Abstract
I wish to respond to the guest editorial by Lees and Hinshaw. 1 Their piece has served to fuel the fire of my dismay at the Royal College of Obstetricians and Gynaecologists' (RCOG) decision to present extremely hard-pressed ultrasound departments in district general hospitals (DGH) with their edict to train specialist registrars (SpRs) in first-trimester ultrasound.
There is a recognized shortage of trained sonographers and despite this, departments have had to expand and undertake first-trimester nuchal scans and also many are trying to extend their scanning time for anomaly scans to comply with Fetal Anomaly Screening Programme recommendations. This, alongside waiting list targets, 24-hour turnaround for all inpatient requests, ever more pressure from the radiologists to perform a lot of the ultrasound that they currently perform, and edicts from managers that we have to keep to and reduce budgets.
The final straw to break this particular camel's back was the decision made by the RCOG that we now have to undertake training for SpRs. It is false to say they will support the ultrasound departments because these doctors are at the start of their careers and will move on and be replaced by the same cohort of junior inexperienced SpRs. In our particular trust we do not have a single consultant obstetrician who undertakes ultrasound so have been left to do all the training.
This is with no further funding or support from anybody – just a firm response from the trust that it has to be done otherwise we will lose the trainees.
I am not sure who the Society of Radiographers (SCoR) or British Medical Ultrasound Society (BMUS) consulted with to access feasibility but I know of no ultrasound superintendent who was included in these discussions. I would also like to stress the difference between training institutions and DGHs. Our local training hospital has employed a sonographer to undertake this training.
There is a lot of ‘smoke and mirrors’ in the statement issued by the RCOG. It implies that the trusts will fund and support this training. This is completely false. The trusts are having to cut back in every area and expect people such as myself to ‘manage it’ with the resources we have. Inevitably this means we just comply and squeeze in the training since this is the line of least resistance.
I found the editorial disappointing at best. It contained assumptions that bear no relation to the reality of the front-line DGH. My solution would have been that before this was decided a tariff should have been allocated to each trainee that the department undertaking the training would be paid.
I wonder how the RCOG would react if universities announced that all sonographers had to be trained to deliver at least one baby prior to qualification without asking any of the obstetricians involved at the coal face.
My final comment is that I am very glad to be at this stage of my career because otherwise I might be looking to change direction and I do not say this lightly having been a devoted and enthusiastic sonographer for some 30 years.