Soundeffects News: The Discussions, Insights and Perspectives Issue

OCTOBER 2023

soundeffects news THE SONOGRAPHY

discussions, insights & perspectives ISSUE

THE SONOGRAPHY

discussions

In this issue

03 05

A message from ASA CEO, Tony Coles Parent/Patient communication Where are we at?

Interview with Dr Kate Russo Interview with Paula Kinnane FASA

08 11

onographer reporting S Interview with Matthew Adams

14

hat does sonography look like in the future?

W Interview with Caterina Watson AFASA Interview with Dr Mark Stieler

17

Protecting the sonographer I nterview with Ian Schroen Interview with Kerry McManus

20

Information sharing in the ‘Dr Google’ social media world/Social media and medical professionalism Interview with Daniel Rae AFASA

Clinical supervision I nterview with Chris Gilmore FASA Interview with Louise Worley FASA

21

Reassessing the ultrasound education model and training Interview with Jane Wardle Interview with Christopher Lewis

23 24

2

soundeffects news

Career pathways for sonographers I nterview with Dr Kerry Thoirs The student experience Interview with Jaimie Feeney Interview with Leah Gordon

THE SONOGRAPHY

discussions

Message from the CEO

I

t is my pleasure to present our latest Soundeffects news: the sonography discussions, insights and perspectives issue. In this issue, we continue the conversations from the first ASA Arena held this year at the ASA Annual International Conference in Brisbane. Those who were there in person had the opportunity to listen to expert panellists, ask questions, offer opinions, and be a part of the discussion on a range of topics currently affecting sonographers.This Soundeffects news issue delves a little deeper into the topics explored at the ASA Arena, including issues such as professional development, workforce challenges, and the future of the sonography profession.

The first topic in this publication, Parent/Patient communication, Dr Kate Russo and Paula Kinnane FASA, highlight the benefits of patient-centred communication in sonography, stressing open, empathetic, and culturally sensitive communication and considering the broader social determinants of health.

Matthew Adams, in the Sonographer reporting section, analyses international reporting models and considers their potential in Australia, examining standards for sonographer reporting across different workplaces.

In the Clinical supervision section, Christopher Gilmore FASA and Louise Worley FASA emphasise the importance of expertise and leadership skills in shaping the next generation of sonographers with experts sharing their experiences and innovative approaches to supervision.

In the forward-looking piece exploring the Future of sonography, Caterina Watson AFASA and Dr Mark Stieler examine point of care ultrasound (POCUS), technological changes, AI’s impact, sonographers’ full scope of practice, and the joined-up care with other allied health professions.

Protecting the sonographer, with contributors Ian Schroen and Kerry McManus, focuses on medico-legal issues and occupational health and safety, aiming to promote better practices for sonographers and address their mental health amid increasing workplace demands.

Information sharing in the ‘Dr Google’ social media world explores the role of sonography in the digital landscape, addressing the challenges of navigating patient expectations and misinformation. Daniel Rae AFASA also discusses using technology for educational purposes and professional promotion.

For the topic Reassessing the ultrasound education model and training, Jane Wardle and Christopher Lewis discuss the need to rethink current ultrasound education models and practices to better align them with industry requirements.

Focusing our attention on Career pathways for sonographers, Dr Kerry Thoirs highlights the diverse career opportunities beyond clinical practice in diagnostic medical sonography, encouraging exploration of further education, nonclinical roles, academics, and other employment alternatives.

Finally, we ask Jaimie Feeney and Leah Gordon about their student and recent graduate experiences, as they share their perspectives on clinical placement and the transition from student to qualified sonographer, providing valuable advice for aspiring sonography students.

I would like to thank all our contributors for their time and expertise in helping us put this publication together. I encourage you to head to our website for more information, send ASA your feedback, or even start your own discussions on these important topics at your workplace, university, or with your peers.

Regards

Tony Coles CEO, Australasian Sonographers Association soundeffects news

3

Need ultra high-frequency imaging? has you covered With broad bandwidth and wide view Simply see more

22 Mhz

24 Mhz

anz.medical.canon

33 Mhz

Introducing LOGIQ Fortis

TM

Small footprint, powerful performer Compact and Lightweight, the LOGIQ Fortis is simple to manoeuvre and can fit into almost any space—from patient rooms to exam rooms to operating rooms.

AI tools to enhance workflow LOGIQ Fortis harnesses the power of artificial intelligence to improve the speed, ease and comfort of exams.

With its AI-based tools, users can achieve exceptional images quickly.

The next generation of LOGIQ ultrasound technology.

Seeing is believing. To book your on-site or virtual demonstration, vist our website or call 1800 659 465 (Australia) / 0800 659 465 (New Zealand).

LOGIQ Fortis—the LOGIQ platform’s newest member—provides a multi-purpose, all-in-one, ultra-secure ultrasound solution that can be easily scaled to fit your specific needs. © GE HealthCare, 2023. GE HealthCare reserves the right to make changes in specifications and features shown herein, or discontinue the product described at any time without notice or obligation. Contact your GE Healthcare representative for the most current information. GE is a trademark of General Electric Company used under trademark license. LOGIQ Fortis, cSound, XDclear and InSite are trademarks of GE HealthCare, GE Medical Systems, Inc., doing business as GE HealthCare. JB00805AU

Parent/Patient communication Where are we at?

THE SONOGRAPHY

discussions

Parent/Patient communication Where are we at?

Effective person/patient-centred communication is a cornerstone of quality healthcare, with a focus on understanding the patient, including their personality, life history, and social context. This interview explores the significance of person/patientcentred communication within the context of sonography, emphasising its potential to enhance the patient experience and health outcomes. Both Dr Kate Russo, Specialist Sonographer at Adelaide Women’s and Children’s Hospital and Paula Kinnane FASA, Professional Development Manager at ASA, underscore the need for sonographers to engage in open, empathetic, and culturally sensitive communication, particularly during brief patient interactions, and highlight the broader social determinants of health that impact patient wellbeing.

Dr Kate Russo

Master’s Program Unit Coordinator, Advanced Communication and Clinical Education | Central Queensland University

Specialist Sonographer | Adelaide Women’s and Children’s Hospital Kate has worked as a Specialist Sonographer at the Women’s and Children’s Hospital in Adelaide for the last 14 years, with a special interest in high risk obstetrics and fetal echocardiography. Her ultrasound career started in Brisbane in 1998 where she spent five years before moving to the United Kingdom. While in London, Kate worked primarily in obstetrics and gynaecology, developing her ultrasound skills in fetal medicine before returning to Adelaide in 2009. She has a keen interest in research, completing her PhD titled ‘Maternal cardiac function in women high-risk for pre-eclampsia’ in 2020. Kate also works as a Senior Lecturer at Central Queensland University and is the Master’s Program Unit Coordinator for Advanced Communication and Clinical Education. She is passionate about delivering high quality education for sonographers.

Your communication during that short time can have a significant impact on the patient’s wellbeing and DR KATE RUSSO ongoing care to develop a shared understanding of the problem and the barriers to treatment and wellness. Sonographers most often have one-off patient interactions; however, your communication during that short time can have a significant impact on the patient’s wellbeing and ongoing care. This can be a positive experience or potentially harmful when there is no consideration for the whole person. This links to social determinants of health, including psychological wellbeing, socioeconomic status, education, social support, family and cultural background, gender/sexual identity, relationships and trauma. Recognising and understanding these factors will enable you to adjust your communication to ensure your patient feels respected, comfortable, listened to, and cared for.

What is considered best practice in person/ patient-centred communication?

