How do we reduce the pressure on clinical services?

At the University of Derby, we offer one of two CASE accredited direct graduate entry MSc programmes that have been developed to enable graduates from outside of healthcare to train in ultrasound.

Despite the focus on alternative training models, attempts to increase trainee numbers are still limited by placement capacity. While national debate continues, pressure on clinical departments is unrelenting and inevitably this impacts on the quality of student experience, staff morale and retention. Despite this, approaches to how we train sonographers ‘on the shop floor’ haven’t really changed for several decades.

At Derby, we have been working with clinical colleagues locally to reduce pressure on clinical services by moving early skills training for sonographers away from busy central imaging departments. This has been part of a wider exploration of how training capacity can be increased, for example by making better use of community-based training locations and establishing dedicated training lists.

We already make extensive use of simulation, and our on-campus facilities include a dedicated ultrasound simulation suite, three ultrasound systems and an immersive space. The next logical step was to increase opportunities for on-campus scanning of both normal volunteers and patients.

Normal volunteer scanning

Historically, we have made extensive use of normal volunteer scanning across most modules. Students either scan each other, or we recruit paid volunteers via the student employment agency. This enables us to include live demonstrations of scan technique during teaching sessions, and students gain valuable hands-on practice without the pressure of patient scrutiny.

All volunteers are consented for scan using the BMUS consent form for volunteers. This has worked well for abdominal, vascular, transabdominal pelvis and musculoskeletal applications. However, the use of normal pregnant volunteers was excluded, in line with the wording of the original BMUS volunteer consent form: “To the best of my knowledge I am not pregnant. I understand that the scan will cease if a pregnancy is found.”

However, in light of the Health Education England (HEE) initiative to train additional obstetric sonographers, we have recently reviewed the use of pregnant volunteers for tutor supported on-campus training sessions. With guidance from the BMUS safety group, we have developed a revised recruitment and consent process for pregnant volunteers.

A key aspect of this work has been close liaison with the obstetrics team at the University Hospital of Derby and Burton NHS Foundation Trust (UHDB), to ensure clear processes are in place for rapid referral back to the obstetrics team, where any complication of the pregnancy or maternal concern is identified. Recruitment will be restricted to low-risk local volunteers who have completed first and second trimester screening, but do not require third trimester monitoring.

This is an exciting development that will enable students to engage with live demonstrations and hands-on practice for second and third trimester scan technique, with the addition of direct feedback from volunteers. We are also exploring opportunities for specialist master classes and CPD events that will be open to the wider clinical teams, including workplace mentors and newly qualified sonographers during their preceptorship period.

On-campus training lists

Alongside these developments, and in collaboration with the UHDB NHS Foundation Trust, we have been working to establish an on-campus satellite ultrasound service. Dedicated training lists will be staffed by experienced mentors from the Trust and patients will be offered a campus-based appointment at the time of booking.

The clinical skills suite facilities at the University of Derby are extensive and include an on-site GP practice, iDXA and x-ray room, along with a new state of the art reporting facility. By investing in N3 connectivity and PACS, ultrasound lists can now be offered at the University as an additional community-based service. Our aim has always been to work in partnership with the Trust (not in competition) and we have been delighted by the energy and enthusiasm that clinical colleagues have invested in this development. This collaborative approach has been key in overcoming some of the considerable challenges in establishing an NHS service in a university setting, and there is still much to learn.

The processes around establishing the required IT infrastructure have been complex and, at times, immensely frustrating. However, by offering on-campus ultrasound lists, we have an opportunity to expand local training capacity. The facility will also be used to work with trainees who need additional support. Our long-term aim is to expand these sessions to include a broad range of examinations, particularly in applications where training capacity is limited.

These sessions provide an ideal ‘low pressure’ environment where students can work (usually in pairs) with an experienced mentor, away from the busy main departments. This is also an ideal setting for students transitioning towards autonomous practice at the end of their period of training.

So, can we move practical ultrasound skills training out of the busy department and onto campus?

Well, certainly not all of it. A high-quality clinical placement experience is still a central part of any training model for sonography. However, I think we could make a strong case against student engagement with busy scheduled lists when they are still struggling to orientate themselves or to recognise normal anatomy. Simulation is a big part of the solution but not the whole answer. Ultimately, I think we need to move early skills development out of clinical departments for ALL ultrasound trainees.

We’re working on it…