P10.01: Learning curve for the detection of pouch of Douglas obliteration and deep endometriosis of the rectum in gynecological sonology trainees

We aimed to evaluate the learning curve of gynecological sonology trainees to correctly classify pouch of Douglas (POD) obliteration state and identify rectal deep endometriosis (DE) in real-time while simultaneously performing and interpreting transvaginal ultrasound (TVS). Three observers, of varying pre-study ultrasound experience, performed a pre-determined 150 examinations (50 each). A standardised educational program preceded study initiation. A DE TVS was performed by the study reference standard as per the IDEA group consensus statement. Subsequently, the observer performed a focused assessment of the rectum and POD, having been blinded to the clinical history and reference standard findings; a final diagnosis was made. Immediate feedback and hands-on teaching were provided. The learning curve using the cumulative sum (LC-CUSUM) was utilised. The acceptable performance rate (proficiency) was set at 15% failure, the unacceptable performance rate was set at 30%, and the equivalence zone was set at 5%. 150 examinations were performed on 145 patients, with rectal DE in 26 (17.3%) and negative sliding sign in 34/145 (22.7%). The overall accuracy of presence or absence of rectal DE was 90%, ranging from 82-94% amongst the observers. The overall accuracy of POD state classification was 92.7%, ranging from 90-96% amongst the observers. LC-CUSUM for rectal DE demonstrated observer 1 did not reach proficiency, whereas observers 2 and 3 required 21 and 25 scans, respectively. For POD obliteration, observer 2 did not reach proficiency, whereas observers 1 and 3 required 40 and 22 scans, respectively. One gynecological sonology trainee became proficient in diagnosing rectal DE and POD obliteration in less than the 50 planned supervised ultrasounds. Contrary to similar studies, we propose that not all trainees can reach proficiency during a program based upon a pre-defined number of scans and competency-based education may be more appropriate. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.