High quality communication is fundamental to providing person/ patient-centred care, which has evolved from the paternalistic approach that ‘doctor knows best’, with no or limited consultation with the patient. Person/patient-centred care is considered a partnership between patients and healthcare providers, with a focus on enhanced patient satisfaction. To achieve this, it is important to establish a connection with your patient, explore the patient’s perspective, provide information and demonstrate interest and empathy. This requires sonographers to show openness, warmth and be attentive from the moment you greet them in the waiting room, so be mindful of your verbal and nonverbal communication.

What is person/patient-centred communication and why is it important?

These simple steps will assist in establishing a rapport and help put your patient at ease. Before starting the ultrasound examination, take the time to actively listen to your patient, so you can understand their concerns and expectations, without being distracted by scanning. Provide information about the ultrasound examination and check for understanding, as this is your responsibility.

Person or patient-centred communication has been shown to improve a patient’s experience of care and leads to better health outcomes, requiring health professionals to have a holistic understanding of the person presenting for care. This includes acknowledging their personality, life history, and social structure

Furthermore, these steps will help build trust and ensure greater cooperation. Take the time to acknowledge their feelings and emotions, as it is easy to overlook the stress and anxiety associated with entering a healthcare setting and the concerns they may have about their health and wellbeing.

soundeffects news

5

THE SONOGRAPHY

discussions

Parent/Patient communication Where are we at?

What are the barriers to person/patient-centred communication?

Barriers to person/patient-centred communication relate to an individual’s ability and skills to communicate effectively. A perceived lack of time and sonographer attitude can be barriers to person/patient-centred communication. Sonographers may not feel that they have enough time to listen to a patient about their concerns and explain what is going to happen during the examination; however, this is essential. Patients should not feel rushed or a burden, even when they run late for their appointment.

Ensure you give your patients time to speak about their symptoms and share their story without interrupting. Ask open-ended questions to encourage disclosure and gain critical insight into the patient’s experience and health. Consider the language you use when explaining the ultrasound examination based on the patient’s level of scientific knowledge. You will be able to gauge this level when listening to their story.

Like all learning, evaluation and reflection is needed to enable personal and professional development. For student sonographers, the role modelling of person/patient-centred communication by supervisors, mentors and other sonographers is critical to ensure the next generation of sonographers’ communication skills and attitudes align with best practice.

Paula Kinnane FASA

Professional Development Manager | Australasian Sonographers Association

Technical jargon should be avoided, not only due to the potential lack of understanding but because it can make people feel inferior. It is also important to consider how your own beliefs and values may influence your communication and be aware of your biases. Judgement of others can readily be perceived without words, so be mindful that your body language, gestures and tone are not relaying an alternate message.

Paula is a specialist obstetric sonographer and is clinically working at Royal Brisbane and Women’s Hospital in the Maternal Fetal Medicine Unit. Paula is also a Professional Development Manager with the Australasian Sonographers Association where she enjoys developing resources and initiatives to assist sonographers, ensuring they can provide the highest level of patient care. Over her career she has worked as a senior sonographer, clinical instructor, and university academic and has a passion for education. Paula was awarded a Fellowship with ASA and was the 2021 Tutor/Clinical Supervisor of the Year.

How can sonographers, students and the sonography profession work towards improving person/patient-centred communication?

For those performing ultrasound, what are some challenges that inhibit effective communication with patients?

There are several approaches that can be implemented to improve our person/patient-centred communication; however, we first need to recognise the importance and value of this communication. Raising awareness through ASA, educational pathways and engaging sonographers to want to learn more about the importance of person/patient-centred communication is needed. At an individual level, we could all work on developing a better understanding of these communication principles, which can then be applied to our own practice. As health professionals, sonographers have a responsibility to develop skills and competency in all areas of ultrasound, including communication.

There are many challenges that can inhibit effective communication. Some of these include:

These ‘soft skills’ are often overlooked and opportunities at conferences are less well attended, with sonographers preferencing the development of technical skills and knowledge.

I would recommend presentations that cover these topics be addressed at plenary sessions, rather than just the optional workshop in the program, so a wider audience is reached. At a departmental level, team leaders and supervising sonographers could incorporate communication competency into professional development and performance reviews, just like other skills sonographers work towards. Professional development sessions could be in the form of group discussions with sonographers sharing challenging interactions and discussing how the situation could have been better managed.

6

soundeffects news

• anxiety and nervousness – patients may be anxious, which can limit their ability to absorb information or ask questions.

Some examinations can be highly emotive and it is important that sonographers support the emotional needs of the patient to facilitate meaningful communication • limited understanding of medical jargon – using technical terms without providing layman’s explanations can lead to confusion and miscommunication • cultural and language barriers – we live and work in a multicultural society and some patients from different cultural backgrounds may struggle to convey their concerns or understand instructions • limited time – busy schedules can mean that sonographers have limited time with each patient, which can hinder explanations. Time is needed to build rapport to allow a patient to share personal or medical information during the procedure • distractions – children, support people, and/or mobile phones can be a distraction. Noise or interruptions in the ultrasound room can disrupt communication and create an environment not conducive to effective communication.

Parent/Patient communication Where are we at?

THE SONOGRAPHY

discussions

Parent/Patient communication Where are we at?

The key is to approach these situations with humility, a willingness to learn, and a commitment to respectful and inclusive communication.

PAULA KINNANE FASA

To address these challenges and promote effective communication with patients during ultrasound procedures, sonographers should use clear and simple language, encourage questions, provide explanations, ensure privacy, and show empathy and understanding of the patient’s emotional state. Additionally, being aware of cultural differences and potential language barriers is crucial, and interpreters or translated materials may be necessary in some cases.

How do you ensure you are communicating in a way that does not come across as politically or culturally incorrect or insensitive?

Some tips to help communication in a sensitive and respectful manner include: • cultural awareness – educate yourself on different cultures, customs, and beliefs to avoid unintentional insensitivity.

Consider cultural competency training • avoid assumptions – don’t make assumptions about a person’s background, beliefs, or preferences based on appearance or name. Treat everyone as unique • active listening – listen actively and attentively and pay attention to non-verbal cues. Regularly check in with your patient during the scan to ensure they are okay

• use appropriate and inclusive language – avoid stereotypes or generalisation. Ensure you use patient/parent-focused language. Use the correct pronouns or gender identities. If you are unsure, ask respectfully • respect personal space – be aware that personal space boundaries and comfort levels with personal contact can vary from culture to culture. Always obtain consent to undertake the examination and explain the procedure, including probe contact • self-reflection – reflect on your own biases or beliefs. Selfawareness and feedback when you have unintentionally made a mistake are important for growth.

Remember that being culturally and politically sensitive is an ongoing process and everyone makes mistakes at times. The key is to approach these situations with humility, a willingness to learn, and a commitment to respectful and inclusive communication.

What advice can you give to those attempting to keep up with current language and terminology?

Read widely to stay informed, watch and listen to TV shows or podcasts which often reflect current terminology, attend conferences on professional topics, and stay open-minded.

Is there a need for cultural awareness training to improve patient communication?

Yes, cultural awareness training is a valuable component of healthcare education. It promotes cultural competency, reduces health disparities, enhances communication, respects individual values, builds trust, and minimises misunderstandings. It also supports informed consent and reflects patient-centred care.

Training should be ongoing and adaptable to the sonographer and the patients they care for. •

soundeffects news

7

THE SONOGRAPHY

discussions

Sonographer reporting

Sonographer reporting The standards and requirements for reporting, carried out by a sonographer, vary from workplace to workplace. What insights can we glean from successful international reporting models in countries like New Zealand, the UK, and the US? Matthew Adams, Chief Vascular Sonographer at Camperdown Vascular Laboratory, has extensive experience working in both international and local sonography fields and has a unique perspective on the difference in reporting. Matt shares his thoughts on some of the successful models and initiatives that have been established internationally and considers what these models would look like if adopted in Australia.

