgo Marrón3, M Pangua Gómez3
1Department of Pediatrics, Hospital Universitario de Getafe, Carr. Madrid-Toledo, Km 12.500, 28905, Getafe, Madrid, Spain. i.mirasaguilar@gmail.com.
Insights
Paediatricians can reliably diagnose developmental dysplasia of the hip (DDH) using Graf method ultrasound after approximately 50 examinations. Consistent diagnostic competency is achieved with about 180 examinations and four months of supervised practice.
Area of Science:
- Pediatric Radiology
- Medical Education
Background:
- Universal neonatal hip ultrasound screening with the Graf method enhances early detection of developmental dysplasia of the hip (DDH).
- Current training requirements for paediatricians performing neonatal hip ultrasound are not well-defined.
Purpose of the Study:
- To determine the training duration and number of examinations needed for paediatricians to achieve diagnostic competency in neonatal hip ultrasound using the Graf method.
- To establish evidence-based training benchmarks for neonatal hip ultrasound screening.
Main Methods:
- An analytical cross-sectional observational study involving 14 paediatricians who completed a 40-hour training course.
- Performance evaluation using cumulative sum (CUSUM) analysis on 3752 ultrasound images from 467 newborns, compared against an expert reference standard.
- Assessment of diagnostic agreement using weighted kappa statistics to evaluate learning curves and competency thresholds.
Main Results:
- Diagnostic competency thresholds were reached around 50 examinations, with performance stabilizing between 50 and 100 examinations.
- Substantial interobserver agreement (weighted κ, 0.60-0.75) comparable to experts was achieved after approximately four months of supervised practice and at least 180 examinations.
- Most diagnostic discrepancies occurred early in training, particularly with borderline hip classifications (Graf IIa-IIc).
Conclusions:
- Paediatricians can attain reliable diagnostic competency in neonatal hip ultrasound using the Graf method.
- Structured training combined with adequate supervised clinical experience is crucial for achieving proficiency in DDH screening.
Abstract:
Early detection of developmental dysplasia of the hip (DDH) is essential to prevent late presentation and long-term morbidity. Universal neonatal hip ultrasound screening using the Graf method improves early diagnosis. However, evidence-based training requirements for paediatricians remain unclear. This study aimed to determine the duration of training and the number of examinations required for paediatricians to achieve diagnostic competency in neonatal hip ultrasound. An analytical cross-sectional observational study was conducted. Fourteen paediatricians completed a standardized 40-h theoretical and practical training course and performed neonatal hip ultrasound examinations using the Graf method. A total of 467 newborns were screened between 4-6 and 12-16 weeks of age over a 10-month period. Images were compared with a blinded external expert reference standard. Diagnostic agreement was assessed using weighted κ statistics and learning curves and competency thresholds were evaluated using cumulative sum (CUSUM) analysis. A total of 3752 ultrasound images were obtained, of which 3182 (84.8%) met Graf standardization criteria. CUSUM analysis showed that diagnostic competency thresholds were reached after approximately 50 examinations, with performance consolidating between 50 and 100 examinations. Paediatricians completing around four months of supervised practice and at least 180 examinations achieved substantial interobserver agreement comparable to expert reviewers (weighted κ, 0.60-0.75). Diagnostic discrepancies occurred mainly during early training and involved borderline hip classifications (Graf IIa-IIc).
Conclusion:
Paediatricians can achieve reliable diagnostic competency in neonatal hip ultrasound using the Graf method following structured training and adequate supervised clinical experience.
What Is Known:
• Universal ultrasound screening using the Graf method improves early detection of developmental dysplasia of the hip (DDH). • Training requirements for paediatricians performing neonatal hip ultrasound remain poorly defined.
What Is New:
• This study defines learning curve thresholds for paediatricians performing neonatal hip ultrasound using the Graf method. • Competency was achieved after 50 examinations, with consolidated performance after 4 months of practice and180 examinations.
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