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What’s the best ultrasound technology to invest in over time? It’s you!

Suean Pascoe

FAIUM, GradCert Clinical Teaching, B.App.Sc (MRT), GradDip MedUS

Founding Director, Zedu Ultrasound Training Solutions

Michael Duncan

PhD, MCom (Hons), Dip Mgmt, BA

Director, Zedu Ultrasound Training Solutions

Utter the word ultrasound and the first thing that comes to mind (after babies) is often the cutting edge technology. Wireless, clarity, touch screens, Doppler, measurements – a bedazzling array of bells and whistles that inspires the gadget geek in many.

While the temptation to focus on the electronic wizardry is alluring, what is more often than not forgotten is the person that operates the system – the human technology.

technology /tɛkˈnɒlədʒi/ | noun | the application of scientific knowledge for practical purposes

For no matter how advanced an ultrasound system is, its utility and clinical relevance is determined by how confident you are as a user to employ the technology, and integrate it into your clinical life. And such confidence only comes with time, experience and knowledge.

Yet if there’s one question I can guarantee that I get asked at the end of each course, it’s this:

‘Without a mentor, without the time, without the access to a system how can I get competent?’

In my travels I’ve found these issues and concerns to be universal – no matter the specialty, no matter the country. And many decry that – given the challenges – they’ll never be as good as Dr X, or as confident as Dr Y. However what’s also true is that the very same individuals that are recognised as ultrasound leaders today also faced those exact challenges but, despite the hurdles, somehow overcame them.

“The key is in not spending time, but in investing it.” – Stephen R. Covey

While not one to pay attention to ‘management guru’ literature found in airport bookstores – or these days in Insta-memes – the late Stephen Covey of The 7 Habits of Highly Effective People fame nailed it when he talks of investing time.

Learning ultrasound is simply not about spending time doing it, it’s about deliberately investing your time in developing your skills.

And having talked to ultrasound leaders around the world and taught many who have gone on to successfully negotiate the challenges of learning ultrasound on the job, it’s the management of time and committing to deliberate practice that in my view is the key to developing ultrasound confidence.

So when I chat with anyone facing challenges or doubting their own ability to ever confidently scan, I rest on the lessons learned through time to develop my own 5 Top Tips for Learning Ultrasound.

Tip #1: Commit to invest your time before you start

Before starting down the path of your own ultrasound learning journey ask yourself this.

Can I commit to at least 20 hours of practice over the next four months? Can I spend 15 uninterrupted minutes each working day over the next 16 weeks solely focused on scanning?

Can you rearrange your work day to accommodate this, not forgetting the additional time you may need to negotiate access to willing patients in day stay, or organise getting an ultrasound system; 15 minutes scanning may require an hour of work to arrange. And in the space of a normal shift, don’t try and do 15 minutes all at once. 5 minute increments are fine, and a realistic target in a busy department. Get your hands on the probe, repeat a process until you nail it.

And while a 20 hour commitment doesn’t sound much, if focused and deliberate it is plenty of time to perform 40 to 50 exams in a specific application. This represents more than enough time to see significant improvements and gain the confidence and ability for independent practice.

So while it’s commonly accepted that 10,000 hours will result in mastery (equivalent to maintaining a full time job for 5 years), it’s important to recognise this isn’t always the goal. Just as we all can’t be Roger Federer, we may well be able to hold our own hitting out as a journeyman on the local courts. Remember, perfect is the enemy of good.

If you can commit to investing your time in a managed way, then you have what it takes to start the learning journey. Write this goal down, diarise your time and book your first course – you’re ready to go.

Tip #2: Take time to remove practice barriers

Despite the best of intentions, it’s inevitable that obstacles to learning ultrasound will present themselves. Be prepared – you may need a sledgehammer.

Barriers will take many forms so anticipating these and taking steps to proactively tackle them will make your learning journey much smoother. These include:

· Machine availability – gaining access to a system can be an issue. Is there a system in your department? Can you reliably use a system in your department to learn on? Will clinical demands prevent uninterrupted ultrasound time? Can you use your own non-clinical time to come in ‘after hours’ and scan? Are there rules that may prevent you getting your hands on a system? Can you afford your own personal system and – if so – will your employer allow you to use this at work for educational purposes?

· Inter/Departmental support – ensuring there is internal support for your learning is essential. Before you hit the floor probe in hand, try and get a sense of how ultrasound works at your place, and what you may have to put in place to manage your own learning. Do your colleagues have the experience and motivation to mentor you, or have they had a negative experience with ultrasound? Do they see value in you investing your time, or regard it as a nice to have skill that ultimately prevents you from doing your job? Can you rely on support from radiology? Are there rules in place that may prevent you from handling a probe?

· Patient access – learning ultrasound requires people willing to help you use their bodies for science. More often than not, patients love the attention (or distraction) that someone scanning them provides. What form of consent will you need to gain before you scan? Will this have to be documented? Can you go beyond your own department to scan? Will you be able to scan in your own non-rostered time?

At the end of the day, you’ll have to make sure you take the time to lay the groundwork, communicate and negotiate to remove – or at least minimise – barriers to practice. Get together with others to brainstorm solutions – it will make your life easier, and others will thank you for making theirs easier too.

Tip #3: Focus your time

When exploring something new – whether a new city, a new language or even a new partner –novelty and excitement can overwhelm. You can easily get lost, confused and later look back wistfully feeling like you could have done better.

The same is true when learning ultrasound.

And as ultrasound seems conceptually simple – probe + gel + patient = diagnosis – it’s all too easy to forget that the equation is far more complex than this. Ultrasound is a complex psychomotor skill in its own right – so to get good you need to find your focus. Finding your focus means you will not only save time, but also realise and recognise your own development which will go a long way to keeping up your motivation.

So focus on learning and developing ultrasound skills that complement what you see during your day-to-day clinical life. This removes the psychological hurdle of having to ‘add’ ultrasound to your examination process, and provides additional opportunities to develop your skills ‘incidentally’.