OBJECTIVE To assess the effectiveness of diagnostic breast ultrasound training provided for general practitioners and nurses in Rwanda via intensive in-person and subsequent online supervision and mentorship .
METHODS Four breast radiologists from Brigham and Women's Hospital trained two general practitioner physicians and five nurses in Rwanda over 9 total weeks of in-person training and 20 months of remote mentorship using electronic image review with e-mailed feedback . Independently recorded assessments were compared to calculate the sensitivity and specificity of trainee assessments, with radiologist assessments as the gold standard . We compared performance in the first versus second half of the training .
RESULTS Trainees' performance on written knowledge assessments improved after training (57.7% versus 98.1% correct, P = .03). Mean sensitivity of trainee-performed ultrasound for identifying a solid breast mass was 90.6% (SD 4.2 %) in the first half of the training (period 1) and 94.0% (SD 6.7 %) in period 2 (P = .32). Mean specificity was 94.7% (SD 5.4 %) in period 1 and 100.0% (SD 0) in period 2 (P = .10). Mean sensitivity for identifying a medium- or high-suspicion solid mass increased from 79.2% (SD 11.0 %) in period 1 to 96.3% (SD 6.4 %) in period 2 (P = .03). Specificity was 84.4% (SD 15.0 %) in period 1 and 96.7% (SD 5.8 %) in period 2 (P = .31).
DISCUSSION Nonradiologist clinicians (doctors and nurses) in a rural sub-Saharan African hospital built strong skills in diagnostic breast ultrasound over 23 months of combined in-person training and remote mentorship . The sensitivity of trainees' assessments in identifying masses concerning for malignancy improved after sustained mentorship . Assessment of impact on patient care and outcomes is ongoing.