A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY
Part 1: What is diagnostic medical sonography?
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What is ultrasonography? Ultrasonography is commonly referred to as sonography or simply ultrasound. It is the use of high frequency sound waves to produce images of organs, tissues, or blood flow inside the body. Sonography is one of the more recent diagnostic medical procedures and helps with diagnosis in many physiological abnormalities. Sonography can also be used to guild a needle during a tissue biopsy. Unlike other diagnostic procedures which produce images, ultrasounds do not use radiation therefore are known for being extremely safe. At this time no known side effects are known therefore ultrasound is deemed as harmless (Human Resources and Skills Development Canada, 2011). What are the roles and responsibilities of a diagnostic medical sonographer? A diagnostic medical Sonographer is a medical professional and their job is to use specialized equipment to obtain images of structures inside the human body that can be used to make a medical diagnosis by a physician (Statistics Canada, 2013; Troy, Digiacinto, Elledge, 2004). Sonographers are responsible for obtaining and recording an accurate patient history, performing diagnostic procedures and obtaining diagnostic images, analyzing technical information, providing an oral or written summary of the technical findings to the physician for medical diagnosis, and collaborating with physicians and other members of the health care team. In addition, many sonographers also assist in scheduling, record keeping, and computerized image archiving. Sonographers may also have managerial or supervisory responsibilities (Human Resources and Skills Development Canada, 2011).
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The recommended requirements for becoming a sonographer are the ability to lift more than 50 pounds, push and pull, bend and stoop routinely, have full use of both hands, wrists and shoulders, distinguish audible sounds, adequately view sonograms, including color distinctions, work standing on their feet 80% of the time, communicate empathetically to patients, assist patients on and off examining tables and work well with other health care professionals. In addition, a sonographer must be able to properly perform an array of various ultrasounds effectively and safely (Human Resources and Skills Development Canada, 2011). There are several areas of specialization within sonography they include, abdomen (AB), adult echocardiography (AE), breast (BR), fetal echocardiography (FE), neurosonology (NE), obstetrics and gynecology (OB), pediatric echocardiography (PE) and vascular technology (VT). Sonographers can be classified under the Canadian Association of Registered Diagnostic Ultrasound Professionals (CARDUP) as Generalist Sonographer or a Cardiac Sonographer. A General Sonographer would include specialization in obstetrical and gynaecological sonography, abdominal sonography and sonography of the superficial structures, the musculoskeletal system, and the vascular system. In contrast, a Cardiac Sonographer could specialize in adult or paediatric cardiac. Other specializations include ophthalmic and neurosonology (CARDUP, 2013; Statistics Canada, 2013). Working environment Sonographers can be employed by hospitals or by private clinics with good working conditions. The only reported work hazards are repetitive strain injuries or aggravation of the muscles, normally in the upper body. In addition, since they work in
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close contact with patients, sonographers may be exposed to infectious diseases. However, these risks are minimal. Working hours for a Full-time Sonographers generally are about 40 hours a week. Sonographers may have to work evening and weekend shifts and they may require being on call (Human Resources and Skills Development Canada, 2013a). Salary The starting salary for a diagnostic medical sonographer depends on the employer, the amount of experience, whether or not they have specialized in a specific field, and the location. The higher paid Sonographers are usually specialized in one or more areas. The salary is based on hourly salary, over time and on-call pay. In New Brunswick the hourly salary for a Sonographer is between 25$ and 31$ per hour. In addition the number of overtime hours per week are 3 and the typical on-call rate is around $3 per hour with the on-call rate of pay is $42 per hour (personal communication, Becky Stockford, February 5, 2013). In Canada, sonographers can generally earn between $28 to $42 per hour which translates roughly to $56, 000 to $84,000 per year (Human Resources and Skills Development Canada, 2013a). Full-time sonographers usually receive benefits, depending on the employer, which may include vacation and sick pay, medical and dental insurance, and a pension plan.
A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY
Part 2: Prospective students
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A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY Medical sonography as an occupation The National Occupational Classification (NOC) 2011 has classified medical sonographers as a sub group under the major group of technical occupations in health (32) (Human Resources and Skills Development Canada, 2013c).The NOC code for medical sonographers is 3216. The following shows the descriptor profile which the Human Resources and Skills Development Canada (2011) has identifies the aptitudes, interests and worker functions related to the main duties of medical sonography in the NOC: General learning ability to operate ultrasound imaging equipment to produce images of those parts of the body requiring examination Verbal ability to prepare examination reports for physicians; may supervise and train students and other medical sonographers Form perception to monitor examinations by viewing images on video screens, to evaluate quality and consistency of diagnostic images and to make adjustments to equipment as required Objective interest in operating ultrasound imaging equipment and in recording, storing and processing scanned images by using camera unit connected to ultrasound equipment; and in performing quality control checks on ultrasound equipment to ensure proper operation and in performing minor repairs and adjustments Methodical interest in speaking with patients while observing and caring for them throughout examinations to ensure their safety and comfort
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Innovative interest in compiling information to aid in the monitoring of pregnancies and the diagnoses of cardiac, abdominal, ophthalmic, vascular and other disorders (paragraph 3). Overview: Accredited programs in Canada The following table outlines the Canadian Medical Association (CMA) accredited programs in Canada. It is important to note that most programs give preference to in province residents and in some cases programs do not allow out of province applicants. In addition, while the majority of programs listed are accredited a few are registered which means an unaccredited program has registered for accreditation and is pending a review by the CMA for accreditation status (CARDUP, 2013a). School
NAIT - Northern Alberta Institute of Technology
SAIT - Southern Alberta Institute of Technology
BCIT - British Columbia Institute of Technology
Program length
Academic requirements
ALBERTA A minimum 60% in each of English 30-1 / Pure Math 30 or 3 years, diploma Math 30-1/Math 30-2 / Physics 30 / Biology 30 At least 60% in Pure Math 30 or Applied Math 30 or Math 30-1, or at least 70% in Math 30-2, AND, 26 month, diploma At least 60% in English Language Arts 30-1, AND, At least 60% in Biology 30, and Physics 30, and Chemistry 20 BRITISH COLUMBIA 27 months, High school graduation diploma English 12 (B) and English language proficiency Biology 12 (B) or BHSC 0100 or equivalent* Physics 11 (B) or PHYS 0309 or equivalent
Approximate tuition
$13, 860
$11, 137
$14, 283.25
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One of the following math requirements: Principles of Mathematics 12 (B) Pre-Calculus 12 (B) MATH 0001 or assessment MANITOBA Prerequisite A Graduation from a Canadian two-year (24 calendar m months) allied health education program that is patientcare related. Academically, a minimum “B” average is desirable.
