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’.
But remember – don’t take a random walk with the probe. Focus your clinical time and treat it as precious. Use the concept of deliberate practice and – instead of trying to complete an entire exam – focus on developing, repeating and fine tuning one thing at a time.
If it’s a FAST scan you’re interested in, don’t start by trying to perform the whole exam in one hit. Deconstruct the exam into smaller parts. Maybe start with the pelvic view, and focus on perfecting your probe moves sweeping through the bladder. Scan, rinse, repeat. Comfortable? Move to the next step.
Limit your scan time to 5 minute increments – this will keep you on task. If you can’t get an image in 5 minutes, chances are spending more time will only result in frustration rather than improvement. Sequence your approach to learning the protocol, and as you reach each stage you’ll build your skills so that your scanning improves exponentially.
Focus your non-clinical time too. Even when you don’t have a probe in hand there are plenty of resources out there that can promote your cognitive development – explore podcasts, blogs, and image libraries. And last but not least, if you have the luxury of having easy access to a mentor, focus your time with them too.
Tip #4: Track your progress over time
A mantra all too familiar in the shoulder padded utopia of the 80s was ‘you only get what you measure’. And while I don’t endorse the hyper-managerial approach – nor the fashion of the time – in the context of learning, the concept of tracking your progress over time has merit. Those who I have seen go on and succeed shared this in common, and their strategies included the following:
· Keeping a logbook. Take note of key details: date, patient presentation, ultrasound findings, confirmatory findings, personal learning points. Take time to reflect on each case, what was unique, how you could improve.
· Seeking independent feedback. Get together with your mentor or an ultrasound education professional regularly to review your imaging. Ask questions: what are you finding easy and why? Are there systematic errors that can easily be corrected? Better to establish good habits than to try and break bad ones.
· Utilising or developing an image series exemplar. Benchmark your images against this and (if possible) refer the images you take to other imaging modalities.
· Celebrating milestones. Were you able to complete an exam on a difficult patient? Did your imaging contribute to a better patient outcome?
Tip #5: Spend time developing skills out of the clinic
Learning on the job might be convenient and offer the simplest solution to getting your hands on ultrasound, but is it the best investment of your time?
While the apprenticeship model remains the norm, this is often not the best way to learn. So instead of struggling alone, or relying on ad-hoc learning moments, take some time to learn outside of your workplace.
Do a course where teaching professionals can work with you to develop skills through repetitive practice, without being compromised by medical and administrative demands. Be kind to yourself, invest your time here and realise quick wins.
The next step is yours
So there you have it – a few top tips condensed from years of talking, listening, teaching and learning. This is by no means an exhaustive list, but if there’s one thing I’d like you to take away is that getting good at ultrasound will take time.
But don’t get frustrated – get going. While there will be many challenges, investing in your personal technology will pay dividends.
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Suean and Michael are Directors of Zedu Ultrasound Training Solutions, an ultrasound education provider based in Melbourne. Zedu was created in 2007, and works with leading medical professionals from around the world to create a fun, focused, and relevant educational experience that ultimately leads to better patient care.
