Direct entry ultrasound: one university's experience #MUAM

Lorelei Waring and colleagues from the Ultrasound Programme Team at the University of Cumbria, UK, write a detailed article for the Society of Radiographers about the direct entry sonography courses

Charting the practical dimensions of understaffing from a managerial perspective: the everyday shape of the UK’s sonographer shortage

Introduction: Across the last two decades, ultrasound services in many healthcare sectors have become increasingly pressurised as a consequence of upsurging demand and difficulties in recruiting viable clinicians. Indeed by 2013, the UK government's Migration Advisory Committee had listed sonography as an official ‘shortage specialty’. Comparatively little research has to date, however, explored the impacts of this situation upon the departments themselves, and the individuals working therein. The core purpose of this study is, thus, to lend qualitative depth to current understandings of the frontline situation in the UK's ultrasound units, many of which are understaffed, from the perspective of their managers. Methods: Using a thematic analysis informed by a Straussian model of Grounded Theory, N=20 extended accounts provided by ultrasound department leads in public (n=18) and private (n=2) units were explored. Results: Four global themes emerged from the analysis of which the first two (the broadly sociological matters) are described in this paper. Theme 1 addresses how a lack of staff in the broader ultrasound economy has created a troublesome migratory system in contemporary UK ultrasound. Theme 2 addresses how this economy works chiefly to the advantage of the most junior and the most senior clinicians, often leaving mid-career professionals in the borderline impossible situation of having to concurrently occupy both junior and senior roles. Conclusions: The findings ideally open up debate on some key practical contingencies of the UK’s sonographer shortage, and reflect upon literature regarding the nuanced aspects of a shifting healthcare workplace constitution

Direct entry postgraduate ultrasound - the University of Cumbria experience: a report for Health Education Northwest, November 2018

This report investigates findings arising from in-depth interviews with five students and six Ultrasound Department Leads throughout the North West of England over a two year period, considering their opinions and experiences in relation to the University of Cumbria direct entry postgraduate MSc in ultrasound. The student participants represent the first cohort on this newly developed programme and the clinical leads represent the placement hospitals responsible for providing the clinical aspect of the students training

The future of ultrasound Advanced Clinical Practitioner education: Mapping the views of clinical leads in the public and private sector

Background: There can be little doubt that current models and mechanisms involved in ultrasound Advanced Clinical Practitioner education, at UK University Level 7, are in need of change to adapt to the challenges of a rapidly changing public healthcare environment, while functioning alongside newer ‘direct entry’ educational routes into ultrasound (Miller, Waring, Bolton and Sloane, 2018; Waring, Miller, Bolton and Sloane, 2018). This research, funded by Health Education England, explores the views of clinical leads in UK ultrasound departments regarding the facility of current education, the changes needed now and the changes that are likely necessary to future-proof the curricula. Methods: With institutional ethical approval, semi-structured interviews were conducted with N=10 clinical leads in public and private ultrasound units. Data were transcribed verbatim, and transcripts analysed using the thematic approach outlined by Braun and Clarke (2008). Results: Four interlinked global themes emerged. 1. Soft Skills: The present and increasing need for better and more flexible verbal/written communication skills, plus team working and management/leadership training. 2. Non-Genericism: The need to prepare sonographers for progressively more varied and/or difficult patients and working environments. 3. Specialisation in Diversification: The need to prepare sonographers for a greater range of diagnostic and interventional tasks in more specific domains of ultrasound. 4. Evolving CPD: Developing new CPD models to facilitate greater ongoing involvement. Conclusion: While the participants were broadly very content with current models/standards of Ultrasound ACP education, the findings underscore a range of concerns they held regarding its adaptation in the short-to-medium terms

