Re: Who should perform the ultrasound examinations in gynaecology?


Dear Sir

We would like to thank Dr Roberts and Dr Hughes for bringing the debate over who should perform ultrasound in gynaecology to a wider audience. Their article[1] presents a convincing argument for a one stop model of care. This model would allow patients to be seen, scanned and managed appropriately in one appointment with a gynaecologist. This has benefits for the service in increased efficiency and capacity as well as the service users reducing the number of appointments and the associated inconvenience. If this is to be the future of gynaecological services, bringing the UK in line with other European countries, then we have to ensure rather than question the standard of that service.

The key to ensuring quality standards are set and maintained is a robust method of training and revalidation. As stated in the article, previously gynaecologists were self-trained in ultrasound; however, this is no longer acceptable. The Royal College of Obstetricians and Gynaecologists recognise the importance of formal ultrasound training and ultrasound has become embedded into the curriculum; however there are barriers to delivering this training. Ultrasound in gynaecology often requires a transvaginal scan. This is an intimate and invasive examination which may not be acceptable to women in the hands of a novice operator. With a national shortage of trained radiologists and sonographers with an interest in gynaecology, departments are often working at full capacity to meet service demand and struggle to take on the additional workload of training. Due to service commitments and a reduction in working hours trainees struggle to find the time and opportunity to learn.

We would like to draw your attention to simulation as a training modality, not mentioned in your review, which could provide a solution to some of the barriers to training. Simulation offers a less pressured learning environment, allowing the trainee to focus on and develop the technical skills of ultrasound away from a clinical setting. Using a system such as the Medaphor® allows trainees to undertake self-directed learning. The experience within our deanery is that a session with a trainer at the beginning of the training is sufficient to set the trainee on the correct path. Once the trainee has reached the required competencies using the haptic simulator then the training can be completed within the clinical setting. The advantage of this approach is that trainees can be up-skilled to a certain level before they train on real patients. This minimises the impact on ultrasound lists and should, hopefully, result in trained sonographers (whatever their background) with less disruption to ultrasound departments. Our hypothesis has formed the basis of a study that we are about to begin, which will explore the validity of our suggestions.