Ultrasound clinical teaching capacity in England: A scoping exercise

IntroductionThe United Kingdom has a sonographer shortage. Health Education England are working with stakeholders to address these shortages and increase clinical capacity for sonographer education. The aims of this survey were to ascertain current sonographer staffing levels, estimate staffing requirements in five years’ time and review current clinical placement capacity.MethodsAn on-line survey was used to explore the aims of the study. Questions included current and predicted sonographer staffing requirements and clinical capacity for teaching ultrasound. Free text comments were available for expanding on responses.ResultsOf 72 completed responses the mean sonographer vacancy rate was 2.65 and the predicted number of sonographers needed to provide the service in five years was 4.6. Departments were teaching an average of two sonographers and 2 non-sonographers. A small number of departments had further capacity for sonography student training which was not being utilised for reasons including limited capacity, inadequate staffing levels or competing demands of teaching other health care professionals. Extended working days and weekend training lists were used to increase capacity, along with rolling programmes for teaching sonographers and the use of simulation.ConclusionThe survey supported previous publications that have shown sonographer shortages in England and this is predicted to increase over the next five years. Departments were teaching a similar number of sonographers as other health care professionals. Many experienced competing demands, which challenged their ability to increase clinical capacity.Implications for practiceSuggestions for increasing capacity are provided to help grow the sonography workforce. With the advent of new sonography programmes the departments with spare capacity could be utilised to support clinical practice for sonography students in need of a placement on a direct entry programme.     

Long-Term Impact of Thyroid Biopsy Specialists on Efficiency and Quality of Thyroid Biopsy

ObjectiveTo assess consistency and long-term progress in thyroid biopsy performed by trained sonographers under supervision of a radiologist.MethodsTrained sonographers started performing thyroid biopsy at our institute in August 2011. The data for this study were extracted from a prospectively maintained database for ultrasound guided thyroid biopsy and included the number of thyroid fine needle aspiration biopsy procedures performed between August 2011 and 2016 and the final cytopathology report as per the Bethesda Classification. For the analysis, the study was divided into two time periods: initial postimplementation period (August 2011 to 2013) and late postimplementation period (2014-2016).ResultsIn all, 5,538 thyroid biopsies were performed by trained sonographers in the period, 2,561 in the initial implementation period and 2,977 between 2014 and 2016. The unsatisfactory rates dropped from 21% to 10% in the two periods (P < .001), and the proportion of malignant nodules on cytopathology increased from 6% to 7% in the two periods (P = .010). Wait times for thyroid biopsies remained low during the period.ConclusionSonographers trained to perform ultrasound guided thyroid biopsies provide persistent improved patient care over a long-term period. This reinforces the role of physician extenders in targeted scopes of practice.     

‘Current trends in lower limb Doppler scanning in Ireland’

IntroductionThe clinical need to diagnose and treat above knee deep vein thrombosis (AKDVT) has long been established in literature and in practice. On the other hand, the need to diagnose and treat below knee deep vein thrombosis (BKDVT) continues to be debated in literature. This has resulted in variation in clinical guidelines and protocols nationwide. This research aims to establish if there is a standard practice in Irish ultrasound departments and if so, what that practice is and where sonographers are getting information to inform this.MethodsA questionnaire was designed using SurveyMonkey and distributed using online platforms. The questionnaire aimed to establish the experience of the sonographer, the types of exams performed, protocols/guidelines used as well as scenarios where the sonographer might deviate from protocol.ResultsThe study yielded 90 responses. The research found 49% of sites perform whole leg ultrasound routinely and 46% perform proximal ultrasound only. 41% of respondents said their protocols were based on clinical guidelines however, 22% of participants didn't know what these guidelines were. 49% of respondents were unaware of what treatment a patient would receive in cases where there is a high clinical suspicion of DVT, but the ultrasound is negative for DVT.ConclusionThe research has established a lack of consistency amongst sonographers and scanning practices with a fairly even split (49% of respondents perform whole leg ultrasound and 46% perform proximal only). Not only has the research identified a lack of standardised scanning approach nationwide, but inconsistencies are also seen in the guidelines that inform our department's protocols as well as inconspicuous terms used in radiology reporting and jargon in literature in relation to DVT.Implications for practice1. An inconsistency in practice has been established. Discussions are now needed to decide what guidelines should be implemented into Irish Ultrasound DVT protocols. 2. A national protocol for BKDVT would result in all patients in Ireland having access to the same standard of care. 3. Call for consensus on appropriate training for sonographers undertaking LLDs.     

