British Journal of Radiology (2005) 78, 55-56
© 2005 British Institute of Radiology
doi: 10.1259/bjr/63858589
Training in neonatal cranial ultrasound: a questionnaire survey
P J C Davis, MRCPCH1,
R M Cox, MRCP (Paeds), MA2 and
J Brooks, MRCPCH, MA3
1 University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, 2 Department of Paediatric Oncology, Llandough Hospital, Penlan Road, Llandough, Vale of Glamorgan CF64 2XX and 3 Department of Neonatology, Birmingham Women's Hospital, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK
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Abstract
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A questionnaire was sent to every paediatric specialist registrar in the West Midlands to assess the training of paediatric specialist registrars in neonatal cranial ultrasound. 26% had never carried out supervised scans. 51% lacked confidence in performance and 57% in interpretation of scans. The current pattern of training in neonatal cranial ultrasound lacks structure, supervision and assessment of competency.
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Background
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Neonatal cranial ultrasound is an integral part of neonatal practice. It is used routinely in the investigation of neonates, both pre-term and with neurological pathologies, and plays a significant role in guiding their management [1–3]. Significant decisions regarding continuing or withdrawing care may be based on scan results, which are dependent on both technical performance and interpretation skills.
In the UK, the majority of neonatal cranial ultrasound is performed by consultant neonatologists or middle grade paediatric staff, mainly specialist registrars (SpRs). The SpR grade is attained usually 2–3 years post registration and after successful completion of the membership of the Royal College of Paediatrics and Child Health examinations. There are no formal training guidelines or compulsory training requirements for neonatal cranial ultrasound in the UK [4], although the Royal College of Radiologists (RCR) cite paediatric transcranial ultrasound as a core skill [5] and the British Society of Paediatric Radiologists (BSPR) have a technical standard for neonatal cranial ultrasound scans on their website [6]. Many SpRs move frequently between neonatal units during their training and are therefore exposed to varying practices.
We aimed to assess the current patterns of training of paediatric SpRs in the West Midlands deanery in cranial ultrasound technique and interpretation.
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Design
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A questionnaire was sent to every paediatric SpR (n=96) in the West Midlands region, including a stamped addressed envelope for return. Each trainee would either have completed core training, or currently be undertaking core training, which includes the neonatal attachment of at least 6 months in a level 3 unit. It asked the trainee to estimate how many supervised and unsupervised cranial ultrasound scans they had performed to date. Details of supervised training in performing and interpreting scans were requested. The respondents were also asked to assess their own level of confidence in performing and interpreting scans. In addition, we asked whether trainees were expected to perform urgent scans and whether they had been trained to use the scanner available to them.
A pilot study involving a group of neonatal senior house officers (SHOs) did not result in any modification to the questionnaire.
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Results
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73% of the 96 questionnaires were returned.
Figure 1
shows the number of supervised and unsupervised scans performed by SpRs during their training to date. 26% had never performed any supervised scans, whilst 55% had performed <20 supervised scans. Only 18% had performed >50 scans (whether supervised or not). Those who had performed >50 unsupervised scans may not have performed any scans under supervision.
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Figure 1. (a) Number of scans performed with supervision. (b) Number of scans performed without supervision.
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Figure 2 shows those who supervised the SpRs performing cranial ultrasound scans. Supervision may have been on an ad hoc or weekly basis.
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Figure 2. Who supervised specialist registrars (SpRs) performing scans? A, other SpR; B, consultant neonatologist; C, consultant radiologist; D, radiographer; E, nurse practitioner; F, other.
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Similarly, Figure 3 shows which health professionals supervised the interpretation of the scans. Supervision may have taken place on a one-to-one basis, or during a ward round or clinical meeting.
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Figure 3. Who supervised specialist registrar (SpRs) interpreting scans? A, other SpR; B, consultant neonatologist; C, consultant radiologist; D, radiographer; E, Nurse practitioner; F, other.
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Figure 4 demonstrates the respondents' levels of confidence in performing and interpreting scans. 51% felt unsure or not at all confident in performing scans, whilst 57% felt unsure or not at all confident in interpreting scans. These data represent the respondents' own interpretation of their skills and not their competence, which this study did not assess.
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Figure 4. Specialist registrars' level of confidence in cranial ultrasound scanning. A, not at all confident; B, unsure; C, adequate; D, completely confident.
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Discussion
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Our survey showed that the current pattern of training in neonatal cranial ultrasound in the West Midlands lacks both structure and adequate supervision. Many SpRs are supervised by other trainees. This is reflected in trainees' level of confidence. In addition, there is currently no measure of competency in this field, although the BSPR technical standard suggests a minimum requirement of attendance at a theoretical course plus scanning under direct supervision of a competent sonographer until competent to scan independently [6]. Despite this, trainees are expected to perform and interpret cranial ultrasound scans even during their core training. As Reynolds et al comment, "it [performing cerebral ultrasound] appears to be a skill hastily acquired once the newly appointed specialist registrar starts his/her neonatal placement" [4].
We suggest that consideration is given to the development of formal training to those who are expected to acquire and interpret scans, along with appropriate assessment of competency in this skill. The RCR are expected to issue guidance of requirements for training in the near future.
Received for publication April 26, 2004.
Revision received August 27, 2004.
Accepted for publication September 20, 2004.
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References
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- Pape KE, Blackwell RJ, Cusick G, Sherwood A, Houang MTW, Thorburn RJ, et al. Ultrasound detection of brain damage in preterm infants. Lancet 1979;1:1261–4.[CrossRef][Medline]
- Levene MI, Wigglesworth JS, Dubowitz V. Cerebral structure and intraventricular haemorrhage in the neonate: a real-time ultrasound study. Arch Dis Child 1981;56:416–24.[Abstract]
- Mercuri E, Dubowitz L, Paterson Brown S, Cowan F. Incidence of cranial ultrasound abnormalities in apparently well neonates on a postnatal ward: correlation with antenatal and perinatal factors and neurological status. Arch Dis Child Neonatal Ed 1998;79:F185–9.
- Reynolds PE, Dale RC, Cowan FM. Neonatal cranial ultrasound interpretation: a clinical audit. Arch Dis Child Neonatal Ed 2001;84:F92–5.
- Core training: core skills in Paediatrics. Structured Training in Clinical Radiology (3rd edn). London: Royal College of Radiologists, 2001. www.rcr.ac.uk
- Technical standard: Neonatal Cranial Ultrasound Scans. www.bspr.org.uk
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Abstract
Background