Matthew Adams

Chief Vascular Sonographer | Camperdown Vascular Laboratory

Matthew began his career in sonography in the United Kingdom where he trained as a clinical vascular scientist and worked with the vascular studies team at the Royal Free Hospital. He spent five busy years scanning, assisting with the teaching and training of those new to the profession, and aiding research conducted by the University College London. In 2017, Matthew made the move to Australia and is now in charge of Camperdown Vascular Lab in Sydney.

The reporting roles of sonographers in Australasia vary considerably. As the sonography profession moves into the future, what expectations do you think will be placed on all sonographers to produce formal reports?

I think the answer to this question depends on the evolving situation of sonography becoming a regulated profession in Australia. I am confident that as a profession we will eventually achieve this. Without it, it would be very difficult for us to gain full autonomy over our reports and allow for written reports to be submitted without a doctor having to sign off on them. I accept that not all sonographers share the same point of view as me regarding this but having trained in the UK where ultrasound reports are not required to be co-signed, I feel that this is something we should strive for.

The main ingredient for sonographers producing formal diagnostic reports in the future within Australia is readily available – a highly capable and willing workforce. The expectation placed on sonographers to be able to do this,

8

soundeffects news

however, will rely on the technicalities associated with the name that needs to be at the bottom of the report being changed.

What insights can we take from successfully established international reporting models e.g. NZ, UK, US? The first thing I would say is that Australia doesn’t have an unsuccessful reporting model. I would say though that the responsibility of the sonographer in relation to the report is highly variable depending on the speciality you’re in and where you work in Australia geographically, which are issues that make this debate so complicated.

I do have an obvious bias towards the UK system because it’s the model under which I trained. I feel that this sort of model, where sonographers are solely responsible for the diagnostic reports they produce, places a well-deserved level of value on these allied healthcare professionals.

We must also accept that there is a wide range of skills across the profession from those who perform at a satisfactory level to those who are advanced practitioners. The New Zealand model recognises this by using the terms ‘reporting’ or ‘specialist’ sonographer when referring to an advanced practitioner. I think that using this sort of differentiation between skill and experience levels would enhance the state of ultrasound reporting in Australia.

Do you see a benefit in sonographer reporting?

We don’t have a situation where sonographers aren’t reporting.

Sonographers around the country are producing diagnostic reports every day based on the scans they perform. I see a benefit in sonographers being able to report autonomously because, in my opinion, the best interpretation of an ultrasound scan can only be given by the person who performed the examination. Having this more streamlined approach would also mean the medical professional previously responsible for signing off on reports would have more time on their hands which could be reassigned to their patients.

What quality assurance measures do you think could be put in place to ensure accurate reporting?

Before we can even start thinking about autonomous sonographer reporting there would need to be a professionwide discussion on the minimum standards of reporting for each study within each subspeciality of ultrasound. Teaching how to report on findings is not offered consistently across the currently running diagnostic medical ultrasound courses in Australia and I think this would be an important element to address going forward if a national standard on reporting is to be achieved.

Sonographer reporting

There would, of course, have to be an audit process if sonographers ended up being the sole signatories of their reports. This could take the shape of an agreed percentage of each sonographer’s reports being audited locally in their place of work by their peers. Conducted in the right way, this sort of activity, performed in a group environment, may also act as a valuable tool for learning. There could also be procedures put in place by professional bodies whereby a predefined number of sonographer reports were audited on a yearly basis, much like CPD activities are now.•

THE SONOGRAPHY

discussions

In my opinion, the best interpretation of an ultrasound scan can only be given by the person who performed the examination.

MATTHEW ADAMS soundeffects news

9

Performance and portability Ultrasound Compact 5000 series

With a Philips Compact Ultrasound System 5000 series, you will never have to trade performance for portability. It allows care from virtually anywhere, delivering premium cart-level image quality in a compact system.

Save time

Uncompromised workflow

when compared to the CX50 ultrasound system

SmartExam workflow protocols

20% faster boot-up and

for exam efficiencies

iSCAN intelligent scanning

for one-button 2D, colour and PW optimisation

AI-powered1 automation tools

33% fewer hard keys

42% reduction in button pushes and

32% reduction in exam time with Philips aBiometry Assist†

One-button push for LV GLS measurements

300% longer battery life with optional battery*

*Compared to the CX50 ultrasound system.

1. According to the definition of AI from the EU High-Level Expert Group.

30% shorter exam time for Focused Assessment with Sonography in Trauma (FAST) †Compared to using the semi-automated aBiometry Assist versus manual operation.

15.6" LCD MaxVue display 10"

adjustable touchscreen

Clinical supervision

THE SONOGRAPHY

discussions

Clinical supervision As a profession, we recognise that clinical supervising is a demanding and often difficult pathway, requiring expertise, leadership skills, and a commitment to the professional growth of sonographers. Supervisors play a crucial role in shaping the next generation of sonographers, providing guidance, mentorship, and practical training in real-world clinical settings. Chris Gilmore FASA, Ultrasound Team Leader, and Louise Worley FASA, Tutor Sonographer, share their experience of clinical supervision and training, address the unique needs and concerns of clinical supervisors, and discuss strategies, best practices, and innovative approaches to supervision.

Chris Gilmore FASA

Ultrasound Team Leader | The Prince Charles Hospital, Brisbane

Chris is a general sonographer who works in Brisbane at the teaching facility at The Prince Charles Hospital (TPCH). In addition to servicing a busy metropolitan emergency and critical care service, TPCH provides a quaternary referral service for cardiothoracic medicine, including heart/lung transplantation, with the facility also providing many other specialist medical services such as gastroenterology, vascular, orthopaedic, geriatric, mental health, endocrine and palliative care. Chris has a broad interest in general ultrasound, including its use in assisting procedures. Chris has been credentialed in PICC insertion procedures and holds a general approval licence to administer local anaesthetics issued by the Queensland Medicine Regulation Unit.

In your experience, do clinical supervisors receive appropriate training?

I would say in general that at the clinical coal-face, a sonographer (clinical supervisor) knows the clinical scan and referrer expectations quite well. In the work-integrated environment, they (clinical supervisors) will be able to impart how they perform the scan to the student. This, however, can be different to how a university teaches the scan. Image series can certainly be different – this creates dissonance. Interestingly, different universities assess competency in different ways – so it is not unusual for clinical supervisors to perform exams with variance. Additionally, only some clinical supervisors have done further training – I think a minority of sonographers have undertaken additional training to be a clinical supervisor. We need to increase this.

Should there be stricter criteria to become a clinical supervisor?

Yes, there should be stricter criteria to become a clinical

supervisor – but there are different facets of where it should be stricter.

Supervision, in my view, is best undertaken by a sonographer (AMS) or a sonologist. An obstetrician who performs a significant number of diagnostic OBGYN ultrasounds can be considered a sonologist, as can a vascular surgeon who performs a considerable number of diagnostic ultrasounds, etc. The key here is ‘considerable number and diagnostic level’.

Sonographers should also attain a minimum standard to be a clinical supervisor – but equally, a student under clinical supervision should only be at a location (site) that can provide a minimum standard of clinical supervision. Ultrasound sits heavily in the clinical examination field, thus a site providing clinical supervision must allow timely intervention by an AMS (working in their field of expertise), such that the AMS can influence the clinical imaging examination – i.e. supervision is onsite and directly accessible to be able to scan the patient in a timely manner. I question remote supervision as not being viable supervision nor best practice. Onsite, both direct and indirect supervision are appropriate to guide a trainee through developing and advanced progress to becoming competent.

How can we better support our trainees in rural and remote settings who have limited access to clinical supervision?