Ultrasound and Dual-Energy X-Ray Absorptiometry Report Transcription Error Rates and Strategies for Reduction

PurposeRadiologists play an essential role in patient care by providing accurate and timely results. An error-free radiology report is an expectation of both patients and referring physicians. Software is currently available that can eliminate measurement and side types of errors while saving radiologists and sonographers time. The objectives of this study were to evaluate the potential reduction in report errors, estimate the potential time savings associated with implementation, and conduct a cost-benefit analysis of implementing two software programs.MethodsData on the number of measurement errors and side errors in ultrasound and dual-energy x-ray absorptiometry reports were collected, and the time required for data entry that the software would reduce was measured by report type. Generalized estimating equations regression was used to estimate error rates and data entry times and corresponding 95% confidence intervals by report type for radiologists and sonographers. Current wages and report volumes were then applied to the time savings to estimate the annual wage savings. Projected volume increases were applied to the annual estimates to generate a 5-year savings estimate.ResultsOverall, measurement errors occurred in 6% to 28% of ultrasound reports, depending on the report type. Side errors were rare. It was estimated that over 5 years, the software could save $693,777 in radiologist wages and $130,771 in sonographer wages, a total of $824,548 (range, $621,866-$1,039,714).ConclusionsThe use of data integration software would both significantly reduce errors in ultrasound and dual-energy x-ray absorptiometry reports and save a considerable amount of time and money.     

Accuracy of upper abdominal ultrasound examinations by sonographers in Norway

BackgroundNorway educated their first sonographers in 2008. The Norwegian Society of Radiology made a public statement discouraging Norwegian hospital departments of radiology to employ sonographers. Few sonographers work in Norway.PurposeTo investigate the accuracy of sonographers educated in Norway and to assess the quality of their work.Material and method244 patients were included in a prospective controlled study involving five sonographers and four advanced radiologists working in three separately located radiological departments belonging to the same hospital trust. All patients underwent ultrasound examinations by a sonographer and subsequently by an advanced radiologist who assessed the work of the sonographer.ResultsThe sonographers demonstrated a sensitivity of 0.97 and a specificity of 0.93, and there was an agreement of 0.9 (Cohens Kappa test) between the sonographers and the advanced radiologists. 95.1% of the sonographers' main findings were consistent with those of the radiologists. 99.2% of their examinations were found to be “best” or “medium” in the overall evaluation by the advanced radiologists. The advanced radiologists reported to have been mistaken in 3.3% of the cases where they considered the sonographers' results to be correct. If examined by the sonographers alone, pathology would have been undetected in 1.64% of the cases.ConclusionNorwegian sonographers are able to differentiate negative from positive findings in the upper abdomen, and demonstrate accuracies similar to experienced radiologists.     

