Reassessing the ultrasound education model and training

Does the current model surrounding ultrasound education and training provide students and aspiring sonographers with the best possible foundation for their clinical careers? Jane Wardle, Central Queensland University, and Christopher Lewis, Tutor Sonographer at I-Med, discuss reassessing the ultrasound education model and training practices, aiming for continuous improvement and alignment with industry needs to ultimately benefit students, sonographers and patients alike.

Jane Wardle

Head of Course, Medical Sonography | Central Queensland University.

Jane has held several clinical roles across private and public healthcare settings and currently relishes the challenge of her learning and teaching role. She is currently completing a Master of Educational Neuroscience and knows that travelling is good for the brain, having been a compulsive traveller herself. Being able to bring travel and education together and share the experience with students has been an absolute privilege for her.

What are the expectations for competency levels in our recent sonography graduates?

Competency levels are outlined in the most recent version (2021) of ‘Professional Framework for Sonographers’, endorsed by the ASA. The framework gives education providers and clinical supervisors guidelines on expectations for competency levels, and educators ensure these standards are achieved by graduation. I think the framework sets appropriate levels of skills and attributes of graduate level sonographers.

Do you think the undergraduate model produces sonographers with adequate skills, maturity and knowledge?

As I am responsible for an undergraduate pathway for sonographers, yes I do. These students have four years immersed in sonography and are scaffolded from novice to graduate competency levels during that time.

Do you think the current ATAR and placement requirements for students are effective, or should there be stricter inherent requirements for entry into courses?

Health professionals require attributes that aren’t necessarily reflected in the ATAR results or even short interviews. I would like to see some type of university clinical aptitude test (UCAT) entry requirements, not just ATAR for entry into sonography.

The chronic workforce shortage is a terrible, vicious cycle with sonographers being overworked… meaning not enough students are being trained, and the cycle continues.

What changes would you like to see in our current educational model to increase student enrolment?

I don’t think the educational model needs to change. Educational providers can educate hundreds and hundreds of students, but they can’t scale up without clinical training opportunities for students.

I think the change needs to come from within the industry. The chronic workforce shortage is a terrible, vicious cycle with sonographers being overworked and not having the time to be able to train students, meaning not enough students are being trained and the cycle continues. Incentivisation of the workforce is also having a detrimental effect on the sustainability of the industry. Incentivisation doesn’t leave room for training and does not promote clinical excellence either. Unfortunately, we see students being exploited as well, so changing the attitudes towards students would be beneficial to supporting the education model and therefore the sustainability of the industry, which I think is at risk.

Christopher Lewis

Tutor Sonographer | I-Med

Christopher Lewis graduated as a radiographer from the Queensland University of Technology in 1977, beginning his career working at the Royal Brisbane and Women’s Hospital, then as the sole radiographer in the first ultrasound unit at Mareeba District Hospital. Christopher has since completed a Graduate Diploma in Medical Ultrasound and a Master of Applied Science (Medical Ultrasound) at Queensland University of Technology. Over the course of his career, Christopher has worked as a radiographer and sonographer at Ipswich Hospital, Royal Brisbane and Women’s Hospital, Logan Hospital and Southern X-Ray (now I-Med). He was the Chief Sonographer at I-Med from 2008 until 2017, where he undertook a two-year sabbatical to run the Sonographer Rural Training Program for Queensland Health. As of 2019, he returned to I-Med as an ultrasound training coordinator and is still enjoying practising, teaching and learning sonography.

What support is lacking under the current clinical training model?

In my opinion, the principal problem in the current training model is the challenge of providing supervised training. This is common across public and private sectors.

The provision of supervised training is almost entirely reliant on public and private medical imaging providers. While they are the sole beneficiaries as well, training is time-consuming and labour-intensive. This amounts to a significant deterrent when sonographer productivity is necessary to meet the ever increasing demand for diagnostic ultrasound services. Accordingly, meeting the requirement for adequate supervised training becomes a major hurdle for accredited training providers.

This, in turn, has the flow-on effect of limiting student intact numbers, which is the key to addressing the sonographer shortage.

Should clinical supervisors be required to have additional qualifications?

From my experience, I don’t believe clinical supervisors require additional qualifications.

They need a range of attributes i.e. experienced, professional, self-motivated, enjoying the respect of their peers and having good communication skills.

The provision of supervised training is almost entirely reliant on public and private medical imaging providers.

What can workplaces do to streamline the experience for students when they are on placement for training?

Try and provide as much one-on-one supervision as possible in the student’s initial skills development phase in the various fields of sonography e.g. general, obstetric, vascular.

Don’t obsess about students learning advanced skills e.g. advanced MSK, vascular, or throwing newly qualified sonographers onto on-call rosters. It is reasonable to allow them to develop advanced skills and competencies with more experience, post-qualification.

What can we do as a profession to address the lack of clinical placements?

A new training model which recognises the maturity of the profession of sonography.

The ASA, in collaboration with ASUM, the College of Radiologists and accredited training providers, orchestrate the establishment of dedicated sonography centres of excellence and training around the country.

The centres would be a partnership between a training provider e.g. QUT or CQU in Queensland, the relevant State Health Department or a major public hospital and larger radiology providers e.g. I-Med, Lumus, Q-Scan and Qld X-ray. Modelled on the QUT Health Clinics (www.healthclinics.qut. edu.au/services), the centres would provide supervised training for students as well as advanced skills training for qualified sonographers in a clinical environment. While clinical placements will still hold some value, if properly resourced these centres will significantly reduce the training burden placed on busy departments and practices. The fundamental aim of such a program is more qualified sonographers with less impact on service providers.

Addendum: Funding

Majority funding by the host provider e.g. university, supplemented by:

• state health departments

• radiology department/practices awarded bulk billing reporting rights

• fees paid by qualified sonographers undertaking short course advanced skills training

• other funding options e.g. fee-paying short courses offered to other medical professionals

• R&D.