Data Collected: Reported: September 2, 2010

Transcription

1 Job Task Analysis for ARDMS Obstetrics and Gynecology Specialty Data Collected: Reported: Analysis Summary For: Obstetrics and Gynecology Exam Survey Dates Invited Respondents 3,750 Surveys with Demographics Completed Surveys 959 (completed at least one question) 879 (completed all questions) Response Rate, Completed Surveys 23.4% Page 1 of 13

2 Demographics Educational Level Education Level N Percent Decline to state 1 0% On-the-job training (apprenticeship) % Certificate program % Associate's degree % Bachelor's degree % Master's degree 33 3% MD 20 2% PhD 6 1% Total % Table 1. Education -- All Survey Respondents Educational level of respondents is represented graphically below. Figure 1. Educational All Survey Respondents Page 2 of 13

3 Studies per Month Table 2. OBGYN Studies per Month shows the number of studies respondents typically conduct per month in their own practices. Obstetrics and Gynecology Studies per Month N Percent Decline to state 1 0% % % % % % Total % Table 2. OBGYN Studies per Month Results from Table 2 are presented graphically below. Figure 2. OBGYN Studies per Month Page 3 of 13

4 Laboratory Studies per Month Table 3, Obstetrics and Gynecology Exams in Respondent s Labs/Month, shows the number of OBGYN sonography exams conducted in the respondent s laboratory in a typical month Laboratory Studies Per Month N Percent Decline to state 5 1% % % % % Total % Table 3. OBGYN Studies in Respondent s Laboratory The results from Table 3 are presented graphically below. Figure 3. OBGYN Studies in Respondent s Laboratory Page 4 of 13

5 Experience as an OBGYN Sonographer The number of years the respondents have spent as a Sonographer are tabulated in Table 4. Years as a Sonographer. Experience as an OBGYN Sonographer N Percent Decline to state 3 0% % % % % % Total % Table 4. Years as a Sonographer Figure 4. Years as a Sonographer Page 5 of 13

6 Years in Obstetrics and Gynecology Practice Table 5. Years in Practice shows the number of years the respondents have been in Obstetrics and Gynecology practice. Years in OBGYN Practice N Percent Decline to state 0 0% % % % % % Total % Table 5. Years in OBGYN Practice Results from Table 5 are presented graphically below. Figure 5. Years in OBGYN Practice Page 6 of 13

7 Survey Topics Listings Below are the complete topic listings as they appeared in the survey. ID OBGYN Survey Tasks 1. Anatomy and Physiology 1.1. Evaluate the myometrial texture 1.2. Evaluate the contour of the uterus 1.3. Assess the texture of the endometrium 1.4. Assess the posterior and anterior cul-de-sac 1.5. Assess both adnexa 1.6. Perform sonography exams in premenarchal patients 1.7. Perform sonography exams on postmenarchal and premenopausal patients 1.8. Perform exams on postmenopausal patients 1.9. Perform exams in the second trimester of pregnancy Perform exams in the third trimester of pregnancy Perform exams on high-risk pregnancies Look for the double decidual sac sign Look for the yolk sac Assess the shape of the fetal head at the level of the BPD Assess the choroid plexus Assess the lateral ventricles Look for the thalami Assess the facial profile Assess the fetal orbits Assess the fetal neck Look for the lens of the eye Look for the ears Document the aortic arch Evaluate the texture of the fetal lungs Evaluate the size of the fetal thorax Evaluate the cardiac size in the thorax Assess the cardiac axis Document the insertion of the umbilical cord in the placenta Evaluate the fetal liver Evaluate the fetal gall bladder Evaluate the fetal spleen Evaluate the renal pelvis Document the fetal adrenal glands Assess the appearance of the fetal bowel Document the fetal diaphragm Page 7 of 13