Winnipeg Health Sciences Ultrasound Training Program
College of the North Atlantic
18 months, diploma
Prerequisite B Hold a relevant Bachelor’s degree. Successful completion of a course in human anatomy/physiology and a course in medical terminology is strongly recommended. A minimum 3.0 GPA is desirable.
Prerequisite C Minimum 24 credit hours of post-secondary education from a recognized college or university including: Introduction to Physics (6 credits) Anatomy and Physiology (6 credits) Biology (6 credits) Medical Terminology (3 credits) Communication (3 credits) A minim um 3.0 GPA is desirable. NEWFOUNDLAND 13 months, post Must have successfully diploma completed an accredited program in Medical Radiation Technology (Medical Radiography, Radiation
$4, 150
$2, 530
A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY
QEII/Dalhousie School of Health Sciences
Michener Institute for Applied Health Sciences
Therapy or Nuclear Medicine) and possess a certificate of registration with the Canadian Association of Medical Radiation Technologists (CAMRT). NOVA SCOTIA High school diploma which includes English, Math, Physics and Biology at the grade 12 level. Acceptance requires no mark below 70% 3 year, diploma in each of these courses with option, 4 year an overall minimum average bachelors degree of 75%. Post secondary students must have a GPA of 2.75 (on a 4.30 scale), with no grade lower than a C in prerequisite courses. ONTARIO Registered health care professionals with a minimum 3 year degree or diploma in their field of study.
22 month, post diploma
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Diploma: $27, 690.40, Degree: $36, 077.20
Minimum CGPA of B- (70%) must be attained in order to be considered. Or Bachelor of Science degree, or Bachelor of Science or Arts in Kinesiology with: $13, 807 One half (0.5) university course in Gross Human Anatomy One half (0.5) university course in Human Physiology CGPA will be calculated using entire undergraduate education A minimum Grade Point Average (GPA) of B- (70%), and a minimum grade of C(60%) in each of the required courses
A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY
MohawkMcMaster Institute for Applied Health Sciences
4 years, Graduates of this program receive both an Ontario College Advanced Diploma from Mohawk College and a Bachelor of Medical Radiation Sciences Degree from McMaster University.
Collège BorÊal
16 months, post diploma certificate
Cambrian College of Applied Arts and Technology
6 semesters, Advanced Diploma
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Completion of the Ontario Secondary School Diploma (or equivalent) and: 6 Grade 12 U or M courses including English U, Biology U, Chemistry U, Advanced Functions U, one of Calculus and Vector U or Physics U and (both are recommended) Completion of one additional U or M course to total six credits Health professionals practicing in one of the following fields: medical radiation technology, radiation oncology, nuclear medicine, nursing, echocardiography or vascular sonography.
$16, 073.97
Or $4,553 Persons with a Bachelor's degree in Science, including a complete course in anatomy and human physiology. The student needs a grade point average (GPA) of B- in anatomy and physiology courses and C- in other courses. Ontario Secondary School Diploma (30 credits) or equivalent or mature student status, including: any grade 12 English (C), (U) or (M) any grade 12 mathematics (C), (U) or (M) any grade 11 or 12 biology or chemistry (C), (U) or (M) any grade 11 or 12 physics (C), (U)
$17, 962.38
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CMA Registered* Programs School
St. Clair College
Program length
2.5 years, Advanced Diploma
Academic requirements ONTARIO Grade 12 English - ENG4U, ENG4C, EAE4C or EAE4U Grade 12 Mathematics MCT4C, MAP4C, MHF4U, or MCV4U Senior Level Physics (C) or (U) Senior Level Biology (C) or (U) Senior Level Chemistry (C) or (U)
Canadian National Institute 20 month, diploma of Health, Inc.
High School Diploma Grade 12 English (U) or (C), 60 % or higher Grade 12 Math (U) or (C), 70% or higher Grade 12 Physics (U) or (C), 70% or higher, University level is highly recommended due to competitive entrance Grade 12 Biology (U) or (C), 70 % or higher, Entrance Exam based on high school English, Math, Physics and Biology and spatial reasoning. Applicant must have a passing grade of 70% or higher. Exam also has an essay component.
Approximate tuition
$7, 323.48
$38, 000
(BCIT, n.d.a; BCIT, n.d.b, BCIT, n.d.c; Cambrian College of Applied Arts and Technology, n.d.a; Cambrian College of Applied Arts and Technology. (n.d.b; Canadian National Institute of Health, Inc. , n.d.; Collège BorÊal, n.d.; College of the North Atlantic, n.d.a; College of the North Atlantic, n.d.b; Dalhousie School of Health Sciences, 2010; Dalhousie University, n.d.; Michener Institute for Applied Health Sciences, n.d.a; Michener Institute for Applied Health Sciences, n.d.b; MohawkMcMaster Institute for Applied Health Sciences, n.d.a; Mohawk-McMaster Institute for Applied Health Sciences, n.d.b; NAIT, n.d.a; NAIT, n.d.b; SAIT, n.d.a; SAIT, n.d.b; St. Clair College, n.d.; Winnipeg Health Sciences Ultrasound Training Program. n.d.)
