Clinical supervision

As a profession, we recognise that clinical supervising is a demanding and often difficult pathway, requiring expertise, leadership skills, and a commitment to the professional growth of sonographers. Supervisors play a crucial role in shaping the next generation of sonographers, providing guidance, mentorship, and practical training in real-world clinical settings. Chris Gilmore FASA, Ultrasound Team Leader, and Louise Worley FASA, Tutor Sonographer, share their experience of clinical supervision and training, address the unique needs and concerns of clinical supervisors, and discuss strategies, best practices, and innovative approaches to supervision.

Chris Gilmore FASA

Ultrasound Team Leader | The Prince Charles Hospital, Brisbane

Chris is a general sonographer who works in Brisbane at the teaching facility at The Prince Charles Hospital (TPCH). In addition to servicing a busy metropolitan emergency and critical care service, TPCH provides a quaternary referral service for cardiothoracic medicine, including heart/lung transplantation, with the facility also providing many other specialist medical services such as gastroenterology, vascular, orthopaedic, geriatric, mental health, endocrine and palliative care. Chris has a broad interest in general ultrasound, including its use in assisting procedures. Chris has been credentialed in PICC insertion procedures and holds a general approval licence to administer local anaesthetics issued by the Queensland Medicine Regulation Unit.

In your experience, do clinical supervisors receive appropriate training?

I would say in general that at the clinical coal-face, a sonographer (clinical supervisor) knows the clinical scan and referrer expectations quite well. In the work-integrated environment, they (clinical supervisors) will be able to impart how they perform the scan to the student. This, however, can be different to how a university teaches the scan. Image series can certainly be different – this creates dissonance. Interestingly, different universities assess competency in different ways – so it is not unusual for clinical supervisors to perform exams with variance. Additionally, only some clinical supervisors have done further training – I think a minority of sonographers have undertaken additional training to be a clinical supervisor. We need to increase this.

Should there be stricter criteria to become a clinical supervisor?

Yes, there should be stricter criteria to become a clinical supervisor – but there are different facets of where it should be stricter.

Supervision, in my view, is best undertaken by a sonographer (AMS) or a sonologist. An obstetrician who performs a significant number of diagnostic OBGYN ultrasounds can be considered a sonologist, as can a vascular surgeon who performs a considerable number of diagnostic ultrasounds, etc. The key here is ‘considerable number and diagnostic level’.

Sonographers should also attain a minimum standard to be a clinical supervisor – but equally, a student under clinical supervision should only be at a location (site) that can provide a minimum standard of clinical supervision. Ultrasound sits heavily in the clinical examination field, thus a site providing clinical supervision must allow timely intervention by an AMS (working in their field of expertise), such that the AMS can influence the clinical imaging examination – i.e. supervision is onsite and directly accessible to be able to scan the patient in a timely manner. I question remote supervision as not being viable supervision nor best practice. Onsite, both direct and indirect supervision are appropriate to guide a trainee through developing and advanced progress to becoming competent.

How can we better support our trainees in rural and remote settings who have limited access to clinical supervision?

I think the ASA is making progress here – but more is needed. I think the repository of all recorded presentations and webinars should be kept available, on call, to the membership. Beyond this, clinical supervisors need ongoing access to the material their students are using from education providers – so education providers have a role here of necessity. Ultimately, training costs $$$, so we need more investment from all imaging providers (government and private) for training. Let’s not forget that our ‘ologist’ compatriots, through various medical registrar programs, are all paid to get their specialty.

What advice would you give to those looking to step into a clinical supervisor role?

Be involved with both your student and the education provider your student uses i.e. get involved with the education provider feedback loop in as many ways as you can – committees and meetings. This will help you be informed and provide ways for you to influence training.

Look to improve yourself in the way you teach and give feedback – enquire into any learning courses that your student’s education provider has, or ASA. Be a member of the ASA.

Be frank with your student in discussions – acknowledge success and use constructive criticism. I have always found that treating students the same as an employee with respect to feedback loops works well – and it will certainly be the best advertisement and exemplar of expectation setting for prospective employees.

Louise Worley, FASA

Tutor Sonographer | I-Med Victoria North-Eastern Region

Louise is a seasoned presenter having given lectures at many ASA and ASUM local, national and international events as an invited speaker for obstetrics, breast, gynaecology, abdominal, vascular, paediatrics and MSK ultrasound. She was awarded ASA Tutor of the Year in 2013 and ASA Victorian Sonographer of the Year in 2017. Louise has presented multiple educational webinars and workshops for breast ultrasound and has been a part of the ASA’s Breast Special Interest Group committee. Louise was awarded a Fellowship of the ASA for her contributions to ultrasound, was the recipient of the 2019 Pru Pratten Lifetime Memorial Achievement Award and has recently been bestowed ASA Lifetime Membership.

What are some of the challenges clinical supervisors currently face?

The main challenge clinical supervisors currently face is the lack of time to train and the lack of support by management to do this during work hours. Clinical supervisors are often expected to train the students while running their own list with very limited extra time or extended booking times to train or check on students. We need more support and time to prepare, demonstrate, instruct and then review what they have done, plus provide feedback. We require more support from management to prepare and implement educational programs such as tutorials and workshops during work hours.

Good training needs to be valued, rewarded and recognised by management as a key pillar of sustainable business success. Many trainers would also benefit from formal training education, ensuring they have the understanding, skills and knowledge of how best to teach and develop others.

How can these challenges be overcome?

To work around these challenges, we have taken some training out of hours by running online educational programs. The qualified sonographers are invited to join and many attend. This has the benefit of aligning them with the students learning, plus more education for themselves. Also, we have implemented weekend workshops where the students have both didactic lectures plus hands-on scanning practice in small groups; organised, minuted planning meetings where the progress and needs of each student is discussed; and trainers continually update the tutor with any immediate student needs and challenges as they occur. These are dealt with promptly and in the best interests of the student. Students are also encouraged to ‘buddy’ with other students and often come into work sites and practise their scans. Tutors can also give short, individual training tutorials and scanning practice, but these are fitted into the day or out of hours. There are also some external private companies that provide ‘start-up’ programs where the students can obtain some practical training and experience in a relaxed environment.

It takes a lot of time, dedication and patience to be a good clinical supervisor.

Do you think clinical supervisors receive appropriate training?

Unfortunately, mostly it is up to the trainer/supervisor, who often model their training on their own experience. It takes a lot of time, dedication and patience to be a good clinical supervisor. Our supervisors are selected for their demonstrated interest, knowledge and dedication to teaching others. Every student has their own unique learning style and needs, and this must be understood. Each trainer has strengths in certain areas and students are matched with them according to their requirements and stage of development. I think sonography would benefit immensely if there were formal clinical educator courses for sonography. There are some ‘train the trainer’ courses available for clinical educators at private institutions and some universities, but not many are purely dedicated to ultrasound.

What methods do you implement as a tutor sonographer to ensure clinical sites deliver adequate supervision?

I work in direct consultation with a very understanding ultrasound coordinator who rosters the students to sites with a case load suited to their learning stage. The students are mostly placed at sites with a tutor or dedicated trainers who understand their abilities and learning requirements. The student lists are monitored for their learning needs, and times are crossed off for in-room hands-on teaching when the cases are available. The coordinator and trainers are involved in minuted tutor and trainer planning meetings, so are up to date with their requirements. Each supervisor training site has received updated protocols, educational materials and checklists, which are in addition to the company ultrasound protocols manual, so they are in tune with what we are teaching. I am also always available at any time to answer questions from students or trainers and to help monitor cases as needed.