I think the ASA is making progress here – but more is needed. I think the repository of all recorded presentations and webinars should be kept available, on call, to the membership. Beyond this, clinical supervisors need ongoing access to the material their students are using from education providers – so education providers have a role here of necessity. Ultimately, training costs $$$, so we need more investment from all imaging providers (government and private) for training. Let’s not forget that our ‘ologist’ compatriots, through various medical registrar programs, are all paid to get their specialty.

What advice would you give to those looking to step into a clinical supervisor role?

Be involved with both your student and the education provider your student uses i.e. get involved with the education provider feedback loop in as many ways as you can – committees and meetings. This will help you be informed and provide ways for you to influence training.

Look to improve yourself in the way you teach and give feedback – enquire into any learning courses that your student’s education provider has, or ASA. Be a member of the ASA. Be frank with your student in discussions – acknowledge success and use constructive criticism. I have always found that treating students the same as an employee with respect to feedback loops works well – and it will certainly be the best advertisement and exemplar of expectation setting for prospective employees.

11

THE SONOGRAPHY

discussions

Clinical supervision

Louise Worley FASA

Tutor Sonographer | I-Med Victoria North-Eastern Region

Louise is a seasoned presenter having given lectures at many ASA and ASUM local, national and international events as an invited speaker for obstetrics, breast, gynaecology, abdominal, vascular, paediatrics and MSK ultrasound. She was awarded ASA Tutor of the Year in 2013 and ASA Victorian Sonographer of the Year in 2017.

Louise has presented multiple educational webinars and workshops for breast ultrasound and has been a part of the ASA’s Breast Special Interest Group committee. Louise was awarded a Fellowship of the ASA for her contributions to ultrasound, was the recipient of the 2019 Pru Pratten Lifetime Memorial Achievement Award and has recently been bestowed ASA Lifetime Membership.

It takes a lot of time, dedication and patience to be a good clinical supervisor.

LOUISE WORLEY FASA

‘buddy’ with other students and often come into work sites and practise their scans. Tutors can also give short, individual training tutorials and scanning practice, but these are fitted into the day or out of hours. There are also some external private companies that provide ‘start-up’ programs where the students can obtain some practical training and experience in a relaxed environment.

Do you think clinical supervisors receive appropriate training?

The main challenge clinical supervisors currently face is the lack of time to train and the lack of support by management to do this during work hours. Clinical supervisors are often expected to train the students while running their own list with very limited extra time or extended booking times to train or check on students. We need more support and time to prepare, demonstrate, instruct and then review what they have done, plus provide feedback. We require more support from management to prepare and implement educational programs such as tutorials and workshops during work hours.

Unfortunately, mostly it is up to the trainer/supervisor, who often model their training on their own experience. It takes a lot of time, dedication and patience to be a good clinical supervisor. Our supervisors are selected for their demonstrated interest, knowledge and dedication to teaching others. Every student has their own unique learning style and needs, and this must be understood. Each trainer has strengths in certain areas and students are matched with them according to their requirements and stage of development. I think sonography would benefit immensely if there were formal clinical educator courses for sonography.

There are some ‘train the trainer’ courses available for clinical educators at private institutions and some universities, but not many are purely dedicated to ultrasound.

Good training needs to be valued, rewarded and recognised by management as a key pillar of sustainable business success.

What methods do you implement as a tutor sonographer to ensure clinical sites deliver adequate supervision?

Many trainers would also benefit from formal training education, ensuring they have the understanding, skills and knowledge of how best to teach and develop others.

I work in direct consultation with a very understanding ultrasound coordinator who rosters the students to sites with a case load suited to their learning stage. The students are mostly placed at sites with a tutor or dedicated trainers who understand their abilities and learning requirements. The student lists are monitored for their learning needs, and times are crossed off for in-room hands-on teaching when the cases are available. The coordinator and trainers are involved in minuted tutor and trainer planning meetings, so are up to date with their requirements. Each supervisor training site has received updated protocols, educational materials and checklists, which are in addition to the company ultrasound protocols manual, so they are in tune with what we are teaching. I am also always available at any time to answer questions from students or trainers and to help monitor cases as needed. •

What are some of the challenges clinical supervisors currently face?

How can these challenges be overcome?

To work around these challenges, we have taken some training out of hours by running online educational programs. The qualified sonographers are invited to join and many attend. This has the benefit of aligning them with the students learning, plus more education for themselves.

Also, we have implemented weekend workshops where the students have both didactic lectures plus hands-on scanning practice in small groups; organised, minuted planning meetings where the progress and needs of each student is discussed; and trainers continually update the tutor with any immediate student needs and challenges as they occur. These are dealt with promptly and in the best interests of the student. Students are also encouraged to 12

soundeffects news

Clinical supervision

THE SONOGRAPHY

discussions

31 MAY – 2 JUNE 2024

ASA2024SYD CONFERENCE EARLYBIRD REGISTRATION OPENS DECEMBER 4

news 13 THE LARGEST SONOGRAPHY CONFERENCE INsoundeffects THE WORLD

THE SONOGRAPHY

discussions

What does sonography look like in the future?

What does sonography look like in the future?

What will sonography look like in the future? – a question on everyone’s mind as we look ahead to the evolving landscape of sonography. Caterina Watson AFASA is a sessional academic at Edith Cowan University, and she shares her insights on point of care ultrasound (POCUS) and the opportunities and challenges it brings. She also discusses how the changes in technology affect sonography in both rural and metropolitan settings and how AI is impacting the sonography profession. Dr Mark Stieler, Director in Charge of Ultrasound at Exact Radiology Clinics, Queensland, discusses the sonographer’s full scope of practice, the role of general sonographers versus specialised sonographers, and the potential involvement of other allied health professionals in sonographic examinations.

Caterina Watson AFASA Sessional Academic | Edith Cowan University

Caterina Watson is an obstetric and gynaecologic sonographer practising in Western Australia.

She completed her Master of Medical Ultrasound, with distinction, at the University of Herefordshire in England.

Caterina is the current chair of the ASA’s Emerging Technologies Special Interest Group committee and enjoys outreach teaching in the South Pacific nations. Caterina is employed as a sessional academic with Edith Cowan University where she is also enrolled as a PhD candidate.

The project combines her special interests in fetal neurosonography and artificial intelligence.

As a sonographer working in POCUS, what opportunities does it bring?

The main opportunity is sharing knowledge and skills with allied health professionals. POCUS is performed by doctors in the ER and midwives in birthing suites. Teaching POCUS in outreach projects has enriched my clinical experience in terms of wider cultural etiquette and alternative medical practices. One of the Brisbane ASA Conference talks this year was: CQU students in VIETNAM ‘it’s not wrong, it’s different’. Exactly. Learning is a two-way process in POCUS work.

What are some of the challenges, if any?

I think the main challenges in outreach POCUS are equipment based. Machines are usually reconditioned and donated for outreach projects. This is a generous act but it is common to see rooms designated for the ultrasound graveyard. Here, well14

soundeffects news

intentioned equipment has been donated but has failed to keep operational after a short time. The support is not long term and programs for maintenance and infrastructure should be considered when donating ultrasound equipment.

Another equipment challenge would be infection control, particularly with transvaginal probes. In rural & remote locations there is a shortage of probe covers, sterilisation methods, and gloves.

In terms of staff challenges, the end user of POCUS equipment should be correctly tutored in POCUS ultrasound, just as a sonographer is comprehensively trained in ultrasound. This includes the basics of ultrasound physics, instrumentation, and image interpretation. AI should not fill in all the gaps – there is a human in the loop and responsible for diagnostic output. Locally, I would like to see all Australasian POCUS staff regulated under ASAR, just as sonographers are. They should be certified by a recognised institution and required to demonstrate an appropriate CPD portfolio each triennium. This is difficult to implement on a global scale but can be benchmark practice in Australia and New Zealand.