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Certification and registration The Canadian Association of Registered Diagnostic Ultrasound Professionals (CARDUP) is the current registry for diagnostic medical sonographers in Canada. CARDUP ensures that all registered diagnostic ultrasound professionals meet national competency standards (appendix A ). CARDUP’s mission is to “promote high standards of professional practice through liaison with provincial regulatory bodies, educational institutions, and both national and international associations and agencies” (CARDUP, 2010, p.1). In order to be eligible for CARDUP specific requirements must be met which include, documented proof of successful completion of a Canadian Medical Association (CMA) accredited diagnostic ultrasound education program or an equivalent ultrasound education program as recognized by CARDUP, successful completion of the CARDUP Clinical Skills Assessment (CCSA), successful completion of CARDUP approved written examination(s) and payment of all required credentialing and registry fees (CARDUP, 2010). As of 2010, CARDUP has implemented Canadian diagnostic ultrasound examinations. The examinations are competency-based and will ensure registrants are prepared for effectively work in the Canadian healthcare system by testing on knowledge and technical skills as well as ethical and professional standards (appendix B). CARDUP recognizes specializations credentials in the following areas: Canadian Registered Generalist Sonographer (CRGS), Canadian Registered Cardiac Sonographer (CRCS) and Canadian Registered Vascular Sonographer (CRVS). Although, Canada does not currently have in place a law regulating professional registration for diagnostic ultrasound professionals, CARDUP “credentials are highly respected and required by
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many employers of ultrasound professionals in the Canadian workplace� (CARDUP, 2010, p.1). Job outlook in Canada and New Brunswick In Canada and around the world sonographers are in extreme demand. The employment growth for the ultrasound profession has been described as faster-thanaverage. In New Brunswick, the average annual employment growth rate is above the average for all occupations (Human Resources and Skills Development Canada, 2013a). According to Occupational Outlook Handbook, 2008-09 Edition, employment is expected to increase by about 19 percent through 2016 (Bureau of Labor Statistics, United States Department of Labor, 2009). Although, most industries in the services area have seen job losses, there has been an increase of nearly 3,000 jobs in the health care and social assistance field. The major contributions for the increase demand for this profession is the population’s need for healthcare (Human Resources and Skills Development Canada, 2013a). According to the most recent (2006) Census, in New Brunswick, medical sonography is a small occupational group with an unemployment rate of zero percent. Compared to the unemployment rate for all occupations in New Brunswick is eight percent. An actual job posting within New Brunswick is included in the appendices (appendix C). The Canadian Occupational Projection System (COPS) for 2011-2020 reported that all occupations which fall under the NOC code 321 labelled as medical technologist and technicians (except dental health) will be in excess demand which means a shortage of workers. Therefore, the expected number of job seekers will be less
A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY than the job openings over the 2011-2020 periods (Human Resources and Skills Development Canada, n.d.).
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A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY
Part 3: Literature review
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Sonographer shortage The current situation that Canada and the rest of the world are facing regarding the shortage of sonographers is significant. Statistics have shown that “one of every six radiology positions is vacant. Radiology managers report that 75% of medical imaging departments are understaffed” (Clay, 2004, p.408). In addition, “medical imaging has seen a tripling of examination volume” (Clay, 2004, p.409). Projections and employment outlooks have not offered much comfort as the shortages are expected to continue at least until 2020 (Clay, 2004; Human Resources and Skills Development Canada., n.d.). It has also been predicted that the current number of graduate each year from educational training programs will not meet the demands now or in the future (Craig, 2003). Essentially, it comes down to supply and demand. There has been a significant increase in demand for ultrasounds for medical diagnostics yet the supply of registered sonographers is limited. An array of contributing factors are to blame for the sever shortage these include the retention rates due to the musculoskeletal injuries and retirements, advancements in technology, lack of accredited educational programs, lack of public awareness and the struggles of defining sonography as an unique profession (Brown, & Baker, 2004; Clay, 2004; Evans, 2006; Hall, 2003; Human Resources and Skills Development Canada, 2013a; Human Resources and Skills Development Canada, n.d.; Kuntz, 2004; Craig, 2003; Moira, 2009; Penny, 2005; Troy, DiGiacinto & Elledge, 2004; Wilson & Cooley, 2006).