Direct entry ultrasound: changing the face of ultrasound training

Background: There is a well-documented crisis within the ultrasound workforce in the UK due to a shortage of qualified sonographers in addition to increased workloads because of expanding services and working hours (Lovegrove and Price, 2002). This is leading to increasing difficulties for many NHS Trusts in meeting the demands on Ultrasound Departments (SCoR, 2009). There have been many consultations over the last 10 – 15 years on this issue, and it is clear that there is no quick fix for this problem. However failure to address this current crisis will mean a number of risks will continue to exist and further manifest themselves. Several additional educational pathways for Sonographic Education have been proposed (SCoR, 2009) offering both long term and short term solutions to the issue and the University of Cumbria through close consultation with their local stakeholders have spent the last 12 months developing a full time Direct Access MSc in Medical Ultrasound Programme to run in conjunction with the traditional part time route open to current healthcare practitioners. Methods: Following a sonography workforce meeting held in Manchester in November 2014 in which HENW highlighted the local issues with sonographer shortages, the University of Cumbria arranged a stakeholder meetings aimed at discussing the development of an additional training route that would welcome applications from non-healthcare based applicants. Following this meeting it was decided that the University would look to develop a full time direct access MSc in medical ultrasound. Throughout the development process continued close consultation with the local stakeholders was maintained. In spring 2015 HENW commissioned a report which investigated the findings arising from in-depth interviews with twenty Ultrasound department leads throughout the North West of England including participants from both the NHS and independent sectors from Merseyside, Greater Manchester, Lancashire and Cumbria. The issues under investigation included current staffing status, preferred model of education and HCPC issues. Results: The stakeholder consultations and commissioned report highlighted the regions desire for action on this issue and reassured the faculty team that the programme would be welcomed and well supported within the region. It also helped to secure some funding for the course. The investment of time into discussing and researching the views of the local stakeholders is vital to ensure the programme and resultant sonographers are fit for purpose. It is hoped that this new and innovative course will over time help to support the current ultrasound education provision and help to ease the current crisis. Conclusions: The national shortage in the Sonography workforce has led to development of the Direct Entry MSc by the University of Cumbria. The process has involved close liaison between the University of Cumbria and their stakeholder in order to ensure the needs of the local area are met by the programme

Fetal membrane bacterial load is increased in histologically confirmed inflammatory chorioamnionitis: A retrospective cohort study

Introduction It is widely debated whether fetal membranes possess a genuine microbiome, and if bacterial presence and load is linked to inflammation. Chorioamnionitis is an inflammation of the fetal membranes. This research focussed on inflammatory diagnosed histological chorioamnionitis (HCA) and aimed to determine whether the bacterial load in fetal membranes correlates to inflammatory response, including histological staging and inflammatory markers in HCA. Methods Fetal membrane samples were collected from patients with preterm spontaneous labour and histologically phenotyped chorioamnionitis (HCA; n = 12), or preterm (n = 6) and term labour without HCA (n = 6). The bacterial profile of fetal membranes was analysed by sequencing the V4 region of the 16S rRNA gene. Bacterial load was determined using qPCR copy number/mg of tissue. The association between bacterial load and bacterial profile composition was assessed using correlation analysis. Results Bacterial load was significantly greater within HCA amnion (p = 0.002) and chorion (p = 0.042), compared to preterm birth without HCA. Increased bacterial load was positively correlated with increased histological staging (p = 0.001) and the expression of five inflammatory markers; IL8, TLR1, TLR2, LY96 and IRAK2 (p=<0.050). Bacterial profiles were significantly different between membranes with and without HCA in amnion (p = 0.012) and chorion (p = 0.001), but no differences between specific genera were detected. Discussion Inflammatory HCA is associated with infection and increased bacterial load in a dose response relationship. Bacterial load is positively correlated with HCA severity and the TLR signalling pathway. Further research should investigate the bacterial load threshold required to generate an inflammatory response in HCA

