ECB Chapter 01 - Introduction~ Educational Aspects in EFSUMB

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EFSUMB – European Course Book Editor: Christoph F. Dietrich

Educational Activities of EFSUMB Gilja OH*, Bachmann Nielsen M**, Tuma J***

* National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, and Institute of Medicine, University of Bergen, Bergen, Norway. ** Dept of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. *** Uster, Switzerland.

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Many medical specialists are undertaking ultrasound examinations on patients referred to them for their clinical opinion as a direct extension of their clinical examination. This may take place in the outpatient department, on the wards and in the assessment of emergency patients.

Ultrasonography has become a very important tool in the management of patients with a great capacity for efficient diagnosis and work-up of a variety of conditions.

Although, ultrasound is the safest imaging modality in medicine, there is one danger: Incompetence. The pitfall of ignoring obvious pathology or making the wrong diagnosis is a consequence of incompetence and poor education. Accordingly, it is of great importance to ensure quality in education and sustain high professional standards in ultrasound scanning. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) is continuously working for improved education in many ways: One way has been since 1992 to arrange Euroson Schools throughout Europe. By end of 2009 over 50 of these post-graduate courses has been arranged and provided state-of-the-art lectures to the European ultrasound community. Furthermore, as Europe is a leading force in clinical applications of CEUS, we have established regular (3-4/year) Euroson Schools on the subject of CEUS. The present book is intended to support all who want to organise courses by providing up-to-date chapters in central fields of ultrasonography. Another task has been to establish recommendations and guidelines in ultrasound education for different medical disciplines. EFSUMB’s minimal training requirements (Table 1) for the practice of medical ultrasound in Europe identify three levels of training and expertise. The boundaries between the three levels are difficult to define precisely and should be regarded as a guide to different levels of competence and experience.

A curriculum for each module for the three levels of training has been developed incorporating theoretical training on anatomy and pathology and a practical syllabus listing conditions which should be included in the experience of the trainee. In appropriate circumstances, a limited anatomical or modular approach may also be acceptable if full competence in that area is demonstrated and future clinical practice is confined to that area alone. Practical experience should be gained under the guidance of a named trainer.

The requirements for the different levels of training are as follows: Level 1 Different trainees will acquire the necessary skills at different rates and the end-point of the training programme should be judged by an assessment of practical competence. Examinations should encompass the full range of pathological conditions listed in the modules.

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A log book listing the number and type of examinations undertaken by the trainee themselves should be kept. An illustrated log book of specific normal and abnormal findings may be appropriate for some modules. Training should usually be supervised by a level 2 practitioner. In certain circumstances it may be appropriate to delegate some of this supervision to an experienced level 1 practitioner with at least two years of regular practice.

Level 2 This requires at least one year of experience at level 1, with regular ultrasound clinics. A significant further number of examinations should have been undertaken in order to encompass the full range of conditions and procedures encountered in each module. A log book listing the numbers and types of examinations undertaken by the trainee should be maintained. An illustrated log book of specific normal and abnormal findings may be appropriate for some modules. Supervision of training should be undertaken by someone who has achieved at least level 2 competences and has had at least two years experience at that level.

Level 3 This requires a practitioner to spend a significant part of their time undertaking ultrasound examinations or teaching, research and development in the field of ultrasound. The syllabus for each practical module is outlined in Appendix 3-8 (www.efsumb.org).

EFSUMB also promotes educational material on its Web site (Fig.1). EFSUMB publishes a caseof-the-month on the web-site. Moreover, we have the ambition to make the EFSUMB web-site an educational portal for ultrasound imaging. Selected lectures from the CEUS Euroson Schools are presented on the website with smooth and integrated access to the ppt-files, video- and audiorecordings.

But what`s is new in this book / this web initiative?

What happens if a gastroenterologist, an intensivist, an angiologist, a nephrologist or a specialist for echo contrast develop their own curriculum independent of the other disciplines?

As an example, let us look to abdominal ultrasonography. The radiologists, nephrologists, gastroenterologists, internists, general practitioners, urologists, emergency physicians and intensivists perform abdominal ultrasound. All of them has to know how an ultrasound scanner works (physics, knobology), and has to be skilled in sonoanatomy and pathology of intraabdominal organs. Every speciality has also some special aspects, which have to be learned and understood in depth. These common fields of abdominal scanning make ultrasonography truly interdisciplinary.