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Current demographics Ultrasound as a medical diagnostic tool is considered a new concept, first being introduced into clinical use in the 1950s. Today, it is one of the fastest growing diagnostic imaging modality and has easily become the preferred tool used in diagnostics because of safety (Lovegrove, & Price, 2002). One contributing factor which led to the sonographer shortage is the demographics of the population. This has impacted the shortage in two ways. The first is due to the aging population which has increase the demand of these services on the healthcare system and the second is the average age of sonographers leading to an increased rate of retirements. In 2010, the average age of workers in the field was 39.9 years old and the average age of retirement was 60 years old (Human Resources and Skills Development Canada, n.d.). Data also shows that “80% of sonographers are between ages 30 and 50 and they are about evenly distributed between these age groups—in other words, 40% between ages 30 and 40 and 40% between ages 41 and 50� (Craig, 2003, p.267). As sonographers age they are at a higher risk for musculoskeletal injuries. For a portion of sonographers, such occupational injuries have prematurely ended their careers as they were forced into retirement or rather accepting non-clinical positions such as educators, supervisors, managers and application specialists (Craig, 2003). Retention rates In 2001, one research study found that turnover rates for health care workers such as diagnostic imaging professional were on average 2% higher compared to their counterparts, registered nurses (Penny, 2005). High turnover rates are the result of
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employees leaving the organization which reflects as poor retention (Penny, 2005). There are many reasons why an employee may leave their current organization especially in sonography. Sonography is commonly reported as a stressful profession with a high risk of burnout, both mental and physical (Craig, 2003). Sonographers in clinical settings often find it challenging to avoid burnout. Studies report that burnout “seems to be a major problem in areas where people deal specifically with the needs of other people (Penny, 2005, p.152). Specific stressors relating to burnout include high demands, hardships, frustrations which ultimately lead to dissatisfaction and unhappiness (Penny, 2005). There are continuously high demands placed on ultrasound departments across Canada and frustrations are building. Physical burnout is mainly due to faulty ergonomics leading to musculoskeletal injuries among sonographers (Craig, 2003). A major factor is that most ultrasound departments are understaffed and sonographers are being over worked to compensate while demands continue to increase (Penny, 2005). Other reasons mentioned as to why sonographers leave their current organization include poor pay and lack of career advancement (Clay, 2004). Musculoskeletal injuries Sonographers continuously struggle with poor ergonomics. Data shows that approximately 20 percent of sonographers are “leaving the profession or taking premature retirement options because of persistent pain problems” (Brown, & Baker, 2004, p.88). While a staggering 80 percent of sonographers work with pain and nearly 40 percent of those sonographers report the pain as severe (Clay, 2004). Musculoskeletal injuries are results of repetitive body misuse. Sonographer daily routine requires “slouched twisting of the spine, protracted scapula on the dominant side due to excessive
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reaching forward, excessive arm abduction, and forceful gripping of a tool in the operating hand” (Brown, & Baker, 2004, p.89). Sonographers often have pain associated with their upper body, including their shoulder (especially their scanning side) and upper spine (Brown, & Baker, 2004). Advancements have been made to minimize musculoskeletal injuries within the profession. Equipment manufactures has taken into consideration proper scanning postures and techniques. Equipment has become adjustable to accommodate to individual preferences and needs such as “height-adjustable machines, lighter transducers, and increased picture resolution” (Clay, 2004, p. 23). These changes have improved working condition for sonographers however work expectations and demands have also increased. The term ‘managed care’ reflects the current state of the health care system as the main focus is on revenue and productivity. Sonographers are expected to be more timeefficient and increase the number of scans thus putting them at greater risk for a musculoskeletal injury (Clay, 2004). Hospital environments Hospital settings are feeling the most affects of sonographer shortages. This may be due to the specific working environments and working commitments required by hospitals. Some of the most obvious drawbacks of working in hospitals setting is that it are a 24 hour a day seven days per week operation which requires sonographers to be on call and work evenings and weekends. The demanding work schedule that is required by sonographers in hospitals is a major stressor which can lead to burnout. Some
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sonographers choose office or outpatient clinic settings opposed to the so-called abusive work environment of the hospital setting (Craig, 2003). Hospitals settings are shown to be more stressful on sonographers. Hospitals regularly add on emergency cases to a sonographers schedule and sonographers are “forced to increase output, and the stress to stay ahead can often be overwhelming (Penny, 2005, p.153). Being on-call is also hard for many health care workers, especially in some cases when sonographers are called in for cases that are not emergent and can be performed the next day. It is also possible for sonographers to be called in on more than one occasion per shift and be expected to work the next day. The lack of sleep and high demands of the profession are wearing our sonographers down especially when salaries do not appropriately compensate the sonographer (Craig, 2003; Penny, 2005). Salaries for diagnostic medical sonographers have improved in some countries to reflect the supply and demand issues we are experiencing today but this is by no means universal (Craig, 2003). Surprisingly even though the undesirable working conditions of hospitals this is usually where the wages are the lowest for most sonographers (Craig, 2003). Advancements in technology Due to technological advancements and improvements made to equipment sonography has broadened its scope. Technology allows for higher frequency transducers which greatly improves visibility and imaging quality. Sonography has moved towards more superficial structures which have increased the variety of exams being preformed. For example, general sonographers are trained in musculoskeletal ultrasounds which
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open the doors for diagnosing sports injuries such as Achilles tendon tears and rotator cuff injuries. Another expanding area for sonography is assisting in visualization for removal of foreign bodies or biopsies, which is made possible by the increase penetration capabilities. Paediatric specific abnormalities are frequently using ultrasounds as a primary diagnostic tool for physical abnormalities such as pyloric stenosis, hip dysplasia, and tethered spine, as well as imaging of the neonatal head. In general, vascular imaging for the detection of peripheral vascular disease and the high sensitivity for carotid disease and venous thrombosis is on the rise. The continued advancement to diagnostic medical sonography equipment is contributing to the increasing demand (Craig, 2003). The dynamic nature of technology is challenging for students and practicing sonographers. Educational programs are increasing their program length because “the amount of information to be learned and the time it takes to become proficient grows continuously� with each technological advancement (Craig, 2003, p. 202). Practicing sonographers may find it challenging to stay current with the new technologies and techniques, however in the now and in future the majority of the job seekers will be coming from the school system (Human Resources and Skills Development Canada, n.d.). Lack of student graduates In order to start and meet the demand of sonographers the number of student outputs must increase. The solution would be to increase enrolment rates per program and also create new accredited program throughout Canada. Although, increasing enrolment sounds simple this is not the case. The didactic component of ultrasound training
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programs would be simple to increase the number of available seats however problems raise with the clinical practicum portion of the training program. In sonography and many other health care professions, the hands-on experiences are extremely valuable. Clinical practice ensures sonographers of highly quality and properly prepared for work in the health care system (Clay, 2004; Craig, 2003). Unfortunately, many ultrasound departments do not feel they have the resources to take on the responsibilities of taking in students and becoming a clinical site. Training students takes time and effort and adds stress to the already high demands placed on current sonographers. This is a continuous cycle to the increased need and decreased number of sonographers (Clay, 2004; Craig, 2003). In sonography programs across Canada there are high rates of interest as there are continually more applicants than number of seats available. Entrance into a training program is highly competitive and potential students are often placed on a waiting list (Moira, 2009). In the Maritimes, Dalhousie University is only school accredited by the Canadian Medical Association. The output of graduates each year is minimal and competition to fill job openings by employers for graduates is fierce (Human Resources and Skills Development Canada, 2013a). Out of region employers may have a better opportunity to employ new Dalhousie graduates as the degree program is one of the most expensive programs in Canada, yet the wages in the province for sonographers is one of the lowest in Canada. Many students are opting to leave the Maritimes for more affordable training programs elsewhere in Canada and those who graduate from Dalhousie are moving to regions with higher wages perhaps to help repay student loans (Craig, 2003).
