Who should perform the ultrasound examinations in gynaecology?

Abstract

Key content This review debates the merits of who should perform the ultrasound examinations in gynaecology. In favour of clinicians (gynaecologists): Gynaecologists, with a captive population, have a vested interest in learning ultrasound examination of the pelvis. Basic ultrasound has been embedded in the core RCOG curriculum and the new RCOG training module in gynaecology has been launched. With the ideals of ‘point‐of‐care’ investigation and ‘one stop’ assessment, future service delivery in gynaecological ultrasound could rely largely on gynaecologists. In favour of radiology staff (radiologists and sonographers): Gynaecological ultrasound is more than an adjunct to bimanual examination. There is a concern that relocation of ultrasound into gynaecology clinics and wards may lead to the loss of the systematic approach seen in radiology departments, which covers patient safety, maintenance of equipment, reporting and archiving. If radiologists are disenfranchised then the risk is loss of specialist radiology support when a vaginal scan does not give all the answers. Learning objectives To be aware of training programmes in gynaecological ultrasound. To be familiar with appropriate methods of record keeping in ultrasound examination. To understand quality assurance in delivery of an ultrasound service. To understand the complementary nature of both a vaginal and a transabdominal pelvic ultrasound scan. Ethical issues Operators in gynaecological ultrasound should be appropriately trained, adequately resourced and should work within their level of competence.

Understanding the Dreyfus model of skill acquisition to improve ultrasound training for obstetrics and gynaecology trainees

“…Obstetricians and Gynaecologists (RCOG) curriculum involved major changes to ultrasound training for trainees. 1 Prior to these changes, basic ultrasound would be 'informally' acquired during training and those wishing to obtain formal qualification in more advanced skills could undertake a diploma from the RCOG. With the introduction of the new curriculum came an expectation that all trainees should be able to scan to a basic level, with optional intermediate modules for those wishing to undertake further training.…”

“…Caesarean section) with progress assessed by a competency-based logbook and work-based assessments. 1 Unfortunately, this has led to ultrasound training becoming one of the most contentious areas of the curriculum. There is often little time in busy rotas to set aside for regular protected scanning sessions.…”

Is bedside ultrasound now a routine part of specialist obstetrics and gynaecology outpatient consultation?

“…The clinician should have already formulated a differential diagnosis based on the patient's symptoms and be able to tell or show the woman what is found during the examination. " 1 The potential adverse consequence of such a fundamental change in practice is that medical imaging specialists may become 'disenfranchised' with future radiologists having little incentive to maintain an interest in pelvic gynaecological imaging. Such an outcome might result in, "loss of any specialist radiology support when a vaginal scan does not give all the answers. "…”

“…Such an outcome might result in, "loss of any specialist radiology support when a vaginal scan does not give all the answers. " 1 In view of the evident enthusiasm of specialist obstetricians and gynaecologists for imaging as an extension of clinical examination, and the potential for improved convenience and economic benefits for patients, it seems vital that continued detailed surveillance of practice and referral patterns in gynaecological imaging is maintained.…”

“…There is anecdotal evidence that ultrasound is increasingly common in routine outpatient gynaecological practice, with authors commenting that, "an ultrasound machine is as vital a piece of equipment in routine or emergency gynaecological assessment as the…speculum." 1 This suggests that ultrasound examination may almost be an extension of routine gynaecological examination. There is an established literature regarding the use of ultrasound in Emergency Departments, for assessment of bladder volume after gynaecological surgery, and even as part of obstetric anaesthetic services.…”