Special issue on education and training in ultrasound.

Abstract

Diagnostic ultrasound is a highly operator dependent imaging modality which requires the practitioner simultaneously to make optimum use of the scanning equipment, produce diagnostic quality images of the target organs and make reliable judgements of the state of health of the patient. Health care professionals from an ever widening range of disciplines need to be trained to acquire a level of competence that will allow them to take responsibility for carrying out such ultrasound scans. The majority of practitioners in the UK are trained and assessed through dedicated CASE accredited courses run by higher educational institutes (HEIs) leading to a qualification in sonography. However, the ever increasing pressure on resources in HEIs may require new and more efficient ways to transfer knowledge and practical skills and assess competence. Teaching technologies may help in the acquisition of scanning skills and reduce costs. Meanwhile, e-learning is fast becoming a widely used means of making educational material freely available to students and providing distance education to those with limited access to teachers and other resources. This special issue of Ultrasound explores many of these aspects of education and training in ultrasound. Gillian Crofts describes a framework for learning derived from an analysis of student progress through elements such as patient communication, navigation skills and image interpretation skills. Her study showed that the acquisition of scanning skills could be broken down into a four-stage process from beginner to competent. Gill Harrison reports on a survey carried out at a BMUS conference on practitioners’ views of how to assess clinical competence. Most respondents preferred assessments to be carried out during routine lists in the clinical department rather than in the training centre. Debra Patten describes staff and student experiences of using portable ultrasound as an aid in teaching clinical anatomy to medical students. Musculoskeletal (MSK) ultrasound is recognised as one of the most challenging applications, but expertise in this area is in great demand. Mike Smith and colleagues from the universities of Cardiff and Keele provide a detailed description of their training, assessment and feedback package for the trainee shoulder sonographer. The package includes scan protocols and definitions of findings and differential diagnoses, followed by proformas for reporting on the findings and the performance of the trainee sonographer. This comprehensive package should serve as a useful model for training in MSK and potentially other areas of application. Crispian Oates gives his view on why sonographers find the physics and technology content of ultrasound courses a challenge and proposes a minimum curriculum. The way that we access information has changed radically over the last decade. Now, we can find out almost anything we need to know in a few seconds via the internet. This information revolution has had a major impact on medical education. The Royal College of Radiologists and e-learning for Healthcare, UK have created the Radiology Integrated Training Initiative, a comprehensive online learning resource for radiologists. Our European umbrella organisation EFSUMB (www.efsumb.org) now provides free access to the Ultrasound Course Book. Justin Bowra and colleagues from Australia and the USA provide a very useful review of internet teaching resources for point of care ultrasound. It seems that there is much material freely available, but there remain significant challenges to this mode of learning to scan, including the complexity of the skills to be learned, the difficulty of acquiring the physical skills required and the frequently absent control over the quality of information. Neha Baj and colleagues describe an e-learning project commissioned by WFUMB to teach ultrasound techniques in pregnancy to health workers in Uganda. The e-learning facility enabled students to study theory in their own rural location complemented by theoretical and practical skills sessions during visits to the urban centre of excellence. Jennifer Bagley and colleagues from the University of Oklahoma describe a study into the impact of introducing distance learning via the internet. It seems that the introduction of this technology can have a disruptive impact in the classroom as well as benefits. We conclude this issue with several letters on sonographer registration. More ultrasound scans are carried out per year in the NHS than CT, MRI, Fluoroscopy and Nuclear Medicine combined, but the HCPC is unable to protect the title of sonographer and offer statutory registration to those who are qualified. The letters discuss the particular problem of registration for experienced sonographers arriving from overseas.