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The lack of student output may be the result of increased program length. Canadian accredited programs span from 13 months to four years in length. One reason is the technological advancements requiring students to have extensive technical skills and knowledge. Moreover, sonographers today are feeling the pressure to specialize. Sonographers have the ability for career advancements by cross-training. Currently, there are three specialized credentials offered by CARDUP. This is positive for the development of sonography as a profession however “it increases the time required for the sonographer to become proficient and comfortable” (Craig, 2003, p.202). Lack of public awareness Sonography has many applications for medical diagnostics. Unfortunately, the profession is not well known by the general public. People tend to automatically associate ultrasound with pregnancy unfortunately this proves that the public is not educated on the true scope of sonography (Craig, 2003). Sonographers are a vital part of the health care team; they provide not old diagnostic medical imaging but are key to prevention and early detection of many illnesses including cardiovascular disease and cancer (Evans, 2006). Often time’s media portrays sonographers poorly by showing inaccurate examples which is causing “audiences to formulate beliefs and also shape personal opinions” (Evans, 2006, p.138). Media greatly impacts society and culture, sonographers should be critical in the way their profession is being presented. Furthermore, the effortless and easy façade of sonography makes other medical professionals believe they could do that “but the casual observer does not realize the cognitive and psychomotor education that is
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required for success” (Craig, 2003, p.264). This puts sonography at risk for blending in with radiology and other medical imaging departments. Sonography as a profession Diagnostic medical sonography as a profession has faced many obstacles in defining a unique identity. The problem stems from failing to “apply appropriate nomenclature to the developing areas of specialization” which probably was due to the faster than average evolution of sonography because of technical advancements (Hall, 2003, p.337; Wilson & Cooley, 2006). Sonography and sonographers lack a standardized name which causes confusion for the general public but also frustration for professionals. Various labels have been given to this profession including, ultrasound technology, sonography, ultrasonography, ultrasound. Professionals themselves have been called sonographer, technician, ultrasonographer, ultrasound technologist, medical ultrasound professional and simply tech (Hall, 2003). It has been proposed by Hall (2003) that “it is time for the science of sonographic imaging to begin to be called sonology” (Hall, 2003, p. 337). Sonography has expanded tremendously. The field employs highly trained and specialized health care professionals- not limited in applications. The scope of practice has evolved to include cardiology, vascular, gastroenterology, urology, obstetrics, gynaecology, ophthalmology, neurology and musculoskeletal (Hall, 2003). It is the responsibility of Professional societal associations, educational programs, and accrediting agencies to advocate for “nomenclature in educational identification, professional labeling, and field specialization” (Hall, 2003, p. 339)
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Canadian regulation Currently in Canada diagnostic medical sonography is an unregulated profession. Sonographers are not required by law to be licensed unlike many of their medical professional counterparts (Kuntz, 2004). If Canada implemented and enforced regulation among sonographers it “would be an incentive for more sonography programs to open, to supply the demand for educated, licensed sonographers� (Craig, 2003, p.204). Conclusion Several factors have caused a severe shortage of sonographers in Canada and around the world including poor retention rates due to demographics, musculoskeletal injuries and work environments, advancements in technology, lack of accredited educational programs, lack of awareness and the struggles of defining sonography as a unique regulated profession. The significant increase in demand for ultrasounds as a diagnostic tool and the limited number of clinical sonographers has exacerbated the sonographer shortage.
A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY
Part 4: Personal reflection
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My love for the profession The main reason why I choose to complete my personal enhancement experience project on diagnostic medical sonography was to be able to spend time in the medical imaging department. It has been nearly four years since I had completed my grade 12 coop term in the same department and I was so excited to go back. During my short time visiting the ultrasound department it has confirmed what I previously knew and felt about ultrasound as my future career. Having a second opportunity to speak with women who already work as diagnostic medical sonographers has given me a different perspective. Now that I have nearly completed my bachelor’s degree and am four years older and have more life experience this has been an outstanding experience, even the second time around. It has also given my confirmation that this is the right career path. There is so much I feel like I need to learn to become a sonographer and at times I feel overwhelmed. Although, I have taken human physiology, human anatomy and medical terminology along with other health science related courses. I know I have much to learn, knowledge wise but also skill wise. My hope is when I start my program in the fall I will have an advantage over all the other students who never got the chance to job shadow for the amount of time I have. During this experience I have come to realize that I am a much better learner when I have the opportunity to work with my hands and complete the task at hand myself. I like when I also feel like when I point to a structure during an ultrasound and label it correctly. However, the most learning that I did was from observing, especially since I am unable to legally perform an ultrasound. I enjoyed observing scans that I have observed before. I am able to distinguish organs and I have become familiar with
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different structures. The sonographers were wonderful they often pointed out the structures more than once, because in most cases they look different from one patient to the next. The tasks that I got to perform were getting towels, sheets and facecloths for all the exam rooms. These items are found on a rack down the hall. I enjoy getting these items because I feel like I am actually getting something accomplished. The other job that was to change the linen on the bed after each exam. There is to a certain degree there is the need for teamwork. In general, most of the technicians work by themselves as they have their own list of patients to do for each day. The average amount of patients one technician gets to see per day is about 6 to 8 depending on what type of ultrasounds are being performed. Therefore, the workers are usually in her room with the curtain closed over doing a scan and are for the most part by themselves with a patient. So, in this case then it does show that you can still be a part of a team and still work alone. I did however take note that many of the workers discuss difficult or troubling cases with each other and enjoy and appreciate feedback from their fellow co-workers or in some cases interesting cases to share their knowledge and understanding with one another. They do a good job enlightening each other on a daily bases. I noticed quite often someone showing their ultrasound pictures to a co-worker for feedback or maybe general interest. This was an amazing experience that I am so thrilled that I had a chance to take part in. Every minute I enjoyed and embraced. The people I was fortunate enough to meet were so kind and really took me under their wing. The people really made the experience for what it was, truly unforgettable.
