The midwife's assistant: Designing integrated learning tools to scaffold ultrasound practice

Ultrasound imaging is an effective tool for identifying maternal mortality risk factors. However, the high cost of ultrasound devices and the scarcity of ultrasound training are two major barriers to adoption in the developing world; complicated and expensive medical technologies are unlikely to meet the needs of users with limited opportunities for formal training and continuing education. To address these particular barriers, we have designed an inexpensive ultrasound system composed of off-the-shelf hardware and custom software. Our system is designed for use by rural midwives-often central medical figures in resource-constrained communities. This paper presents our work integrating help and tutorial software into the ultrasound system we developed. Our goal is to supplement a midwife's conceptual and operational knowledge of diagnostic ultrasound through appropriate and adaptive scaffolding. The design of our help system is informed by interviews with sonographers and radiologists in the United States and Uganda, and data collected during two fieldwork visits to Uganda. Through our fieldwork and preliminary evaluations, we have found that in addition to in-context reference material accessible during an exam, midwives need in-depth learning materials that can be accessed outside of a medical exam scenario.