Evaluation of burnout in physician members of the American Brachytherapy Society

PURPOSETo evaluate the prevalence of burnout among brachytherapy specialists and to identify factors associated with burnout.METHODS AND MATERIALSAn anonymous, online, cross-sectional survey was administered to non-trainee physician members of the American Brachytherapy Society. Burnout was evaluated using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Demographic and practice-specific questions were collected from respondents. Univariate and multivariable analysis of outcomes were performed using probabilistic index models.RESULTSOverall, 51 of 400 physicians responded (13% response rate). Fifty-seven percent of respondents demonstrated at least one symptom of professional burnout. However, only 6% of respondents met strict criteria for high burnout. Analysis of the individual MBI-HSS subdomains demonstrated higher subscale scores for emotional exhaustion and depersonalization, but also higher scores for personal accomplishment. On multivariable analysis after adjusting for increased feelings of burnout due to the COVID-19 pandemic or total hours of work per week, younger age was associated with both increased subscale scores for emotional exhaustion (p = 0.026) and lower personal accomplishment (p = 0.010). Lastly, nearly half of all respondents (47%) reported increased feelings of burnout due to the COVID-19 pandemic. Respondents from academic facilities were significantly more likely to report increased burnout due to COVID-19 compared to those from non-academic facilities (odds ratio, 7.04; 95% CI 1.60–31.0; p = 0.010).CONCLUSIONSNearly 60% of brachytherapists demonstrated symptoms of professional burnout, which is higher than other radiation oncology groups (academic chairs, program directors, residents). Managing stressors related to workload, COVID and support for junior physicians are potential areas for improving feelings of burnout.     

Achieving universal access to obstetric ultrasound in resource constrained settings: A narrative review

ObjectivesThe potential benefits and challenges of achieving universal access to obstetric ultrasound services in resource constrained settings were reviewed, with a view to making some recommendations to address the huge burden of avoidable maternal and child morbidity and mortality.Key findingsIn most resource-poor settings of the world, antenatal ultrasound is available only to a privileged few in urban centres, while the majority of the population living in rural areas have little or no access to diagnostic imaging services. There is also the extreme shortage of sonographers and doctors with specialist training in sonography. A comprehensive regulation must be put in place to achieve maximum benefits and to ensure quality assurance; appropriate use and application of ethics and training must be comprehensive.ConclusionUltrasound service provision, in resource-scarce settings, has the potential to improve access and quality of health care services in areas like the point of care ultrasound service provision and in the fields of obstetrics and gynaecology. A comprehensive regulation must be put in place to achieve maximum benefits and to ensure quality assurance.Implications for practiceMaking ultrasound technology available and affordable in resource scare settings has the potential to improve access to diagnostic imaging services and reduce avoidable maternal and child death in resource constrained settings.     

Is there a role for professional supervision in supporting the professional and personal wellbeing of the sonographic workforce? A literature review

ObjectivesThe sonographer workforce in the UK is under pressure due to chronic staff shortages and increased service demands. The Health and Care Professions Council and the Society of Radiographers both advocate for the use of professional supervision to support wellbeing and development, however the use of professional supervision is not widespread within the sonographer workforce. The aim of this literature review was to explore the evidence around the use of professional supervision and how this could support sonographer wellbeing.Key findingsProfessional supervision was found to be of importance for providing emotional support which can lead to increased job satisfaction, lower levels of burnout and subsequently impact on retention of the workforce. Professional supervision supported personal development and therefore increased quality of patient care, allowing professionals to discuss evidence-based care, policies and practice development through reflection.Whilst important for emotional and professional support, this review found that there are conflicting pressures which can impact the effectiveness of supervision including the supervisory relationship itself and time and organisational pressures. Demands on the workforce made a significant impact on the availability of quality clinical supervision.ConclusionProfessional supervision has an important role in supporting the sonography workforce and enable increased wellbeing and emotional support. There are clear benefits to undertaking professional supervision to support the workforce however there are competing demands which may affect the effectiveness of professional supervision.Implications for practiceThere is limited international research on the use of professional supervision in the radiographer and sonographer workforce. There are clear benefits for supporting professional wellbeing and development under a structured professional supervision framework however within the United Kingdom there is a significant gap in the literature where further research is required.     