How does POCUS affect how sonographers work in both metropolitan and rural/remote locations?

The target audience for teaching POCUS will change between metropolitan vs remote locations. Metropolitan POCUS training would provide role extension skills to ER clinicians and midwives/nurses. My experience of POCUS for rural/remote locations has been to provide education and training for 4th-year medical students and local sonographers. Local sonographers will have been working for significant periods of time without certified training. Many of them are keen to see how their skills align with Australian practices and they are interested in adopting Australian approaches for ultrasound assessment.

With greater demands on sonographer knowledge, increasing protocols, and decreasing scan time, do you see a benefit to sonographer specialisation, or will the general sonographer still be the mainstay of most departments?

It is in the interest of the patient to keep the general sonographer as the department mainstay. However, both are equally important to serve the healthcare model. Advances in AI will enable the general sonographer to perform more focused scanning techniques and perhaps be directed to achieve more accurate diagnostic images. This, in turn, will reduce scanning errors and improve the quality of patient care.

For the future, I see little change in the ratio of general vs specialised sonographers. They are different players on the same football team.

What does sonography look like in the future?

In what ways do you anticipate AI impacting sonography?

AI is another tool in the diagnostic package. As AI develops in sophistication, I imagine reduced sonographer MSK injury, and greater assistance for examination diagnosis. The future might include robotic scanning and augmented reality equipment operation. Far from replacing the sonographer, I see AI enabling the sonographer to work independently from the radiology clinic hub. Generative AI can also impact our sonography workload and facilitate sonographer autonomy.

This year, radiology conference material includes discussion of ChatGPT and report writing. These same issues are also of interest to the ultrasound community.

How will the current education model and sonographers need to adapt to use AI in the diagnostic medical imaging space?

Medical AI is an area of intense research which continues to impact sonographer working environments. Sonographers should be educated in AI to the same depth of knowledge as radiologists. In both Australia and United States, training radiologists learn about defining the quality of AI data,

THE SONOGRAPHY

discussions

The end user of POCUS equipment should be correctly tutored in POCUS ultrasound, just as a sonographer is comprehensively trained in ultrasound.

CATERINA WATSON AFASA pre-processing & post-processing AI data methods, computer science metrics for algorithm evaluation, and the clinical validation. They can appreciate how generative AI has been used to create synthetic data to test machine learning algorithms. For sonographers, the same impetus exists to understand these technical subjects. Through focused AI education at the tertiary and postgraduate level, higher levels of sonographer engagement with AI can produce more significant research in ultrasound.

soundeffects news

15

THE SONOGRAPHY

discussions

What does sonography look like in the future?

Dr Mark Stieler

Director in Charge of Ultrasound | Exact Radiology Clinics, Queensland

Mark has been heavily involved in musculoskeletal ultrasound for 30 years and in more recent years has been performing a wide range of ultrasound-guided interventions. He is committed to extending his knowledge in sonography and has acquired extensive educational qualifications including a Post-graduate Diploma in Diagnostic Medical Ultrasound, a Master of Applied Science in Medical Ultrasound, a PhD, a Post-graduate Diploma in Cardiac Ultrasound and a Postgraduate Certificate of Ultrasound-Guided Interventions.

Are sonographers currently meeting their full scope of practice?

I think many sonographers are currently able to fully satisfy their professional goals within the current framework.

However, there is still more that we as a profession can accomplish in this regard. There are two main areas where this can occur. The first area is in the performance of ultrasound-guided interventions, particularly steroid injections. The second area is that of sonographer-issued reports. In both areas, as a profession, we need to ensure that only those sonographers with a sufficient level of expertise enter these areas of expanded scope of practice to ensure the highest standards are maintained.

From your perspective, does the role of the general sonographer have longevity?

Given the generally low population density in Australia, there will always be a large number of ‘sole practitioner’ sites where there is no option other than a single sonographer performing the entire range of scans that present to the practice. However, these sonographers must be able to recognise when situations arise that require the attention of someone with more specialised skills and patients must be on-referred when necessary. It is detrimental to the patient, and the sonography profession in general, if a sonographer performs a procedure that is beyond their level of knowledge or expertise.

It is likely the ‘specialist’ sonographers will eventually outnumber the generalists, particularly in major urban areas.

DR MARK STIELE

16

soundeffects news

Do you think sonographers with subspecialties will eventually outweigh general?

The field of sonography has become so large and diverse that it is simply not possible for any sonographer to be an expert in everything. It is both desirable and inevitable that sonographers focus their attention on their fields of interest.

For this reason, it is likely the ‘specialist’ sonographers will eventually outnumber the generalists, particularly in major urban areas.

We are seeing a trend in overseas models where other professions are currently performing modified sonographic examinations. Do you think we should embrace the training of other professions or try to maintain our own professional skills?

There is no single answer to this question! There are numerous situations where the use of diagnostic ultrasound by other health professionals is crucial to patient management (e.g. emergency physicians and anaesthetists). However, there are also many situations where certain health professionals perform ultrasound examinations for purely financial reasons. This will often be done with little or no proper training and at appalling levels of technical and diagnostic proficiency. As a profession, we should certainly be prepared to be actively involved in the training and support of those professionals who require the use of diagnostic ultrasound for the management of their patients, but we should also be prepared to actively oppose the ‘cowboys’ that are pursuing financial gain and have little regard for the diagnostic quality of the scans they perform. •

Protecting the sonographer

THE SONOGRAPHY

discussions

Protecting the sonographer When discussing how best to protect the sonographer, there are two key focus areas: medico-legal issues and professional occupational health and safety. Ian Schroen, ASA President, and Kerry MacManus, Berkley Insurance Australia, share their views on how to promote better and safer practices for sonographers in the future, while also addressing the need to protect their mental health amid burnout and increasing workplace demands.

Kerry McManus Senior Claims Adjuster | Berkley Insurance Australia

Kerry is a legally qualified insurance professional specialising in medical malpractice and professional indemnity, with experience in claims both nationally and internationally.

She started her career in a private litigation practice in Ireland before moving to Australia and taking up a claims role in a niche allied health insurer. Kerry has since moved on to work with a major international insurer where she managed a portfolio of high profile, blue-chip clients, including private hospitals. Her current role at Berkley Insurance Australia sees her managing a varied portfolio, including significant claims for health professionals, lawyers and accountants.

What potential legal risks do sonographers face?

There are many risks sonographers may face, as with any profession, but not all risks automatically result in legal proceedings. Although sonographers generally work under the direction of a radiologist in a clinical or hospital setting and carry out procedures in accordance with a specific referral, they still have an individual responsibility to their patients to carry out their work with due care and skill.

While we can’t provide an exhaustive list of potential exposures, some examples include: • clinical risks, such as errors in imaging, resulting in a missed diagnosis of cancerous lesions, or missed opportunities to identify abnormalities during morphology or obstetric scans • practical risks, such as failing to take appropriate steps to identify fall hazards, resulting in falls from the treatment table • communication risks, such as failing to obtain informed consent before a procedure or examination • information risks arising from breaches of confidentiality.

Building that rapport and communicating openly and effectively can assist in minimising the risk of a claim or complaint.

KERRY MCMANUS Have you noticed any trends in sonographerrelated lawsuits?

The main areas we see activity in are the areas of clinical risks resulting in misdiagnosis or delayed diagnosis, and communication risks relating to informed consent and miscommunication. However, it is important to remember that an allegation does not always result in legal proceedings.

If a circumstance arises that calls into question the integrity, skill or professionalism of the sonographer, regardless of whether it results in a claim, it can be an incredibly worrying and stressful time for that individual and it is important to notify professional insurers without delay.

How can sonographers best protect themselves from being listed in a complaint?

