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

Ideological dilemmas and work-related musculoskeletal disorders in ultrasound practice: an interpretive phenomenological analysis of the lived experiences of sonographers

Background: Since 2005, the UK government’s Migration Advisory Committee has listed sonography as an official ‘shortage specialty’ (Migration Advisory Committee, 2019). Work-related musculoskeletal disorder (WRMSD), already widespread among sonographers, is in-creasing due to the additional physical stresses of working in understaffed environments (Harrison & Harris, 2015). While contemporary research has described the broad picture regarding WRMSD in ultrasound (Bolton & Cox, 2015), none has, to date, extensively explored its personal and professional impacts from a qualitative perspective. Method: Extended semi-structured interviews with N=9 experienced sonographers working in the UK were conducted and analysed using a model of Interpretative Phenomenological Analysis (IPA) (Miller et al., 2017). Core thematic areas that emphasised personal and professional impacts of WRMSD were then further examined to highlight how participants specifically made sense of them. Findings: The key ideological tensions evident in the findings pertained to those between individuality and collectivity, and freedom and necessity. Evidence indicated that the participants held a range of perspectives highlighted in the following themes: (1) ‘WRMSD, Sonographer identity, attribution and context’ which included acknowledgement, or denial, in terms of experiencing symptoms of WRMSD. (2) WRMSD and the cultural, professional, and environmental perspectives of sonographers. (3) Ideological dilemmas and WRMSD. The concept of Ideological dilemmas (Billig et al., 1988) provided the theoretical framework on which to build the final findings and analysis chapter. Conclusions: Participants acknowledged their role as professionals, and also their own commitment to a broader altruistic model that reinforced their identities as good healthcare professionals. The concept ‘ideological dilemmas’ provided a useful analytic framework for understanding some of the everyday feelings of sonographers towards the phenomenon of WRMSD. Further exploration of the conceptual facility thereof is recommended in future studies

Eddy current testing of AGR fuel cladding

The scope of the presented study was to investigate feasibility of Eddy Current Testing (ECT) for detection in storage of inter-granular attack (IGA) cracking and general clad thinning of irradiated fuel cladding from Advanced Gas-cooled Reactors (AGR). The impact of the storage environment, particularly the effect of immersion in water compared to measurements in air, has also been investigated. A miniature EC probe was developed to induce eddy currents in a pin and to read out EC response. The transducer was robotically moved along the AGR pin and multi-frequency EC responses were acquired using a spectrum analyser. Main results of the experimental investigation are the following: even very small artificial defects such as short EDM notches of depth of 100μm produce distinguishable EC response; localised clad thinning of depth of 100μm and above produces considerable EC response levels; effect of water environment on the EC response is negligible; effect of anti-stacking grooves on the EC response is considerable

Sonographers’ experiences of work-related musculoskeletal disorder: the everyday consequences of physiological stress and injury in contemporary ultrasound

Background: By 2013, the UK government’s Migration Advisory Committee had listed sonography as an official ‘shortage specialty’ (Migration Advisory Committee, 2013; Parker & Harrison, 2015). As a consequence of the working stresses allied to this shortage, British sonographers have increasingly been reducing hours or leaving clinical practice entirely (Society and College of Radiographers, 2014). Moreover, among those who remain, incidences of reported chronic pain and active injury are also on the increase within a profession that was already synonymous with high rates of work-related musculoskeletal disorder (WRSMD; Harrison & Harris, 2015). While contemporary research has described the rates of WRMSD among ultrasound practitioners (Bolton & Cox, 2015), none has to date extensively explored its personal and professional impacts. Methods: Using a model of Interpretative Phenomenological Analysis with proven facility in medical imaging research (Miller et al., 2017), extended semi-structured interviews with N=10 experienced sonographers were analysed. Results: Participants routinely reported a sensation of guilt and depleted self-efficacy that not only permeated any working absence resultant of their own WRMSD, but also to taking legitimate leave when colleagues were suffering from WRMSD. An upshot of this was to recurrently “take one for the team” and work through excessive pain, even when this would likely result in greater prospective physical damage. While the basic shortage of sonographers was the core attribution for such behaviours, participants also cited (1) increasingly obese patients, (2) increasingly unhelpful (i.e. profiteering) equipment manufacturers, and (3) their own paternalism regarding healthcare. Conclusions: The present situation in ultrasound mirrors a culture of potentially dangerous pain acceptance that been noted in the psychology of sport for some time (Weinberg et al., 2013) albeit for altruistic, rather than egotistic, reasons. There is a clear body of evidence to suggest that sonographers are in crisis point both in terms of staffing levels and in terms of inter-related issues of WRMSD. The issue of WRMSD remains complex and under-researched and few studies are able to establish a definitive cause of the condition, because the causes are multifactorial. However, the majority of the literature seems to agree that poor posture, repetitive movements and insufficient strength seem to be the main physical causes, but little has been explored in terms of how the philosophy of being a sonographer, their behaviours and cultures might also be contributing to this issue. This study contributes to a new body of knowledge, looking at the unique experiences of (n=9) individual sonographers and the ideological dilemmas they are facing. It is acknowledged that extensive deeper levels of analysis and interpretation need to take place around the data collected for this study in order to draw more comprehensive conclusions. References: Bolton, G.C. & Cox, D.L. (2015) 'Survey of UK sonographers on the prevention of work related muscular‐skeletal disorder (WRMSD)', Journal of Clinical Ultrasound, 43 (3), pp.145-152. Harrison, G. & Harris, A. (2015) 'Work-related musculoskeletal disorders in ultrasound: Can you reduce risk?', Ultrasound, 23 (4), pp.224-230. Loaring, J.M., Larkin, M., Shaw, R. and Flowers, P. (2015) 'Renegotiating Sexual Intimacy in the Context of Altered Embodiment: The Experiences of Women With Breast Cancer and Their Male Partners Following Mastectomy and Reconstruction', Health Psychology, 34(4), pp. 436. Migration Advisory Committee. (2013) Skilled Shortage Sensible: Full review of the recommended shortage occupation lists for the UK and Scotland, a sunset clause and the creative occupations. London: Migration Advisory Committee. Miller, P.K., Waring, L., Bolton, G.C. and Sloane, C. (2018) 'Personnel flux and workplace anxiety: Personal and interpersonal consequences of understaffing in UK ultrasound departments', Radiography; Radiography, . doi: 10.1016/j.radi.2018.07.005. Miller, P.K., Woods, A.L., Sloane, C. & Booth, L. (2017) 'Obesity, heuristic reasoning and the organisation of communicative embarrassment in diagnostic radiography', Radiography, 23 (2), pp.130-134. Parker, P.C. & Harrison, G. (2015) 'Educating the future sonographic workforce: membership survey report from the British Medical Ultrasound Society', Ultrasound, 23 (4), pp.231-241. Smith, J.A., Flowers, P. and Larkin, M. (2009) Interpretive Phenomenological Analysis; Theory, Method and Research. SAGE; London. Weinberg, R., Vernau, D. & Horn, T. (2013) 'Playing Through Pain and Injury: Psychosocial Considerations', Journal of Clinical Sport Psychology, 7 (1), pp.41-59