Occupational burnout among radiation therapists in Australia: Findings from a mixed methods study

IntroductionEvidence demonstrates that health care professionals in the palliative care context are more burned out than other health professionals. The aims of this study were to examine: (1) occupational burnout levels among radiation therapists in Australia, (2) association between demographic factors on burnout and (3) radiation therapists' perceptions of burnout.MethodsA cross-sectional online survey including the Maslach Burnout Inventory was administered to Radiation Therapists in Australia. Data were analysed using SPSS Ver 20 and open ended comments were analysed thematically using Nvivo 10.ResultsA total of 200 radiation therapists participated in the survey. RTs had a high mean (±SD) burnout score for emotional exhaustion (38.5 ± 8.2), depersonalisation (17.5 ± 4.7) and personal achievement (30.5.3 ± 4.3) compared to RTs and health workers in other studies. High levels of emotional exhaustion, depersonalisation and low levels of personal achievement were present in 93% (186/200), 87% (174/200) and 61% (122/200) of participants respectively. RTs identified high workload and staff shortages, interpersonal conflict and technology as key sources of stress in the RT work environment.ConclusionAustralian RTs' level of burnout on all three stages of burnout exceed previously reported burnout levels for similar cohorts both locally and internationally. It is important that future interventions aimed at minimising or preventing stressors are identified and implemented in the radiation therapy work environment.     

Evaluation of critical thinking application in medical ultrasound practice among sonographers in south-eastern Nigeria

PurposeTo investigate the application of critical thinking (CT) in medical ultrasound by sonographers in south-eastern Nigeria as a measure of the quality of practice.MethodsA semi-structured questionnaire based on six elements of CT was distributed to 82 sonographers selected through a simple random sampling. The questionnaire investigated the application of the elements of interpretation, analysis, evaluation, inference, explanation and self-regulation involved in CT by medical sonographers. The data for each respondent were categorized into age, experience and the elements of CT. Statistical analyses were done using mean and Spearman's Rank correlation.ResultsThe overall mean score of the practitioners on all the elements of CT application was 8.65 ± 6.76 against a total of 60. The application of CT did not show any correlation with age or clinical experience using Spearman's Rank correlation (r = −0.017; p > 0.05 and r = −0.086; p > 0.05, respectively).ConclusionsThe results show that there is poor application of CT by medical sonographers in the locality which may impact negatively on the outcome of this diagnostic process. Increase in the number of formal training programmes in sonography and inclusion of CT skills in the curriculum are recommended.     

Prevalencia y factores de desgaste profesional en radiólogos durante la pandemia COVID-19

BackgroundThe coronavirus 2019 (COVID-19) epidemic spread throughout the world from the beginning of 2020, increasing healthcare professionals’ workloads and levels of physical and emotional stress.AimsTo determine the prevalence of burnout syndrome in Spanish radiologists during the COVID-19 pandemic and the factors associated with the development of this syndrome, and to compare these findings with those obtained before the pandemic.MethodsThis observation study took place between April 2020 and August 2020 (during the pandemic) through an online survey. A total of 150 responses were obtained. Demographic and work-related information was compiled. Burnout syndrome was measured with the Maslach Burnout Inventory Human Services Survey (MBI-HSS). The prevalence and characteristics of burnout syndrome obtained in this survey were compared with those of the same survey done in 2019. We performed a statistical analysis to identify possible risk factors and protective factors associated with this syndrome and to determine the homogeneity of the two samples.ResultsThe prevalence of burnout syndrome increased during the COVID-19 pandemic (49.3% vs. 33.6%, p = 0.002). No risk factors or protective factors that were valid both before and after the pandemic were identified. No correlations were identified between sociodemographic or work-related characteristics and burnout syndrome.ConclusionThis study demonstrates that burnout syndrome increased significantly in radiologists during the COVID-19 pandemic, affecting nearly half of all those who responded to the survey. These results underline the need to assess support for professional wellbeing of radiologists in Spain. No correlations were identified between burnout and gender, age, number of calls, years in the job, annual income, teaching, marital status, number of children, or type of contract.     