There is no guaranteed way to wholly prevent a claim or complaint being brought, and it all comes down to individual circumstances. There are, however, some ways to potentially mitigate or reduce the chances: One area we see claims or complaints arising is actual or perceived miscommunication. In these circumstances, the rapport that the sonographer builds with the patient is important.

Building that rapport and communicating openly and effectively can assist in minimising the risk of a claim or complaint.

Accurately document communications and actions in sufficient detail so that others can read and understand what was said, what was done and why it is not only a requirement for medical records but can greatly assist if a claim or complaint is made.

Good records can prevent issues arising from a misunderstanding. It is also more difficult to defend something without contemporaneous records.

A more obvious preventive step is to make sure that imaging is as accurate and clear as possible and if there are issues compromising this, for example, body mass, to specifically note the limitations experienced so that the referring doctor is aware of the problem.

Mistakes do happen, and unintentional errors can occur despite best efforts. One way to protect a sonographer in the event they are named as a defendant in legal proceedings is to ensure up-to-date professional indemnity insurance is in place. soundeffects news

17

THE SONOGRAPHY

discussions

Protecting the sonographer

If an individual practitioner has a concern regarding a particular situation, they should seek professional and legal advice as soon as possible and notify their professional indemnity insurers.

Patient consent is a complex issue. What resources would help sonographers navigate a patient consent form/policy?

The primary responsibility for the consent process in relation to the referral rests initially with the referring clinician. A sonographer should give appropriate weight to the referring clinician’s instructions, but sonographers should also keep in mind their own obligations.

A good starting point for sonographers is to become familiar with the employer, clinic, or hospital’s own written protocols and procedures, and ensure these guidelines are always followed during examinations and procedures. If any gaps are found, the sonographer should raise concerns and provide solutions, prioritising patient safety.

The Code of Conduct is a vital resource, as is staying up to date with continuing professional development, knowing the landscape is always evolving.

If available, suitable chaperones can be a really good resource too, providing the sonographer and the patient with a sense of safety and support. It can help minimise the risk of confusion as to consent at the outset of the scan and throughout the scan.

The patient should, however, always consent to the presence of a chaperone and should be comfortable with the selected chaperone.

The offer of a support person during an examination can be useful – for example, a family member, a friend or a legal guardian, someone whom the patient may feel more comfortable with, and/or who can speak up on behalf of the patient, if necessary, and particularly if the sonographer misses a patient’s nonverbal cues.

18

soundeffects news

Ian Schroen

President | Australasian Sonographers Association

Ian’s career to date has been diverse, challenging and centred around ultrasound.

Ian first gained a passion for vascular ultrasound during the 1990s, and after several years in clinical ultrasound, he moved to a corporate role. Well known for his work at Philips Healthcare, Ian returned to clinical ultrasound and completed a Master of Medical Ultrasound, and continues to be engaged in clinical ultrasound, research and teaching opportunities. Ian regularly presents in various forums across a range of clinical and nonclinical topics and is the current president of the Australasian Sonographers Association.

How can sonographers protect themselves against burnout and mental health-related issues?

Sonographers can take several steps to protect themselves against burnout and mental health-related issues, including: • looking after yourself – especially after the stresses of the past few years. Sonographers should prioritise basic healthy habits, such as getting enough sleep, maintaining a balanced diet, and engaging in regular physical activity to improve overall wellbeing • managing your workload – try to maintain a reasonable workload. If you’re feeling overwhelmed, communicate with supervisors or employers. Also, ensure appropriate work/life balance without excessive overtime or on-call commitments • sharing and connecting – connect with colleagues and seek peer support. Sharing experiences and challenges can help reduce feelings of isolation and stress. Don’t hesitate to get

Protecting the sonographer

professional help through your employer’s Employee Assistance Program (EAP) • maintaining learning – stay up to date with sonography changes and advancements through continuing professional development (CPD) programs. Feeling competent in your role can reduce stress and increase job satisfaction.

What is the significance of employers in advocating for, aiding, and upholding a state of positive mental wellbeing among their employees?

Employers play a really important role in advocating for and upholding the positive mental wellbeing of their sonographer employees. They can offer leadership and support through: • mental health support programs – employers can offer mental health programs, workshops, or access to counselling services to support their employees’ mental wellbeing • work/life balance – encourage and support a healthy work/ life balance. Promote flexible work rostering and reasonable workload • communication – foster open communication between management and employees. Encourage employees to voice concerns, and actively listen and respond to their needs • training and education – provide training on stress management, resilience, and mental health awareness. This can help employees recognise signs of burnout and seek help when needed • safe work environment – ensure equipment is in good working order and safety protocols are followed to reduce the risk of work-related injuries • recognition and appreciation – acknowledge and reward employees for their hard work and dedication. Feeling appreciated boosts morale and workplace enjoyment.

Work-related injury is at an all-time high. What can we as a profession do to combat this?

To decrease work-related injuries in the sonography profession, some key initiatives could include: • stretching and injury prevention – incorporating stretching into the daily routine of sonographers is a proactive measure that not only safeguards their physical health but contributes to job longevity and effectiveness in this demanding profession

THE SONOGRAPHY

discussions

Sharing experiences and challenges can help reduce feelings of isolation and stress.

IAN SCHROEN injuries. Mini breaks involve briefly stepping away from the ultrasound machine, changing positions, and performing light stretches or movements • reporting and investigation – encourage reporting of all workplace injuries and near-miss incidents. Investigate the causes and implement corrective measures to prevent future occurrences • education and training – continuously educate sonographers about the potential risks associated with their work and train them on injury prevention techniques.

There is a current trend of scan times decreasing. Where should the line be drawn to avoid professional exhaustion across the industry?

To address the trend of decreasing scan times, and avoid professional exhaustion across the industry, there are a number of strategies employers can implement, including: • setting realistic expectations – employers should set realistic expectations for scan times that prioritise patient safety and image quality over speed • ensuring quality over quantity – emphasise the importance of producing high quality diagnostic images even if it takes slightly longer. Quality should never be sacrificed for speed • ensuring workflow optimisation – invest in technologies and workflow optimisation techniques that can help streamline the scanning process without compromising quality • ensuring regular breaks – encourage sonographers to take regular breaks to rest and recharge during shifts, especially if they have a high workload • protecting staffing levels – ensure adequate staffing levels to distribute the workload evenly and prevent individual sonographers from becoming overwhelmed • introducing feedback mechanisms – establish feedback mechanisms for sonographers to communicate concerns about scan times and workload to management

• ergonomics – promote proper ergonomic practices to reduce the risk of musculoskeletal injuries. Provide ergonomic equipment and training to sonographers

• promoting continuing education – provide opportunities for sonographers to further their education and skills, which can lead to increased efficiency without compromising quality.

• mini breaks – long ultrasound exams can require sonographers to maintain fixed positions and perform repetitive motions for extended periods, which can lead to fatigue, discomfort, and increased risk of musculoskeletal

Balancing efficiency and quality are essential in the field of sonography to ensure both patient care and the wellbeing of sonographers. Employers should prioritise the health and professional satisfaction of their sonographer workforce. • soundeffects news

19

THE SONOGRAPHY

discussions

Information sharing/Social media

Information sharing in the ‘Dr Google’ social media world/Social media and medical professionalism Information sharing in the ‘Dr Google’ world focuses on the challenges faced by healthcare professionals in an increasingly digital world where patients have easy access to both reliable and unreliable information. This influx of information presents a challenge for healthcare professionals, including sonographers, who must navigate the complexities of patient expectations, self-diagnosis, and potential misinformation. Daniel Rae, Head Sonographer at Sunshine Coast Vascular, discusses the role of sonography in the IT landscape and explores how technology can be utilised for educational purposes and the promotion of the profession.

