In the course of the last 20 years, ultrasound has become a dominant technology in the daily practice of obstetrics and gynecology. Except for women living in rural outposts in underdeveloped countries, there is hardly a pregnant woman in the world who does not have at least one ultrasound and there are many who have five, ten or more ultrasound examinations. In some countries this is part of a structured, determined screening program, entitling every woman to one or two, sometimes three, ultrasound examinations, specifically for the purpose of finding fetal malformations and considering the option to terminate pregnancies should the malformation found on ultrasound be severe enough. In other countries, ultrasound in pregnancy is almost entirely left to the forces of the free market that happened to position themselves in that niche by buying equipment and offering their services, whether for the detection of malformations or just for the fun of watching the fetus on "baby TV". Large regional differences in the uptake of ultrasound and in the quality of diagnosis have been observed in multicenter studies such as the Eurocat study. Only a few years ago, ultrasound units in maternity hospitals were sinister dark rooms where dedicated eccentrics practiced the dark art of deducting information from the mysterious patterns of grey and black shown on their screens. Now, ultrasound machines are everywhere. There are ultrasound machines in the delivery and operating rooms, on the wards and in the outpatient units. Next to every obstetrical and gynecological chair is an ultrasound machine, usually with Doppler and color options, invariably with transvaginal and abdominal transducers. Most of the training in ultrasound is "learning by doing" - the more experienced junior doctor showing the young colleague where the knobs and switches are and encouraging him - or her - to just go ahead and scan. This is where the problems begin: in obstetrical and gynecological ultrasound, we have apparently accepted a chaotic autodidactic training system that would not be tolerated in air traffic control, cytology screening programmes or radiological breast cancer screening mammography programmes. All these occupations deal with pattern recognition - and decisions based on the interpretation of these patterns have wide-ranging consequences. As every teacher and parent knows, bad habits are acquired fast and unlearned very slowly. On the other hand, hands-on training in ultrasound is incredibly time-consuming and boring.

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European Clinics in Obstetrics and Gynaecology
Department of Gynaecology & Obstetrics

Brezinka, C. (2006). Training, certification and CME in obstetric ultrasound scan in Europe. European Clinics in Obstetrics and Gynaecology, 1(4), 223–226. doi:10.1007/s11296-006-0015-z