Evaluation and impact of cardiotocography training programmes: a systematic review

BACKGROUND: The interpretation and management of cardiotocography (CTG) tracings are often criticised in obstetric malpractice cases. As a consequence, regular CTG training has been recommended, even though little is known about the effect of CTG training.

OBJECTIVES: To perform a systematic review of the existing literature on studies on CTG training in order to assess educational strategies, evaluation of training programmes, and impact of training programmes.

SEARCH STRATEGY: The Medline database was searched to identify studies describing and/or evaluating CTG training programmes. The literature search resulted in 409 citations.

SELECTION CRITERIA: Twenty studies describing and evaluating CTG training programmes were included. There was no restriction on study design.

DATA COLLECTION AND ANALYSIS: Data regarding study design, study quality, educational strategies used for training in CTG interpretation and decision making, target groups, number of participants, methods used for evaluation, quality of evaluation, level of evaluation and results of training was extracted from 20 articles, and analysed using Kirkpatrick's four-level model for the evaluation of education.

MAIN RESULTS: Training was associated with improvements on all Kirkpatrick levels, resulting in increased CTG knowledge and interpretive skills, higher interobserver agreement, better management of intrapartum CTG, and improved quality of care. Computer-based training (CBT) might be less time-consuming than classroom teaching. Clinical skills seem to decrease faster than theoretical knowledge.

AUTHOR'S CONCLUSIONS: Training can improve CTG competence and clinical practise. Further research on CBT, test-enhanced learning and long-term retention, evaluation of training and impact on clinical outcomes is recommended.