8 1.36. Look specifically for the fetal hands/fingers Look at the fetal ankles and feet Examine the fetal genitalia Establish the placental grade Identified a dichorionic - diamniotic twin pregnancy Identified a monochorionic - diamniotic twin pregnancy Identified a monochorionic - monoamniotic twin pregnancy Identified higher order multiple pregnancy, e.g., triplets, quadruplets, etc Perform gynecological exams Perform first trimester obstetric exams Perform second and third trimester exams Perform both gynecological and obstetrical exams Evaluate the fetal heart for normal cardiac rhythm Perform biophysical profiles 2. Pathology 2.1. Encountered a pregnancy complicated by maternal diabetes 2.2. Encountered a pregnancy complicated by maternal hypertension 2.3. Encountered a fetus exhibiting intrauterine growth restriction 2.4. Encountered an anembryonic pregnancy 2.5. Encountered embryonic demise 2.6. Encountered an enlarged or echogenic yolk sac 2.7. Encountered an enlarged nuchal translucency 2.8. Encountered a pregnancy with oligohydramnios 2.9. Encountered a pregnancy with polyhydramnios Encountered a pregnancy with anhydramnios Identified twin-twin transfusion syndrome or other problems associated with monochorionic twins Identified fetal demise Encountered a lethal fetal head anomaly, e.g., anencephaly, acrania, hydranencephaly, other Encountered enlarged ventricles in the head Encountered a fetus with holoprosencephaly Encountered orbital abnormalities Encountered facial deformities, e.g. cleft defect, other Encountered a fetus with cystic hygroma Encountered a fetus with other neck anomalies Encountered a fetus with heart anomalies Encountered a fetus with other chest anomalies Encountered a fetus with diaphragmatic hernia Encountered a fetus with an abdominal wall defect Encountered a fetus with an intestinal deformity, e.g., esophageal atresia, small bowel atresia, bowel obstruction of any kind, organ defect, other Page 8 of 13

9 2.25. Identified a fetus with an abnormality of the kidneys Identified a fetus with an adrenal abnormality Identified a fetus with a bladder abnormality Identified a fetus with a urinary obstruction Identified a fetus with an inherited disease involving the kidneys, e.g., autosomal recessive polycystic kidney disease, autosomal dominant polycystic disease, Meckel-Gruber Syndrome, other Encountered a fetus with a kidney mass Identified a fetus with renal agenesis Identified a fetus with a genital abnormality Encountered a fetus with a skeletal abnormality Encountered a fetus with a dwarfism syndrome Identified a fetus with a spinal abnormality Identified a fetus with a chromosomal abnormality Encountered a fetus with an umbilical cord anomaly Identified conjoined twins Identified hydatidiform mole, complete or partial Encountered ovarian cysts Encountered ovarian solid masses Encountered dermoid cysts Encountered cul-de-sac echo-free fluid Encountered cul-de-sac fluid containing echoes Encountered other adnexal pathology Encountered uterine leiomyomas Encountered other uterine myometrial masses Encountered endometrial hyperplasia Encountered endometrial carcinoma Encountered endometrial polyps Encountered endocervical polyps Encountered endometrial fluid Encountered pelvic inflammatory disease Encountered endometrioma(s) Encountered cervical pathology Encountered an incompetent cervix Encountered hydrosalpinx Encountered pyosalpinx Encountered tubo-ovarian complex or abscess Encountered vaginal pathology Encountered an ectopic pregnancy Identified a vasa previa Identified a placenta previa Page 9 of 13

10 2.64. Identified placenta accreta, increta, percreta Identified an accessory lobe of the placenta Identified an eccentric cord insertion into the placenta Identified a marginal cord insertion into the placenta Identified a velamentous (membranous) cord insertion into the placenta Encountered a placental abruption Encountered a pregnancy complicated by maternal drug or alcohol abuse Encountered a pregnancy complicated by other maternal disease e.g., syphilis, systemic lupus erythematosus, preeclampsia, other 3. Protocol 3.1. Look for multiple gestations 3.2. Document the fetal number 3.3. Look for the amniotic membrane in the gestational sac in the first trimester in singleton pregnancies 3.4. Assess multiple pregnancies for chorionicity and amniocity 3.5. Look for adnexal masses/cysts when assessing a gravid patient 3.6. Document uterine, ovarian, or other adnexal areas when assessing a gravid patient 3.7. Look for the cavum septi pellucidi 3.8. Assess the shape of the cerebellum 3.9. Assess the nose and lips Assess the fetal spine in long axis Assess the fetal spine in transverse/axial views Document the four-chamber view of the fetal heart Document the right and left ventricular outflow tracts Document the fetal stomach Document the insertion of the umbilical cord in the fetal abdomen Assess the number of vessels in the cord Document the fetal kidneys Document the fetal bladder Look for the upper extremities of the fetus Look at the lower extremities of the fetus Establish fetal lie and presentation Document placental location Assess amniotic fluid Use transvaginal scans in gynecological patients Use transabdominal scans in gynecological patients Use both transabdominal and transvaginal scans in gynecological patients with approximately equal frequency Use transperineal/translabial scans with gynecological patients Use transabdominal scans in first trimester obstetric patients Use transvaginal scans in first trimester obstetric patients Page 10 of 13

