title: Formative assessment based on an audit and feedback improves nuchal translucency ultrasound image quality.
abstract: OBJECTIVE
  The purpose of this work was to study the impact of an audit and feedback on the quality of routine first-trimester nuchal transparency ultrasound images.
  
  
  METHODS
  Eighty-eight sonographers were each sent 2 different series of 30 consecutive nuchal translucency images at a mean interval of 3 months to a dedicated, protected server for remote double-blind independent analysis based on the new Collège Français d'Echographie Foetale/Centre National de la Recherche Scientifique image-scoring method (https://www.cfef.org/evaluation/ISMCFEFCNRS.pdf). The sonographers were classified as low (score below the median) or high (score above the median) scorers for each series. Before their second evaluation, 73 of the 88 sonographers received a feedback report on their first series of images, whereas the other 15 participants received no feedback. The baseline characteristics of the participants who did and did not receive feedback were comparable.
  
  
  RESULTS
  Participants who received feedback increased their average score significantly, from a mean ± SD of 11.1 ± 1.3 to 13.4 ± 1.4 among low scorers (P < .00001) and from 15.1 ± 1.2 to 16.0 ± 1.4 among high scorers (P < .001), whereas no significant change was seen among participants who received no feedback (low scorers, 10.9 ± 1.5 to 12.1 ± 2.0; P = .11; high scorers, 14.7 ± 1.3 to 14.6 ± 1.3; P = .99). The proportion of satisfactory images increased by 48% among low scorers who received feedback.
  
  
  CONCLUSIONS
  Formative assessment based on a moderately intensive audit and feedback is feasible and effective for improving the quality of routine first-trimester nuchal transparency ultrasound images.
authors: Department of Obstetrics and Fetal Medicine, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants-Malades, Paris, France.
authors: Gihad E
authors: GE
authors: Chalouhi
authors: Laurent J
authors: LJ
authors: Salomon
authors: Marianne
authors: M
authors: Fontanges
authors: Marc
authors: M
authors: Althuser
authors: Georges
authors: G
authors: Haddad
authors: Olivier
authors: O
authors: Scemama
authors: Jean-Michel
authors: JM
authors: Chabot
authors: Michel
authors: M
authors: Duyme
authors: Nicolas
authors: N
authors: Fries
mesh_terms: D004311:Double-Blind Method; D004502:Education, Medical, Continuing / Q000379:methods* / Q000706:statistics & numerical data; D004650:Employee Performance Appraisal / Q000379:methods* / Q000706:statistics & numerical data*; D005246:Feedback; D005260:Female; D005602:France; D006801:Humans; D020407:Internet; D008297:Male; D008485:Medical Audit / Q000379:methods* / Q000706:statistics & numerical data; D009333:Neck / Q000000981:diagnostic imaging; D048208:Nuchal Translucency Measurement / Q000379:methods*; D015588:Observer Variation; D011361:Professional Competence / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Down syndrome; audit; formative assessment; nuchal translucency; quality control