CTG training

By Anita Hedditch on 07 March 2018 Electronic fetal monitoring

Cardiotocographs are notoriously tricky to interpret, so the RCM and RCOG have come together to develop an online training resource for midwives, doctors and students.

Interpretation of cardiotocographs (CTGs) can be difficult and, as a result, prompt differing opinions on an appropriate course of action. This is why the RCM and the RCOG have collaborated and developed a free online training resource that will help bridge certain gaps in knowledge and understanding.

Anita Hedditch, clinical lead for the fetal monitoring programme (eFM), answers questions on the resource.

How long has eFM been available, and who is responsible for its development?

The eFM resource was developed in 2012 under the remit of e-Learning for Healthcare (e-LfH), on behalf of the RCM and the RCOG. You can read their consensus statement at rcm.org.uk/position-statements

e-LfH is a Health Education England programme that works in partnership with the NHS and other professional bodies, providing e-learning to educate and train the health and social care workforce.

Who is the target audience of eFM?

It is designed for midwives, junior and senior obstetricians, and for university settings. The aim is to provide a robust clinical grounding for CTG analysis, based on the most up-to-date sources available.

How does someone access eFM?

Any midwife with RCM membership, or doctor affiliated to the RCOG, can access eFM. It’s a free educational online resource, unlike leading competitors, and can be found at e-LfH.org.uk/efm

Students can also use eFM via OpenAthens in addition to access from university sources. We have full technical support through e-LfH so any issues relating to logging in, or using the e-learning, can be resolved promptly by emailing [email protected]

Once you’ve logged in, what does eFM look like to users?

The programme is currently organised into five modules of knowledge sessions. These comprise background and practical issues, care in normal labour, normal and non-normal CTGs, management issues, and education and governance. The foundation for CTG interpretation is developed around the updated 2017 NICE intrapartum guidance.

Each module has an assessment session attached to it. On completing the assessment, a certificate can be downloaded for revalidation purposes.

The resource is evolving, with new developments planned. For example, we aim to add up to 12 real-life CTG case studies each year, all of which have been assessed by a group of experts who have provided a professional opinion of optimum management. Two of these are labelled ‘test cases’ and, as such, provide an assessment opportunity.

The remaining CTG case studies are labelled ‘learning cases’, and provide a real-life source for the individual to practise their CTG analysis in a non-test environment. Alternatively, the ‘learning cases’ can be used as a resource for group sessions and discussion. Currently, we have 27 case studies live and available to all.

Why is the learning package so long?

CTG analysis requires a sound understanding of physiology and the risk factors that influence fetal wellbeing. Without these sessions, your CTG analysis would not have the foundation of knowledge required for the assessments.

It is not necessary, or possible, to complete this e-learning package in one sitting. eFM will log your progress and, each time you enter, you can pick up where you left off. We suggest that you complete the assessment session after you finish each module, ensuring everything you’ve learned is fresh in your mind.

We are looking at ways of streamlining the package so that it can be utilised by junior and senior staff, and look less daunting.

What makes this learning resource different to others that are available?

The main difference is that eFM is free. It’s also updated regularly to align with updates from NICE and other sources. Users can be reassured that the knowledge sessions have been, and are being, written by expert clinicians in the field. eFM is not run as a business venture within the UK – its purpose is free education of a high quality.

What are the plans for eFM in 2018?

We hope to release a new series of interactive case studies, divided into ‘test’ and ‘learning’ modules. However, the biggest change to eFM will be the restructuring of how the knowledge sessions will be used. Currently sitting in five modules, we aim to revise this and move all the sessions into ‘learning paths’. Knowledge can be built by working through each of the learning paths, ranging from basic foundation for fetal heart analysis for more junior staff, to more advanced analysis for senior and experienced staff. Each learning path will culminate with an assessment.

By doing this, we hope to make the programme more user-friendly, offering learning at different levels. This would mean users were not overwhelmed by a feeling that they must complete everything. However, we want to provide a robust package that is useful in clinical practice. So, to align with other e-learning domains, we will be raising the pass mark to 80% for each learning path and all test-case CTGs. The aim is to have this restructuring in place in the early part of 2018.

This eFM package will introduce an intermittent auscultation knowledge session early in 2018, with assessment of learning undertaken within level one of the new proposed pathway.

eFM is free to access, updated annually with new material, and follows NICE guidance and updates closely. If you haven’t done so already, register at e-LfH.org.uk/efm

Anita Hedditch is clinical project lead for eFM, and a senior midwife at Oxford University Hospital NHS Trust