The Republic of Ireland sonographer reporting pilot study

Background: In the Republic of Ireland (ROI) speciality radiographers (sonographers) undertake ultrasound examinations however, outside of obstetrics they are limited to providing a provisional report which a radiologist will verify. Sonographers in ROI are usually educated to the same standard as their independently reporting UK counterparts having attended CASE-accredited post-graduate courses. This report investigates the comparability of sonographer and radiologist reporting throughout ROI. Methodology: The report follows a clinical audit methodology. To ensure full population representation CEOs from all hospitals in the ROI were contacted to take part. Participants were all sonographers, covering 6 of the 7 hospital groups of ROI. Each sent data from 400 randomly chosen non-obstetric examinations over 6 months, provisionally sonographer reported then reviewed by the supporting radiologist. The radiologist allocated an agreement score to the report based on the Riley et al (2010) grading system. Results: 6037 ultrasound examinations were included in the audit. Over 99% of the reports fell into the acceptable range of Grades 1 and 2. 0.35% (21) of reports were classified as Grade 3. Only 2 reports within the Grade 3 classification were changed to upgrade the classification of pathology seen. No reports were classified as Grade 4. Conclusion: This large, multicentre audit demonstrates the accuracy of sonographer reporting in the ROI with an acceptable agreement score of over 99%. Sonographers in ROI can report as accurately as their UK counterparts who report independently. With the increasing demand for non-obstetric ultrasound, the existing workforce needs to be utilised efficiently

Personnel flux and workplace anxiety: personal and interpersonal consequences of understaffing in UK ultrasound departments

Introduction: By 2013, the UK government’s Migration Advisory Committee had determined sonography to be a formal shortage specialty, and understaffing remains a key concern for research in the domain. This paper, emergent of a qualitative study funded by Health Education North West, explores unit managers’ perspectives on the present state of UK ultrasound. The focus herein falls upon the personal and interpersonal consequences of this circumstance for individuals working in specific understaffed departments. Methods: A thematic analysis informed by a Straussian model of Grounded Theory was utilised; N=20 extended accounts provided by ultrasound department leads in public (n=18) and private (n=2) units were collected and analysed accordingly. Results: The global themes addressed herein describe (a) how both inter-departmental movement of senior sonographers and early retirement, within a nationally understaffed picture, impacts upon local knowledge economies, and (b) how such staffing instabilities can undermine the day-to-day confidence of managerial staff and practicing sonographers alike. Conclusions: It is personnel flux, rather than simple short-staffing, that is reported to cause the greatest social-psychological problems for both managers and sonographers. The issues raised herein require further examination from the perspective of sonographers themselves, in order to corroborate the views of the managers interviewed

Future-proofing education for advanced practice in ultrasound: the perspectives of clinical leads in England

Background: Ultrasound departments in the UK’s public health sector have now remained critically understaffed for well over a decade, and there is a pervasive concern in the contemporary National Health Service that sonographers are moving into Advanced Practice (AP) roles in insufficient numbers to even compensate for early retirements and other premature workforce departures. This report investigates how University curricula and other forms of training might be best adapted to accelerate sonographers’ movement into AP roles in the short to medium terms. In the service of this, the facility of current educational models/training and their ACP-relevant content was explored from the perspective of current Clinical Leads (henceforth CLs) working in English ultrasound units. Methodology: With institutional ethical approval, N=10 Clinical Leads of ultrasound units in England were recruited, through existing networks. Each participant sat for a single semi-structured telephone interview, typically lasting between 30 and 60 minutes. Interviews were digitally recorded, transcribed verbatim, and redacted of all personally identifying detail at the point of transcription. Redacted transcripts were then thematically analysed. Findings: Analysis yielded four interlinked global themes: (1) Specialisation and Learning, (2) Communication Skills, (3) Teamworking and Leadership, (4) Continuing Professional Development. Recommendations: Six key recommendations derived from the findings are made. These are, in summarised form: (a) There is a need for greater national clarity regarding the competencies and levels of capability that define Advanced Practice, as well as the graduate, enhanced, and consultant stages. (b) The concept of the four pillars of AP needs to be more extensively familiarised and clarified at all levels of the sonography workforce. (c) A greater emphasis on developing sonographers’ advanced communication skills is needed in both the HEI and clinical settings. (d) Opportunities to develop leadership skills are needed both within the HEI programmes and locally in ultrasound departments. (e) More emphasis Is needed on local training and development opportunities to facilitate sonographers taking-up additional learning opportunities. (f) The overarching sonography workforce shortage remains highly problematic; attempts to move forward by allowing the existing workforce to develop skills in AP are often hampered by the requirement to prioritise the daily ‘bread and butter’ workload