11 3.30. Use both transabdominal and transvaginal scans in first trimester obstetric patients Use both transvaginal and transabdominal scans in second trimester patients Use both transvaginal and transabdominal scans in third trimester patients Use transperineal/translabial scans in second trimester patients Use transperineal/translabial scans in third trimester patients Require maternal bladder filling in preparation for a first trimester ultrasound Require maternal bladder filling in preparation for a second trimester ultrasound Require maternal bladder filling in preparation for a third trimester ultrasound Perform quality assurance checks on the equipment Measure uterine length Measure uterine width Measure uterine depth Measure fewer than three dimensions of the uterus Assess the cervix Measure the cervical length Measure the cervical width Measure the cervical depth Measure the endometrium in the anteroposterior diameter Measure both walls of the endometrium together Measure each wall of the endometrium separately Alter the way you measure the endometrial walls (thickness) if fluid is visualized in the endometrial cavity Measure the ovarian length Measure the ovarian width Measure the ovarian depth Calculate ovarian volume Measure fewer than three dimensions of the ovaries Measure gestational sac using the mean sac diameter in the first trimester Measure one dimension only of the gestational sac Measure the yolk sac Measure the crown-rump length Measure the nuchal translucency in the first trimester Measure the BPD Measure the head circumference Measure the head circumference using the outer edges of the cranium Measure the head circumference using the middle of the cranial bones Assess the cephalic index Measure the atrium of the lateral ventricles Measure the distance from the atrium wall to the choroid plexus Measure the cerebellum Measure the cisterna magna/posterior fossa Page 11 of 13

12 3.70. Measure the nasal bone Measure the outer orbital distance Measure the inner orbital distance Measure the orbit Measure the nuchal fold between 15 and 20 weeks gestation Evaluate the size of the fetal kidneys as a ratio of the abdomen circumference Measure the abdomen circumference Measure femur length Measure the humerus length Measure the radius Measure the ulna Measure other bones (other than those specified above) Measure the Amniotic Fluid Index (AFI) Use the single deepest pocket method for assessing amniotic fluid Use the subjective method for assessing amniotic fluid Measure the thickness of the placenta Participate in any contrast procedures of the pelvis Use Doppler (color/power/pulsed) Assess the middle cerebral artery with Doppler Assess and record uterine position Assess the embryonic heart rate Perform an ultrasound of the pelvis prior to sonohysterography Perform an ultrasound of the pelvis during sonohysterography 4. Physics and Instrumentation 4.1. Use Doppler to assess the umbilical cord vessels 4.2. Use Doppler to assess the uterine arteries 4.3. Use Doppler to assess venous structures in the fetus 4.4. Utilize M-mode to assess embryonic and/or fetal heart rate 4.5. Utilize Doppler to assess embryonic and/or fetal heart rate 4.6. Use harmonics 4.7. Use spatial compounding 4.8. Use panoramic scans 4.9. Use B-Color scans Use 3-D or so-called 4-D scanning with gynecological patients Use 3-D or so-called 4-D scanning with obstetric patients Use a linear array transducer Use a curved linear array transducer Use a phased array sector transducer Use a mechanical sector transducer Use M-mode Use pulsed spectral Doppler Page 12 of 13

13 4.18. Use continuous wave spectral Doppler Use color-flow imaging Use power (angio, amplitude) Doppler 5. Treatment 5.1. Perform exams for assisted reproduction techniques 5.2. Assist in oocyte retrieval/ivf 5.3. Perform exams to assist with percutaneous umbilical blood sampling 5.4. Perform exams to assist with amniocentesis before 15 weeks 5.5. Perform exams to assist with amniocentesis after 15 weeks 5.6. Perform exams to assist with fetal or embryonic reduction 5.7. Perform exams to assist with transvaginal chorionic villus sampling 5.8. Perform exams to assist with transabdominal chorionic villus sampling 5.9. Perform exams to assist with other fetal intervention techniques, e.g., amnioreduction, shunt placement, other Inform the supervising physician of findings that may be of an emergent nature Use volumetric imaging 6. Integration of Data 6.1. Obtain pertinent clinical history as a part of the exam 6.2. Review lab results as a part of the exam 6.3. Review other relevant studies, e.g., x-ray, MRI, etc., as a part of the exam 6.4. Use results of maternal serum screening markers to assist in assessing fetal anatomy 6.5. Attempt to correlate hcg levels with abnormal pregnancies, e.g., ectopic, hydatidiform mole, invasive trophoblastic disease, other 6.6. Use the 2nd international standard when evaluating hcg levels 6.7. Use the 1st or 3rd international reference preparation when evaluating hcg levels 6.8. Tailor the exam to evaluate pregnancies where a maternal and/or fetal condition indicates a potential complication 6.9. Document embryonic and/or fetal cardiac activity with videotape Document embryonic and/or fetal cardiac activity with CD Document embryonic and/or fetal cardiac activity with digital imaging systems Check the results of a previous ultrasound exam Page 13 of 13