Evolution in training in ultrasound

Abstract

When I started to learn sonography, I remember my training was informal, largely on patients, and very specific to the supervisor's skills and approaches. There was little standardisation and protocols, and much was ‘borrowed’ from overseas departments where our first leaders and mentors had trained themselves. We learnt on the job, and, on real patients. The pathology was opportunistic and dependent on the nature of the hospital. The caseloads were also much lower as clinical efficacy data were only emerging. These days, it seems every patient gets an ultrasound, and every doctor is learning to use ultrasound. This changes both the way we teach sonography and how ultrasound is used to diagnose cases.

Today, many ultrasound diagnoses are first made in the emergency room, and in this issue of the AJUM, Elsayed et al.¹ present compelling data showing that advanced trainees in Emergency Medicine highly value ultrasound in their clinical management and training, yet significant barriers to both training and credentialling exist, that are both perceived and real. They propose structured internal training systems are needed to overcome these hurdles, including time restrictions, access to training and technical challenges. It is no longer good enough to learn opportunistically from supportive colleagues.

In the face of similar staff resource limitations, Peters et al.² investigated the role of remote supervision for ultrasound-guided peripheral intravenous cannulation by new users (in this case junior medical staff). By reducing the need for direct supervision, they found that remote supervision increased the number of available supervisors yet had no significant impact on success rates.

Of course, training in ultrasound is one aspect, but exposure to pathology is yet another essential step in a sonographer's training journey: one needs to see and recognise pathology. In this issue of AJUM, Rathbun et al.³ present another simulated training opportunity: describe how to make a ‘homemade’ aortic aneurysm and dissection phantom. It provides an inexpensive solution that any department could manufacture in order to teach the appearance of aortic pathology. It facilitates familiarisation with the ultrasound appearances before scanning suspected rare, yet potentially life-threatening, clinical cases.

Ultrasound has an important, and often primary, role to play in diagnosing rare pathology, but rarely do any of us see enough cases. That is why it is essential that we share our experience such as this 10-year retrospective review of nontubal ectopic pregnancies by Loh et al.⁴ Ectopic pregnancies (1% of all pregnancies) are commonly diagnosed by ultrasound, and since most are tubal, an understanding of the appearances and outcome of nontubal pregnancies is of course outside of the everyday practice of many operators, especially for those outside of specialist obstetric services.

How we learn and train in ultrasound is no longer confined to a couple of experts working in a dark room. Learning opportunities are all around us, including AJUM. The Editorial Board of AJUM and the Board of ASUM are committed to offering our diverse readers varied solutions to their own training needs. We are stronger when we learn and work together.