Daniel Rae AFASA Head Sonographer | Sunshine Coast Vascular

Daniel Rae completed his ultrasound training through the University of South Australia and has spent most of his ultrasound career working in Queensland and Western Australia. Daniel has a passion for vascular education with a particular interest in vascular haemodynamics. He presents regularly at a local, national and international level. Daniel was awarded the ASA’s Volunteer of the Year in 2022.

What has been your experience with interacting with patients who consult ‘Dr Google’ before their appointments?

Patients are becoming increasingly informed about the pathologies that are being scanned for and in some instances the ultrasound appearances. It does place added pressure on sonographers performing these scans. For example, colleagues have stated that they have felt the need to take extra pictures during obstetrics scans, as the parents asked ‘Were they sure they were happy?’ making them doubt their interpreting skills.

When patients compare ultrasound experiences with others online, does their heightened knowledge hold sonographers to account? Or does it contribute to increasing misinformation?

We live in a world where patients like to share and compare the experiences they have with medical services. One thing that is missing when these experiences are compared is context. For example, patients don’t always appreciate the skill and patience required to get a baby into the correct 20

soundeffects news

You can make valuable connections within the ultrasound community from all over the world with social media.

DANIEL RAE FASA imaging position or the emotional toll that the previous patient may have taken. If a patient does feel they have had a negative experience, in the past they contact the HR department, but today it seems leaving a negative review on Google is an easier avenue to air grievances. I feel this may not be the fairest of processes.

How do you mitigate the potential stress and worry from patients that may come from misinformation and self-diagnosis?

I like to explain that having an ultrasound scan performed is part of the process of taking the guesswork out of diagnosis.

Although we won’t always be able to confirm what’s causing the patient’s symptoms, we can help make their medical journey less stressful. Our empathic behaviours really do make a difference, as some patients just want someone to listen to them.

In your opinion, how does social media benefit the sonography profession?

I think there are two answers to this question: Firstly, ‘microlearning’ on a more regular basis is one of the ways sonographers are choosing to consume educational content, and social media platforms make this easily accessible.

Secondly, on the social aspect, sonographers can see that others are going through similar struggles and consequently are not alone. You can make valuable connections within the ultrasound community from all over the world with social media.

What can sonographers and patients do to ensure the content they consume on social media is legitimate and accurate?

Sonographers and patients do have to be wary of misinformation or purely opinion-based content. As social media is unregulated, fact checking is an important step for sonographers and patients to take before they act upon information obtained from social media. I do find that most quality educational content creators reference sources within the material that they are producing. •

Reassessing the ultrasound education model and training

THE SONOGRAPHY

discussions

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.

JANE WARDLE 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.

soundeffects news

21

THE SONOGRAPHY

discussions

Reassessing the ultrasound education model and training

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 everincreasing 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.

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

CHRISTOPHER LEWIS 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

Should clinical supervisors be required to have additional qualifications?

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

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

• state health departments

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

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.

22

soundeffects news

• 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.

Career pathways for sonographers

THE SONOGRAPHY

discussions

Career pathways for sonographers The field of diagnostic medical sonography offers various opportunities, diverse career paths and potential growth areas beyond the traditional clinical pathway. Sonographers should feel empowered and confident to make informed decisions about their professional development, and that begins with understanding their career options.

Career options available to sonographers may include further education, nonclinical roles, academia and other alternative employment options, each with its own unique potential. Dr Kerry Thoirs, Research and Standards Manager at Australasian Sonographers Association, shares her experience with further education and research and provides her view on how a career in academia can improve the standing of the sonography profession.

Dr Kerry Thoirs

Research and Standards Manager | Australasian Sonographers Association

Prior to her position as the Research and Standards Manager at the ASA, for over more than 35 years Kerry Thoirs has been involved in clinical practice, teaching in clinical and university settings (University of South Australia), and research. Research interests have included sonographic practice, teaching and professional issues.

What does a day in the life of a researcher or educator look like?

I can only talk from the perspective of when I was employed at a university, with a role that included teaching and research. This type of role is very demanding, but also very rewarding. What I like about academia is the freedom to manage your own time.

Except for scheduled meetings and scheduled teaching times, the rest is up to you when you do what is required of you. It is quite different to clinical work where you need to attend to patient lists that are scheduled for you. Time management can be challenging, but most academics will find a way to manage this. You might find periods where teaching is intensive, and there is not much time to do research, and you might be lucky enough to get some quarantined time to do research so that you can concentrate on that instead of teaching.

How does research improve the standing of the sonography profession?

and skills come from a recognised body of learning derived from research, education and training at a high level. Ongoing research is key as we must not fall into the trap of doing things a particular way because that is the way it has always been done.

In the interests of our patients, we must question what we do, how we do it, and when we do it … nothing is off limits. Every question can be answered by undertaking research, whether that be referring to existing literature (secondary research) or undertaking primary research. If we are not performing research, we are not fulfilling our obligations as a profession collectively, and we cannot claim to be a profession of high standing.

What can organisations and employers do to assist their employees who are wanting to undertake research?

The first step for organisations is to recognise the importance of research and the second step would be to support research in their organisations by quarantining time to undertake research.

What I think would work well would be to have a dedicated position for a ‘research lead’. There is a growing number of sonographers with research degrees and they will not all get positions in academia. What a waste not to utilise this expertise in the clinical setting. I believe that research performed in a clinical setting can have relevant outcomes that translate into better services and patient experiences. A ‘research lead’ could manage research projects and provide mentorship. Benefits include increased funding opportunities, an improved research and workplace culture in the organisation, enhanced research and clinical skill development of staff, and increased professional development opportunities.

What steps would you recommend sonographers take if they are interested in research or education as a career path?

Contact a university or universities. The role of universities is to educate and generate research and train researchers. In relation to education, universities do provide opportunities to ‘try before you buy’. There is often contract work available, which gives you a taste of teaching. And of course, let’s not forget clinical education, which is important. You can explore this in your own workplace and by talking to other clinical educators in other organisations. You might even consider doing a short course on clinical education. In relation to research, universities provide a training ground for researchers via research degrees, such as Master of Research and PhD. These degrees are ‘learning by doing’ and you will be closely supervised by experts in the field.

If you are lucky enough to work in a clinical department where research is undertaken, then you might get a taste of what is involved in research before undertaking a research degree. •

A lot. For a profession to have a high standing it will be recognised by the public as its members having special knowledge and skills, but also, and importantly, that knowledge soundeffects news

23

THE SONOGRAPHY

discussions

The student experience

The student experience As we look to the future of sonography, it is important to reflect on the current educational system and ensure the transition from university to the workplace is seamless. There is no better cohort to speak on the student experience than current sonography students and recent graduates.

Jaimie Feeney and Leah Gordan have unique perspectives on their experience with clinical placement and the transition from being a student to a fully qualified sonographer. Being either amid or have recently completed their studies, the advice they would give to current and aspiring sonography students is most valuable.

Jaimie Feeney

Graduate Diploma Medical Ultrasound/Sonography (Vascular) Student | Western Sydney University

Jaimie Feeney is a current student in the final year of her Diploma of Vascular Sonography at Western Sydney University. Through her work, Jaimie sees a wide range of vascular pathology referred from specialists, including vascular surgeons, orthopaedic surgeons, phlebologists, emergency departments and GPs. She originally started her career in radiography where she worked in several locations such as tertiary hospitals, emergency departments, breast imaging and computed tomography.

What drew you to study sonography?

After developing an interest in physics during high school, I was drawn to sonography due to the autonomy and responsibility of the role. During my career as a radiographer, I developed an interest in vascular pathology through experiences such as vascular imaging in the operating theatre at a tertiary hospital with vast trauma cases, as well as interesting pathologies seen throughout my years working on both trauma and outpatient CT examinations. I was looking for a new challenge when a traineeship position was advertised at my workplace and I was fortunate enough to be the successful applicant.