The personal impact of work-related musculoskeletal disorders (WRMSD) on sonographers

Background: Since 2005, the UK government’s Migration Advisory Committee has listed sonography as an official ‘shortage specialty’ (Migration Advisory Committee, 2019). Work-related musculoskeletal disorder (WRMSD), already widespread among sonographers, is increasing due to the additional physical stresses of working in understaffed environments (Harrison & Harris, 2015). While contemporary research has described the broad picture regarding WRMSD in ultrasound (Bolton & Cox, 2015), none has, to date, extensively explored its personal and professional impacts. Method: Extended semi-structured interviews with N=9 experienced sonographers working in the UK were conducted and analysed using Interpretative Phenomenological Analysis (Miller, et al, 2017). Core thematic areas that emphasised personal impacts of WRMSD were then further examined to highlight how participants specifically made sense of them. Results: The key ideological tensions evident in the findings pertained to those between individuality and collectivity, and freedom and necessity. Evidence indicated that the participants held a range of perspectives highlighted in the following themes: (1) acknowledgement, or denial, in terms of experiencing symptoms of WRMSD (2) recognition of own vulnerability, (3) ‘spinning plates’ against emotional investment, (4) metaphorically ‘jumping through hoops’ and (5) total denial of the phenomenon. Conclusions: Participants acknowledged their role as professionals, and also their own commitment to a broader altruistic model that reinforced their identities as good healthcare professionals. The ‘personal self’ provides a useful analytic framework for understanding some of the everyday feelings of sonographers towards the phenomenon of WRMSD. Further exploration of the conceptual facility thereof is recommended. References 1. Bolton, G.C. & Cox, D.L. (2015) 'Survey of UK sonographers on the prevention of work related muscular‐skeletal disorder (WRMSD)', Journal of Clinical Ultrasound, 43 (3), pp.145-152. 2. Migration Advisory Committee. (2019) Full review of the Shortage Occupation List Migration Advisory Committee. London: Migration Advisory Committee. 3. Miller, P.K., Woods, A.L., Sloane, C. & Booth, L. (2017) 'Obesity, heuristic reasoning and the organisation of communicative embarrassment in diagnostic radiography', Radiography, 23 (2), pp.130-134. 4. Parker, P.C. & Harrison, G. (2015) 'Educating the future sonographic workforce: membership survey report from the British Medical Ultrasound Society', Ultrasound, 23 (4), pp.231-241

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

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

Success rates at cervical catheterisation in a sonographer-led HyCoSy service: a retrospective baseline audit

HyCoSy (Hysterosalpingo-contrast sonography) is the investigation of choice for the evaluation of tubal patency as recommended by the National Institute for Health and Clinical Excellence (NICE) (2004) - now the National Institute of Health and Care Excellence. Role extension and development in Ultrasound has led to sonographer-performed HyCoSy being undertaken in many UK centres in recent years. However, published audit surrounding sonographer-performed HyCoSy is limited. The aim of the study was to evaluate success/failure rates of cervical catheterization in women referred for HyCoSy examinations in a sonographer-led service in a hospital setting and to explore the methods and techniques identified in the literature for improving success

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