Wellness Program Implementation in an Academic Radiology Department: Determination of Need,Organizational Buy-in,and Outcomes

ObjectiveTo implement a multifaceted wellness program in an academic radiology department to prevent burnout and to assess initial outcomes with special focus on the challenges related to the coronavirus disease 2019 (COVID-19) pandemic.MethodsA wellness program was established to address institutional and personal factors of burnout. The program focused on interventions to improve efficiency of practice, provide personal and career support, and create a culture of wellness. The components of the program were designed with input from radiology faculty, and the program was financially supported by the hospital’s physician organization. A survey was performed 6 months after the initiation of the program to determine radiologist engagement and satisfaction. With the onset of the COVID-19 pandemic, a new survey was administered to identify needs of faculty and adjust initiatives. This study was exempt from institutional review board approval.ResultsThe majority of radiologists (79%) agreed or strongly agreed that the wellness program provided opportunities to connect with coworkers. All radiologists agreed that the program was helpful and should be continued. During the COVID-19 pandemic, 49% of physicians requested initiatives focused on well-being, emotional health, and mindfulness to support them during the crisis.ConclusionsThe implementation of a faculty wellness program in an academic radiology department addressed institutional and personal factors of burnout, allowed faculty to connect with coworkers, and was found to be helpful by all radiologists. The COVID-19 pandemic shifted needs to well-being and emotional health initiatives. Follow-up data are necessary to assess its effect on burnout reduction.     

Longitudinal Resilience and Burnout in Radiology Residents

PurposeThe aims of this study were to determine resilience levels of radiology residents at the start of radiology residency, investigate changes in resilience and burnout during residency, and assess the relationship between resilience and burnout among radiology residents.MethodsDiagnostic radiology residents were invited to participate in online surveys from 2016 to 2019. Resilience was assessed using the Connor–Davidson Resilience Scale. Burnout was assessed using the Maslach Burnout Inventory–Human Services Survey. For each data set, genders’ scores were compared using either analysis of variance or Kruskal–Wallis tests. Pearson correlation coefficients were calculated to explore the correlations between resilience and burnout.ResultsWomen and men had no statistically significant difference among baseline resilience scores (P = .78). However, there was a statistically significant overall decrease in resilience scores among women (P = .002). Baseline Maslach Burnout Inventory–Human Services Survey scores indicated that residents began residency without frequent symptoms of burnout. There was no statistically significant temporal change across subjects among burnout scores in any scale (P ≥ .09 for all) or between women and men (P ≥ .37 for all interactions). However, among women, there was a statistically significant difference in depersonalization scores during training (P = .009). Additionally, higher resilience scores were associated with a greater sense of personal achievement (r = .52) and less emotional exhaustion (r = −.56) and depersonalization (r = −.59).ConclusionsThe results of this study demonstrate that gender differences in resilience and burnout occur during radiology residency and that resilience has a protective effect against experiencing symptoms of burnout. Radiology residency programs should consider building longitudinal resilience for all trainees, especially women.     

Exploration of the Relationship Between the Subcomponents of Burnout Throughout Radiology Training

PurposeThe aim of this study was to investigate the relationship between the subcomponents of burnout and year of training among radiology residents.MethodsIn this cross-sectional analysis, the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS [MP]) was distributed to eligible United States (US) radiology residents. Primary outcomes included the MBI-HSS (MP) subcomponents: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Multivariate analysis of variance, tests of between-subjects effects, and Tukey post hoc analysis with 95% confidence interval were conducted.ResultsA total of 770 of 2,823 residents (27.3%) responded, with 488 of 770 completing the MBI-HSS (MP). There was a statistically significant difference in subcomponent scores between cohorts based on year of training (P < .005) and a statistically significant effect between year of training and EE (P < .05) and DP (P < .005), but not PA. Third-year (R3) residents reported a higher frequency of EE than first-year (R1) residents and a higher frequency of DP than R1 and second-year (R2) residents. Fourth-year (R4) residents reported more DP than R1 residents.ConclusionsThis analysis shows variation in burnout subcomponents during training, with the highest recorded EE and DP means and lowest recorded PA means among R3 residents. Although these findings demonstrate evidence of burnout among radiology residents, mean subcomponent scores for EE (21.3) and DP (8.4) were lower and for PA (35.1) was higher for all trainees than in previous studies assessing radiology residents, which correlates with less burnout. DP was the only subcomponent that remained statistically elevated between matriculating R1 and graduating R4 residents.