by Bryan Williams, MHA, RT(R), RDMS, RVT, RDCS, LAS, Ultrasound Specialist, Tammy Stearns, MS, RDMS, RVT, RT(R), FSDMS, FAIUM, LAS, Ultrasound Specialist, and Christa Brown BSN, RN, LAS, Senior Director of Medical Impact
Even after your primary training is complete and the initial ultrasound skills are mastered, there remains the question of how to retain competency. To best help the women and families we serve, our skills must remain up-to-date to provide relevant information, clear images, and accurate reports. This leads to several areas of discussion regarding the specific requirements needed to maintain competency. Given that each imager is different, each pregnancy help medical clinic (PHMC) has its own number of scans per day and that leads each of them to have their own guidelines for what is necessary to remain competent. It is no surprise that there are varying opinions on what should be required to maintain competency.
We live in a world where medical professionals are constantly running up against new “rules” and recommendations. Different organizations working to improve quality often set arbitrary rules on how to retain skills and remain competent in the field. This is likely done with good intentions and oftentimes leads to a variation of many different ideas and suggestions dependent on the focus of that specific organization.
Training and teaching people is one of the most dynamic activities that occurs in this world. As with any user-dependent learned skill, ultrasound requires continual practice and education throughout an imagers career. These vary greatly dependent on the natural ability of the imager and the foundational level of education specific to ultrasound, making it difficult to set a required number. Heartbeat International recommends the policies set by the Medical Director of that specific PHMC regarding the requirements to maintain competency in conjunction with any federal or state licensure or legal requirements.
Heartbeat International recommends quarterly or bi-annual peer reviews. In a peer review, all staff performing ultrasounds have a quarterly peer review which assesses the quality of an exam provided by experienced nurses and sonographers. The cases are chosen randomly and are reviewed blindly. A peer review includes an assessment ensuring that all required forms are being completed thoroughly and properly and all protocols of imaging and measurements are being followed. Any issues revealed in a peer review are corrected with feedback, goals set, and continued education.
The minimum requirement for continued education differs dependent on several factors. Registered Nurses are governed by their licensing board which is dependent on the state in which the board oversees. Registered Diagnostic Medical Sonographers' requirements are dependent on the requirements of the organization that has awarded their credentials, along with state licensure laws dependent on their state.
However, these are specific to the credentials of the professional, not necessarily specific to imaging limited obstetrical ultrasounds. Because each medical professional has a different skill set and frequency of scans in their clinic, some may be experiencing very few scans. Because of this, less pathology is being seen and less diversity of images and gestational ages. This makes it challenging to maintain proficiency. Policies need to be set within each PHMC to ensure that competency within the level of imaging being seen is maintained.
Heartbeat International recommends that only licensed or credentialed medical personnel trained in limited obstetrical ultrasounds (nurses, registered diagnostic medical sonographers, nurse practitioners, midwives, physicians, and physician assistants) perform scans within PHMCs.
Just as when you started your training, continued education should be a combination of didactic and clinical learning. Maintaining skills ensures you remain competent and confident in your ultrasound skill to image life most effectively.
If your PHMC has a team of medical professionals who have experience in ultrasound scanning, periodic group training may be helpful. This could be a time to review didactic material, share difficult cases, and perhaps perform a few practice scans. Consider scheduling a time for group training, overseen by experienced nurses and sonographers within your PHMC or even with a few clinics combined, who can provide feedback, support, and insight. Personal and dependent growth continues far beyond the initial training period.
For those that have a smaller or newly developed medical department, Heartbeat International offers a didactic ultrasound refresher course that allows continued education online. The course is reissued every two years to allow for a continual source of learning for the more experienced imagers. In addition to the didactic components, there is a clinical component that requires ten exams to be completed along with an assessment completed by an experienced observer. For those without an experienced observer, personal arrangements may be made.
Another more in-depth option would be to attend the clinical training, L.O.V.E. Approach Ultrasound Clinical, which is available to all levels of ultrasound proficiency. These events are also great for those who have been scanning for many years and have proven to be a time of encouragement while fine-tuning existing skills.
At times, it can be difficult to navigate all the legal requirements for the services PHMCs offer. However, it may be more difficult to navigate the areas that are not legally governed. These gray areas are often met with suggestions from organizations that do not govern ultrasound or medical services but rather have an opinion on what is best for all. That can add to the confusion of what is actually a requirement and what is a guideline or recommendation. As you discern what is best for your PHMC and the community you serve, it can be helpful to consider a few things:
Together, these things can guide policy for your PHMC in light of the purpose of the scan…to image life.
Thank you for all you do for your communities. You put your heart into your work and want the very best for the women, babies, and families you serve. You are making a difference.
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