Background: Studies of prenatal detection of congenital heart disease (CHD) in the UK, Italy, and Norway indicate\nthat it should be possible to improve the prenatal detection rate of CHD in Sweden. These studies have shown\nthat training programs, visualization of the outflow tracts and color-Doppler all can help to speed up and improve\nthe detection rate and accuracy. We aimed to introduce a more accurate standardized fetal cardiac ultrasound\nscreening protocol in Sweden.\nMethods: A novel pedagogical model for training midwives in standardized cardiac imaging was developed, a\nmodel using a think-aloud analysis during a pre- and post-course test and a subsequent group reflection. The\nself-estimated difficulties and knowledge gaps of two experienced and two beginner midwives were identified.\nA two-day course with mixed lectures, demonstrations and hands-on sessions was followed by a feedback session\nthree months later consisting of an interview and check-up. The long-term effects were tested two years later.\nResults: At the post-course test the self-assessed uncertainty was lower than at the pre-course test. The qualitative\nevaluation showed that the color Doppler images were difficult to interpret, but the training seems to have\nimproved their ability to use the new technique. The ability to perform the method remained at the new level at\nfollow-up both three months and two years later.\nConclusions: Our results indicate that by implementing new imaging modalities and providing hands-on training,\nuncertainty can be reduced and examination time decreased, but they also show that continuous on-site training\nwith clinical and technical back-up is important.
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