Key result
Extended CTG education improved observer reliability for variability and accelerations compared to web-based learning alone, with overall intra-observer agreement ranging from κ 0.65 to 0.93.
Why the study?
Does an extended education program improve inter- and intra-observer reliability in CTG interpretation among obstetricians compared to web-based learning alone?
Observational (n=6)
Yes
Does an extended education program improve inter- and intra-observer reliability in CTG interpretation among obstetricians compared to web-based learning alone?
A combination of web-based learning, on-site lectures, and case discussions may improve CTG interpretation agreement compared to web-based learning alone.
INTRODUCTION: Previous studies have shown poor reproducibility in cardiotocography (CTG) interpretation. Studies evaluating the Swedish web-based CTG-education program have not proven to increase accurate CTG assessments. The aim of this study was to evaluate whether an extended education can improve inter- and intra-observer reliability in CTG interpretation. MATERIAL AND METHODS: Six obstetricians from two different departments interpreted 106 CTG tracings on two occasions. Both departments used a Swedish national web-based CTG education and test for training. One department had, in addition, an extended education program consisting of on-site lectures and oral examinations. Inter- and intra-observer agreements were calculated by simple or weighted kappa (κ) values for the five parameters assessed on CTG. RESULTS: In both departments inter-observer and intra-observer κ showed moderate to excellent agreement (ranges for κ 0.41-0.76 and 0.65-0.93, respectively). Obstetricians at the department with extended CTG education had better inter-observer reliability for variability and accelerations. This was also the case for intra-observer reliability with the addition of baseline frequency. Both inter- and intra-observer agreement increased from moderate to substantial in both departments when decelerations were dichotomized into harmless (including early and simple variable decelerations) or hypoxic (including late, severe variable, prolonged and combined decelerations) (κ 0.63-0.78) compared with the current sub-classification of decelerations (κ 0.42-0.65). CONCLUSIONS: Agreement in CTG interpretation was better than expected in both departments, especially when divided into harmless/hypoxic changes. Combination of different learning methods (web-based, on-site lectures and case discussion) might result in a better CTG interpretation agreement compared with web-based learning solely.
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Gyllencreutz et al. (2017) conducted an observational in Cardiotocography (CTG) interpretation (n=6). Extended education program (on-site lectures and oral examinations) vs. Web-based learning solely was evaluated on Inter- and intra-observer agreement (kappa values) for five parameters assessed on CTG. Extended CTG education improved observer reliability for variability and accelerations compared to web-based learning alone, with overall intra-observer agreement ranging from κ 0.65 to 0.93.
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