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References
British Columbia Institute of Technology School of Health Sciences (BCIT). (n.d.a). Diagnostic medical sonography: Program entry. Retrieved on March 22, 2013 from http://www.bcit.ca/. British Columbia Institute of Technology School of Health Sciences (BCIT). (n.d.b). Diagnostic medical sonography: Costs & supplies. Retrieved on March 22, 2013 from http://www.bcit.ca/. British Columbia Institute of Technology School of Health Sciences (BCIT). (n.d.c). Diagnostic medical sonography: Program details. Retrieved on March 22, 2013 from http://www.bcit.ca/. Brown, G., & Baker, J. (2004). Work-related musculoskeletal disorders in sonographers. Journal of Diagnostic Medical Sonography, 20(2), 85-93. Bureau of Labor Statistics, United States Department of Labor. (2009). Occupational Outlook Handbook, 2008-09 Edition. Diagnostic Medical Sonographers. Retrieved on March 22, 2013 from http://www.bls.gov/. Cambrian College of Applied Arts and Technology. (n.d.a). Diagnostic medical Sonography: Ultrasound (USPG). Retrieved on March 22, 2013 from http://www.cambriancollege.ca/. Cambrian College of Applied Arts and Technology. (n.d.b). Tuition and fees for 2012 2013. Retrieved on March 22, 2013 from http://www.cambriancollege.ca/.
A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY Canadian Association of Registered Diagnostic Ultrasound Professionals (CARDUP). (2013a). Educational programs. Retrieved on March 22, 2013 from http://cardup.org/. Canadian Association of Registered Diagnostic Ultrasound Professionals (CARDUP). (2013b). Examination. Retrieved on March 13, 2013 from http://cardup.org/. Canadian Association of Registered Diagnostic Ultrasound Professionals (CARDUP). (n.d.). Code of Ethics for the Profession of Diagnostic Medical Ultrasound. Retrieved on March 22, 2013 from http://cardup.org/. Canadian Association of Registered Diagnostic Ultrasound Professionals (CARDUP). (2010). CARDUP credentialing examinations: Candidate guide. Retrieved on March 22, 2013 from http://cardup.org/. Canadian Association of Registered Diagnostic Ultrasound Professionals & Canadian Society of Diagnostic Medical Sonographers. (2008). National competency profiles: General sonographer, cardiac sonographer, vascular sonographer version 4.2. Retrieved on March 22, 2013 from http://cardup.org/. Canadian National Institute of Health, Inc. (n.d.). Diagnostic medical sonography *(probationary). . Retrieved on March 22, 2013 from http://www.cnih.ca/programs/. Clay, N. (2004). Strategies for eliminating the sonographer shortage: Recruitment, retention, and educational perspectives. Journal of Diagnostic Medical Sonography, 20(6), 408-413.
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Collège BorÊal. (n.d.). Ultrasonography (post diploma certificate). Retrieved on March 22, 2013 from http://www.collegeboreal.ca. College of the North Atlantic. (n.d.a). Information sheet for diagnostic ultrasonography. Retrieved on March 22, 2013 from http://www.cna.nl.ca/. College of the North Atlantic. (n.d.b). Diagnostic ultrasonography (post diploma). Retrieved on March 22, 2013 from http://www.cna.nl.ca/. Craig, M. (2003a). Sonographer shortages: A day late and a dollar short? Part 1. Journal of Diagnostic Medical Sonography. 19(3), 199-207. Craig, M. (2003b). Sonographer shortages: A day late and a dollar short? Part 2. Journal of Diagnostic Medical Sonography. 19(4), 261-271. Dalhousie School of Health Sciences. (2010). Diagnostic medical ultrasound. Retrieved on March 22, 2013 from http://schoolofhealthsciences.dal.ca/. Dalhousie University. (n.d.). Money matters: fee calculator. Retrieved on March 22, 2013 from http://www.dal.ca/. Evans, K. (2006). Focusing on the issues. Unplugging the public as to the production of sonography. Journal of Diagnostic Medical Sonography, 22(2), 138-141. Government of Canada. (2013). Working in Canada: Explore careers - Job market report. Retrieved on March 13, 2013 from http://www.workingincanada.gc.ca/.
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Hall, R. (2003). The science of sonology: The semantics of the professional. Journal of Diagnostic Medical Sonography. vol. 19. 6 337-339 doi: 10.1177/8756479303258141. Horizon Health Network. (2013). Horizon job postings. Retrieved on March 13, 2013 from http://horizon.ca/. Human Resources and Skills Development Canada. (2011). Unit group: 3216 medical sonographers. Retrieved on March 13, 2013 from http://www5.hrsdc.gc.ca/. Human Resources and Skills Development Canada. (2013a). Labour market bulletinNew Brunswick (quarterly edition). March 13, 2013 from http://www.hrsdc.gc.ca/. Human Resources and Skills Development Canada. (2013b). NOC code list. Retrieved on March 13, 2013 from http://www5.hrsdc.gc.ca/. Human Resources and Skills Development Canada. (n.d.). Canadian Occupational Projection System (COPS Medical Technologists and Technicians (Except Dental Health) (321). Retrieved on March 22, 2013 from http://www23.hrsdc.gc.ca/. Kuntz, K. (2004). Focusing on the issues: Accreditation of sonography programs: Building a house of cards. Journal of Diagnostic Medical Sonography, 20(2), 144-146. DOI:10.1177/8756479303262920.