Have you completed clinical placements? Does the training and work you experience on these placements complement what is being covered in your classes?

My training is through an ongoing workplace traineeship rather than set clinical placements. This traineeship has absolutely complemented what is being covered in my university content. I am very fortunate to have several knowledgeable tutors who each have their own special interests and strengths. This assists in combining the theoretical side of university with the practical side of my scanning. Our tech meetings (where cases are 24

soundeffects news

The variety of pathology I have experienced from working in a regional setting has certainly cemented the learnt knowledge.

JAIMIE FEENEY reviewed and discussed with our vascular surgeons) shed light on the understanding of why and how we do our examinations.

To add to this, the variety of pathology I have experienced from working in a regional setting has certainly cemented the learnt knowledge. Working alongside general sonographers in the same workplace has also enhanced my skills and knowledge from their own specialised experience.

What area of your studies would you like to have more of a focus on?

Paediatrics would be amazing to learn more about.

Unfortunately, this is quite a specialised field in vascular ultrasound as most of our patients are from an older demographic. From what I have heard when talking to other sonographers, it seems that there are different elements that need to be considered when undertaking a paediatric examination.

Are there any extra resources that you use to further your education outside your coursework? What are they and how are they assisting with your development? e.g. listen to podcasts, attend events, read about new research, etc.

I have found the sonography industry to be one that is eager to learn from others from different workplaces, which is fantastic. I have been lucky to have access to a great network of people, not only from my supportive and knowledgeable work colleagues, but also from the Western Sydney University team.

The lecturers and support staff from WSU have been outstanding, not only from a knowledge perspective but also from a supportive and personal aspect. Everyone has been incredibly approachable, and it is obvious how passionate they are about education. The other students in my year have been an invaluable source of knowledge and support, especially given that each of us is at workplaces that have their own specialised interests and techniques. Networking through events such as the ASA’s Student and Early Career Working Group, Special Interest Group Days and seminars have been an important tool for me to extend and challenge my knowledge and opinions.

The student experience

Leah Gordon

Clinical Sonographer | Lumus Imaging, Brisbane

Leah is a general sonographer currently working for Lumus Imaging across several sites in Brisbane, Queensland. She graduated from Central Queensland University at the end of 2022 and is working clinically full-time. Leah was awarded the Clinical Excellence Award from the ASA for her studies in 2022 and has a passion to encourage students to make the most of their studies.

How did you find the transition from student to fully qualified sonographer?

The transition from student to sonographer is an incredibly exciting yet also a daunting stage of your career. Nothing feels as exhilarating as sending away your first abdominal scan without grabbing a senior to check. As students, we are sheltered by our seniors, which gives us a comfortable sense of security.

Once this safety net is pulled back we can feel a bit out of our depth. When encountering those tricky and complex cases, I found that as a student, it was my first reaction to let my seniors take the wheel. Upon reflection, this is the perfect time to do the complete opposite and to have some faith in your abilities. Take

THE SONOGRAPHY

discussions

on these daunting cases and give them your best crack before resorting to a helping hand. Throwing yourself in the deep end as a student will allow you to advance your critical thinking skills and you’ll most likely handle these situations better once solo!

Personally, I have felt comfortable and supported during my transition. When I feel like a case is out of my skill set, I’ll often reach out to some fellow colleagues who will happily lend their thoughts. The transition experience depends heavily on your attitude towards your own abilities and your learning. Being able to self-reflect on your skills while taking the time to research and build your confidence will make all the difference in this phase.

Do you feel your education/degree adequately prepared you for the workforce?

Yes, I personally felt that I had been well equipped with the knowledge, patient care, and scanning experience to prepare me for the leap into clinical life. I completed my studies through the undergraduate program offered at Central Queensland University, Brisbane. Studying was an enjoyable time for me; I loved the challenge of learning the ‘ins and outs’ of the human body while also providing patients with the best clinical outcomes. When it comes to your education, you get out of it what you put into it.

Undergraduate students gain experience in a laboratory environment from the second year, with their first scanning experiences performed on each other under supervision. The laboratory classes introduced an element of confidence, which also removed some of the pressure when scanning for the first soundeffects news

25

THE SONOGRAPHY

discussions

The student experience

Take on these daunting cases and give them your best crack before resorting to a helping hand.

LEAH GORDON time in the workplace. University written examinations also challenged our ability to explain detailed sonographic findings, which is crucial to writing a thorough worksheet. The majority of university tutors also worked clinically and were able to provide insight to shape our expectations of the workplace. This included tips on how to interact with our radiologists and what a typical day in the clinic might look like.

How did you deal with the challenges of being on placement while studying?

As exciting as placement is, it really is a juggle to keep on top of things. Both post and undergraduate students face the same challenge of making the most of their placement and staying afloat with assignments and study. I can personally empathise and relate to students currently in this position. I don’t think anyone has it all worked out. I wish I could tell you that it is possible to maintain both a busy social life and top grades while working full-time for clinical experience. At times you will feel on top of it all but you’re also not alone in feeling overwhelmed.

I found it helpful to review my semester prior to placement, along with scheduling my goals and due dates for upcoming assignments. It’s also a bonus if you can prepare or even begin your assessments early. I promise you will thank yourself later! I was fortunate to have had experience in the medical field prior to my placements, therefore my time management skills were

26

soundeffects news

quite well practised. For those who haven’t had opportunities to practise this, I encourage you to plan your weeks in a calendar/ diary, as it’s super easy to miss a due date among the growing lists of looming assessments. I also want to stress the importance of keeping a balance between your social and study life. After all, you won’t do your best work until you take care of your wellbeing too!

What advice would you give aspiring sonographers and current students?

Being a student is a tricky time; it’s not easy to constantly take in and act on feedback. But the most important advice I could give is to remain open-minded to different techniques and protocols for scanning. I have lived through the days of changing your protocols or altering your worksheet to suit your supervisors’ preferences, so I understand this is easier said than done!

I also encourage you to try some different methods of retaining information to determine what works best for you. Otherwise, you’re sure to forget some tips and facts thrown at you during the day.

Once qualified, it can be difficult to take on new exams or update your skills with supervision. So, I encourage all of you to take on new challenges and use this time to broaden your skill set and to build confidence in your abilities. Make the absolute most of every clinical day because no one is lying when they tell you the placement days fly by! My final piece of advice is to enjoy your studies.

I know first-hand that studying can be a stressful time in your life, but you will make lifelong relationships with both your classmates and your tutors. I look back fondly on my university memories and still catch up and even share cases with my old classmates. Learn and laugh at your mistakes, and don’t take negative feedback or criticism to heart, but rather be grateful that some experts are taking part in shaping your career.•

ASA2024 SYDNEY | 31 MAY – 2 JUNE 2024

Do you have an original research project, case study, new clinical technique, or educational presentation?

Submit an abstract for presentation at the ASA2024 Sydney International Conference.

SUBMIT

Submissions close 14 January 2024

THE SONOGRAPHY

discussions, insights & perspectives ISSUE

soundeffects news is the biannual magazine of the Australasian Sonographers Association (ASA) Ltd. The information in this publication is current when published and is general in nature; it does not constitute professional advice. Any views expressed are those of the author and may not reflect ASA’s views. ASA does not endorse any product or service identified in this publication. You use this information at your sole risk and ASA is not responsible for any errors or for any consequences arising from that use.

Please visit www.sonographers.org for the full version of the ASA’s publication disclaimer.

soundeffectsnews Level 2, 93–95 Queen Street, Melbourne 3000, Victoria, Australia T +61 3 9552 0000 W sonographers.org