Decades ago, Switzerland, Germany and Austria developed courses in abdominal sonography with these interdisciplinary aspects included.

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Because of the large inteerdisciplinarity and similarity in Switzerland, Germany and Austria the basic and advanced courses in these countries were recognized by each others societies and the course content were extensively compared. The main pathologies of the abdominal organs were lectured in the advanced course.

One can also design specific basic courses for users of the musculoskeletal system or for the users exclusively working on the peripheral vessels, and such courses are developed on a national level. A further international integration, which is highly warranted, has not yet taken place.

A curriculum of these courses have been approved by the boards of all three societies and submitted to EFSUMB (http://www.efsumb.org/euroson-sch/curriculum.pdf). This curriculum serves as a basis for the abdominal ultrasound courses and may help other countries to establish their own by using this course curriculum as foundation.

A specially designed textbook, compiled by Prof. C.F. Dietrich, is a common work of ultrasound lecturers from Germany, Austria and Switzerland and has been in use for many years and enjoys great popularity. The 5th Edition has been translated into Czech and is actively used in both the Czech Republic and Slovakia. These days the 6th Edition is out for printing.

Based on analysis of the course curriculas of many European countries as well as discussions with colleagues around Europe we believe that a similar textbook might be a good idea for all European countries. Prof. C.F. Dietrich has supplied the authorships of the three countries with leading authors from many other European countries to create a common, truly European, interdisciplinary course book. The core of the first version of this course book is abdominal ultrasonography.

The investigation techniques in three levels: basic, advanced and completion courses are content of the common course curriculum, which is revised and updated every two years. In these courses, there is a minimum of 50% of hands on training on patients with maximum 4-5 participants per instructor per scanner. Similar courses also exists in musculoskeletal, pediatric, vascular and ear-nose-throat specialties, which all are divided into basic, advanced, and speciality-wise in the final course.

It is our hope that this systematic theoretical approach in combination with hands-on training led by experienced and eventually nationally licensed tutors should make a decisive contribution to counteract the complains of incompetent ultrasound operators. Furthermore, we wish that you may enjoy reading these chapters and that the curriculum and the textbook may be of value for you in the development of systematic ultrasound training in your country.

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Table 1

Overview of EFSUMB’s minimal training

requirements for the practice of medical ultrasound in Europe.

Introduction: EFSUMB Published Newsletter Issue 1 - February 2006.

Appendix 1: Description Of Levels Of Training And Assessment Sheet - Published Newsletter Issue 1 February 2006 Appendix 2: Theory Syllabus (Outline) And Assessment Sheet - Published Newsletter Issue 1 - February 2006 Appendix 3: Gynaecological Ultrasound And Assessment Sheet - Published Newsletter Issue 1 - February 2006 Appendix 4: Obstetric Ultrasound And Assessment Sheet - Published Newsletter Issue 1 - February 2006 Appendix 5: Gastro-Enterological Ultrasound And Assessment Sheet - Published Newsletter Issue 1 February 2006 Appendix 6: Nephro-Urological Ultrasound And Assessment Sheet - Published Newsletter Issue 1 February 2006 Appendix 7: Breast Ultrasound And Assessment Sheet - Published Newsletter Issue 1 - February 2006 Appendix 8: Vascular Ultrasound And Assessment Sheet - Published Newsletter Issue 1 - February 2006 (Revised November 2008) Appendix 9: Endoscopic Ultrasound In Gastroenterology And Assessment Sheet - Published Efsumb Newsletter Issue 1 - February 2007 Appendix 10: Cranial Ultrasound in Infants and Assessment Sheet Appendix 11: Thoracic Ultrasound And Assessment Sheet - Published Efsumb Website October 2008 Appendix 12: Musculoskeletal Ultrasound and assessment sheet - EFSUMB Newsletter Issue 1 – 2008 Appendix 13: Intensive Care Ultrasound.

Appendix 14: Contrast Enhanced UltraSound - CEUS.

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Figure 1. A screenshot of EFSUMB’s internet home page, which contains a lot of educational material.