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Lovegrove, M., & Price, R. C.(2002). Recruitment, training and retention of healthcare professionals in clinical ultrasound (April 2001 - December 2002). Radiography, 8(4), 211-214. Michener Institute for Applied Health Sciences. (n.d.a). Tuition fee policy. Retrieved on March 22, 2013 from http://www.michener.ca/. Michener Institute for Applied Health Sciences. (n.d.b). Ultrasound graduate diploma program. Retrieved on March 22, 2013 from http://www.michener.ca/. Mohawk-McMaster Institute for Applied Health Sciences. (n.d.a). Post-secondary fees for 2012-2013. Retrieved on March 22, 2013 from http://www.mohawkcollege.ca/. Mohawk-McMaster Institute for Applied Health Sciences. (n.d.b). Admission requirements. Retrieved on March 22, 2013 from http://www.mohawkcollege.ca/. Moira, M. G. (2009). Career awareness and recruitment strategies in Canadian health professions programs: A preliminary study. Canadian Journal of Medical Laboratory Science, 71(1), 18-27. Retrieved from http://ezproxy.library.dal.ca/ Northern Alberta Institute of Technology School of Health Sciences (NAIT). (n.d.a). Programs & courses: Diagnostic medical sonography. Retrieved on March 22, 2013 from http://www.nait.ca/. Northern Alberta Institute of Technology School of Health Sciences (NAIT). (n.d.b). Programs & courses: Diagnostic medical sonography about the program. Retrieved on March 22, 2013 from http://www.nait.ca/.
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Penny, S. (2005). Focusing on the issues: Stressors and employee retention in the diagnostic medical sonography department. Journal of Diagnostic Medical Sonography, 21(2), 152-155. Southern Alberta Institute of Technology (SAIT). (n.d.a). Diagnostic medical sonography: Admission and selection. Retrieved on March 22, 2013 from http://www.sait.ca/. Southern Alberta Institute of Technology (SAIT). (n.d.b). Diagnostic medical sonography: Costs and supplies. Retrieved on March 22, 2013 from http://www.sait.ca/. St. Clair College. (n.d.). Diagnostic Medical Sonography. Retrieved on March 22, 2013 from http://www.stclaircollege.ca/. Statistics Canada. (2013). National occupational classification (NOC) 2011: 216 Medical sonographers. Retrieved on March 13, 2013 from http://www23.statcan.gc.ca/. Troy, S, Digiacinto, D., & Elledge, B. (2004). Advancement of higher education in sonography: Is distance education the answer? Journal of Diagnostic Medical Sonography. vol. 20 no. 2102-111. doi: 10.1177/8756479303262284. Wilson, M. & Cooley, B. (2006). The Implementation of a sonographer's career ladder. Journal of Diagnostic Medical Sonography. 22: 191-199. doi: 10.1177/8756479306287674.
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Winnipeg Health Sciences Ultrasound Training Program. (n.d.). School of Diagnostic Medical Sonography PROGRAM INFORMATION. Retrieved on March 22, 2013 from https://sites.google.com/site/hscwinnipegultrasound/.
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Appendices
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Appendix A
NATIONAL COMPETENCY PROFILES GENERALIST SONOGRAPHER CARDIAC SONOGRAPHER VASCULAR SONOGRAPHER VERSION 4.2 APPROVED BY THE BOARDS OF CARDUP & CSDMS NOVEMBER 2008 ACCEPTED BY THE CANADIAN MEDICAL ASSOCIATION COMMITTEE ON CONJOINT ACCREDITATION FOR USE IN PROGRAM ACCREDITATION EFFECTIVE JANUARY 2010 INTRODUCTION This document lists the occupational competencies (job skills) of the three categories of entrylevel sonographer that have been identified by the Canadian Association of Registered Diagnostic Ultrasound Professionals (CARDUP) as the basis for establishing a Canadian controlled registry of practitioners. As well as defining national registration categories, the Competency Profiles have been accepted by the Canadian Medical Association for incorporation into the requirements for accreditation of training programs. Accredited programs must ensure that their graduates possess all the competencies listed in the Profile for the relevant practitioner category. The Profile is a minimum training standard and programs are free to include additional skills, at their discretion. The three practitioner categories are: • • •
the Generalist Sonographer the Cardiac Sonographer the Vascular Sonographer.
The three Competency Profiles are integrated, and include a common core of skills possessed by all practitioner categories. Category-specific skills build upon the core:
The job skills are grouped into Competency Areas as follows: 1. Communication
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2. Professional Responsibilities 3. Patient Assessment and Care 4. Operation of Equipment 5. Critical Thinking and Problem Solving 6. Workplace Health and Safety 7. Imaging The Competency Areas are subdivided into General Competencies and Specific Competencies. General Competencies are broad skill statements. Specific Competencies are skills that have "stand-alone, job-outcome" significance in the workplace, and will be recognizable by employers, physicians or patients. Specific Competencies may of course be further broken down into component tasks (creating "sub-competencies" or "enabling competencies"). CARDUP has not carried out this subdivision, since it is more appropriately done by educators as part of the training program design process. Each Specific Competency is designated as "core" (applying to all three practitioner categories) or as applying to just one or two practitioner categories. Appendices to the competency profiles list essential knowledge and skills in the areas of: 1. Sonographic examination techniques 2. Pathophysiology (this section is currently under review) 3. Physics and Instrumentation (this section is currently under review) (introduction of NATIONAL COMPETENCY PROFILES for General, Vascular, and cardiac sonographers, Canadian Association of Registered Diagnostic Ultrasound Professionals & Canadian Society of Diagnostic Medical Sonographers, 2008).
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Appendix B Code of Ethics for the Profession of Diagnostic Medical Ultrasound PREAMBLE The goal of this Code of Ethics is to promote excellence in patient care by fostering responsibility and accountability thereby helping to ensure the integrity of professionals involved in all aspects of diagnostic medical ultrasound. OBJECTIVES • • •
To create an environment where professional and ethical issues are discussed To help the individual practitioner identify ethical issues To provide guidelines for individual practitioners regarding ethical behaviour
PRINCIPLES Principle 1: In order to promote patient well being, professionals shall: A. B. C. D. E. F. G.
Provide information about the procedure and respond to the patient’s concerns and questions. Respect the patient’s self-determination and the right to refuse the procedure. Recognize the patient’s individuality and provide care in a non-judgmental and non-discriminatory manner. Promote the privacy, dignity and comfort of the patient and his/her family. Protect the confidentiality of acquired patient information. Strive to ensure patient safety. Promote equitable access to care.
Principle 2: To promote the highest level of competent practice, professionals shall: A. B. C. D. E.
F. G. H.
Obtain the appropriate education and skills to ensure competence. Practice according to published and recognized standards. Work to achieve and maintain appropriate credentials. Acknowledge personal limits and not practice beyond their capacity, education, certification and skills. Perform only those procedures that are medically indicated and properly requisitioned, restricting practice to validated and appropriate tests. For research studies follow established research protocol, obtaining and documenting informed patient consent as needed. Ensure the completeness of examinations and the timely communication of important information to the appropriate interpreter. Strive for excellence and continued competence through continuing education. Perform ongoing quality assurance.
A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY I.
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NOT compromise patient care by the use of substances that may impair judgment or skill.
Principle 3: To promote professional integrity and public trust, professionals shall: A. B. C. D. E. F.
Be truthful and promote honesty in interactions with patients, colleagues and the public. Accurately represent their level of competence, education and certification. Avoid situations which may constitute conflict of interest. Maintain appropriate personal boundaries. Promote cooperative relationships within the profession and with other members of the health care community. Refrain from involvement in situations which exploit others for financial gain or misrepresent information to obtain reimbursement.
(Code of ethics, CARDUP, n.d.).
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Appendix C
Location: Moncton Competition #: 2012-4889-CB Bargaining Unit: PARAMED Location/Department: The Moncton Hospital/ Medical Imaging/ Ultrasound Position Type: Permanent Full Time, English Essential Hours of Work: Rotating Shift, Subject to Change due to Operational Requirements Rate of Pay: $25.43 to $31.87 per hour Job Purpose: The Medical Sonography Technologist is responsible for performing ultrasound examinations. Essential Qualifications: Graduate of a Diagnostic Sonography Program. Must be registered with the Canadian Association of Registered Diagnostic Ultrasound Professionals. o o o o
Ability to attend work on a regular basis Ability to perform the duties of the position Good work record Written and spoken competence in English is required
Key Responsibilities: The Medical Sonography Technologist is responsible for: Assessing and preparing patients for ultrasound examinations Preparing and operating equipment Performing procedures in accordance with standards of practice Assessing test results and preparing Impressions Using clinical information systems to access and maintain clinical records and documentation o Assisting with or performing quality assurance activities/initiatives o Providing mentoring and support for DI staff, students and other health care o o o o o
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professionals Competencies: Competencies identified by Horizon Health Network: o o o o o o o o
Attention to Detail Decision Making Interpersonal Skills Patient/Client Focus Planning and Prioritizing Work Results Orientation Stress Management Teamwork and Collaboration
NOTE: There will be no further postings for this position should there be no fully qualified applicants. If you wish to be considered for this position and have most of the qualifications as posted and the registration or licensure where required, you are encouraged to apply at this time. Applications for this position must be submitted in writing to applications.HR@HorizonNB.ca. Please quote Competition # 2012-4889-CB. Horizon Health Network (Moncton Zone) appreciates expressed interest, however, only candidates considered for an interview will be contacted. Human Resources Department, Horizon Health Network (Moncton Zone), 135 MacBeath Avenue, Moncton, NB, E1C 6Z8, Fax: (506) 857-5590. Horizon Health Network adheres to all privacy legislation and policies to ensure confidential patient, business, financial and employee information is disclosed only to those authorized to receive it for the purpose of fulfilling their job duties. (Sonographer job posting, Moncton Zone, Horizon Health Network, 2013).
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Appendix D
Work environment
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This image shows what normal liver tissue appears like on ultrasound. The darker linear areas in the liver are veins bringing blood and nutrients to the liver and others are draining blood from the liver and returning it to the heart.
Carotid bifurcation, This view is called tans-sagital giving the image a cross section appearance.
Color doppler, The red demonstrates the oxygenated blood flowing away from the heart and to various tissues and organs. The blue demonstrates the veins carrying deoxygenated blood back to the heart. Where the red and the blue meet is called the bulb. The external carotid artery
A CLOSER LOOK: DIAGNOSTIC MEDICAL SONOGRAPHY (ECA) and the internal carotid artery (ICA) are what supply the face and brain with blood.
Obstetric ultrasound, This is a 17 week fetus.
Head circumference, We are able to see the ventricles and temporal lobe and other structures of the brain. Most importantly checking to see if a cysts or bleeds are present in the brain.
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Appendix E
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Appendix F
Contact information Rachelle Gaudet, RTR, RTMR Director of Diagnostic Imaging Moncton Area Horizon Health Network 135 MacBeath Avenue Moncton, NB E1C 6Z8 Phone: (506) 857-5281 Fax: (506) 857-5298 Email: Rachelle.Gaudet@horizonnb.ca Misti Murray BSc.,RTR,ACR,RTMR Assistant Director of Diagnostic Imaging Moncton Area Horizon Health Network 135 MacBeath Avenue Moncton, NB E1C 6Z8 Phone: (506) 857-5277 Fax: (506) 857-5298 Email: Misti.Murray@HorizonNB.ca
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Appendix G I would like to extend a special thank you to, Becky, Rachelle, Misti, Mary Beth, Karen, Nancy, Debbie and Meghan. I had a wonderful experience once again in the Ultrasound department. I am happy to report that it looks like I will be attending the Michener ultrasound program this coming fall and I will be completing my clinical practicum at the Moncton Hospital starting in September 2014! But you will be seeing a lot more of me this summer as I have accepted a position as a Diagnostic Imaging Assistant and I am very excited to work along side of you once again! Many thanks for your support over the last 4 years, Brenna (Thank you note)