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A day in the life of a newly qualified sonographer (preceptee)

30 October, 2019

Author: Harriet Rzeskiewicz, BSc Hons Medical Ultrasound, Birmingham City University and Sonographer (preceptee), University Hospitals Birmingham NHS Foundation Trust

Harriet Rzeskiewicz
Harriet Rzeskiewicz

I have completed my undergraduate qualification in medical ultrasound and am now employed full time and undertaking my preceptorship period within a busy tertiary centre department, while attending university to gain my PgCert Medical Ultrasound (Preceptorship). 

According to the university literature, the preceptorship aims to be a transition phase for newly qualified practitioners to develop the skills to become an autonomous professional and to guide the 'transition from novice to expert'.

In addition, Health Education England’s (HEE) proposed new career framework states I would be considered a Practitioner, career level 5, working under the supervision of experienced sonographers with increasing levels of autonomy.

For the first portion of my preceptorship my manager, preceptor and I have agreed that I work in the in-patient department, because I spent the majority of my undergraduate training in outpatients. Later in my training, I will spend more time in outpatients again, building the skills of running my own list, working with an assistant. 

I start at 9am and there are not too many in-patients awaiting scan, with many requiring fasting for this afternoon, so I should be able to scan a few patients this morning without affecting the service.

I spend the first part of the morning vetting requests, checking that they make sense and that ultrasound can answer the questions being asked. I check previous history to exclude any duplicate requests or any that may have been superseded by other imaging tests. I also decide any preparation required. I get these checked by a more experienced member of the team and discuss any changes/queries.

I undertake a renal scan with the clinical indication ‘AKI 3 ?obstruction’. I check and there is no relevant imaging. A colleague observes the scan and agrees there is no hydronephrosis. I note the kidneys are little bright and irregular in contour but normal in size with no focal abnormalities. As the supervising sonographer scans the next patient, I write my report. They make one amendment before verifying and we discuss the importance of reporting the limitations of the scan.

The practitioner role suggests the use of templates at this stage in my post graduate training. However, my trust does not use reporting templates. I have had the advantage of practising free text reporting throughout my undergraduate training and so I am reasonably comfortable with my report style, even if I do reword a few times as I go.

I continue with this set up for the rest of the morning, with varying degrees of assistance, completing scans for: ?biliary sepsis, ?abdominal pathology ?collection post hernia repair, ?cholecystitis. Anytime I or my supervisor feel necessary they re-scan. I am expected to save all the images and write the report whenever possible.

As part of my post qualification PgCert, I am building a professional portfolio. This morning, after scanning the patient with a clinical indication of ?biliary sepsis, I note down to revisit the ultrasound signs of cholangitis and any relevant biochemistry that may accompany it, for my portfolio.

Next I go with a colleague up to the wards to do two portable scans. We decide to do the ‘Day one post kidney transplant’ patient first as the second had an infection risk. On the way we discuss some of the possible difficulties I might find, such as large dressings, post-operative oedema, and what we may do if any family members are present.

On arrival, I am surprised how well the patient looks and that she is alert and chatty. I scan her transplant kidney noting the general appearance (size, echogenicity and contour), and exclude hydronephrosis. The kidney is well perfused throughout and has normal arterial waveforms and RI values at the hilum and peripheral vessels, with no collections identified. On the walk to the next patient we discuss the possible appearances of perinephric collections and how slow acceleration times in the arterial waveforms can be suggestive of arterial stenosis; I make a note to read up more about this later. 

The second patient has had a re-do liver transplant and was sedated on ventilation. This is a stark comparison to the previous patient, but I follow suit and explain everything to the patient just as I would had they been awake. I warn of the cold gel and note some eye movement when contact is made. My supervising sonographer remarks that the liver is a bit patchy in appearance with some hypoechoic areas in the right lobe. The portal vein is patent with high velocity flow (not unusual), and the hepatic veins are patent with normal waveforms.

I really struggle to find the hepatic artery despite optimising my settings and altering my technique. My supervising sonographer couldn’t get it either at the porta hepatis, although she did detect some intermittent arterial flow intra-hepatically. After writing the report, I took the opportunity to contact the referrer and give the results verbally. My preceptor has arranged for me to attend the liver MDT meeting next week as I had identified specific learning goals and planned how to achieve them. Attending some MDT meetings and communicating more with referrers are a couple of my current learning targets. 

We return to the department and I do a gynaecological scan under supervision. A transabdominal and transvaginal ultrasound with clinical indications of ?ovarian pathology?appendicitis. The patient is extremely tender, and I struggle with applying the necessary pressure to get diagnostic results. I will base a reflective piece on this and include it in my portfolio too.

The ultrasound appearances are all normal and I explain to the patient that appendicitis is a clinical diagnosis and the doctor will combine my results with any blood tests. I document on the report that she is particularly tender on the right side.

It’s almost 5pm, so I check my emails and make sure I’ve documented all the scans I’ve completed.

My preceptor is working late today and scanning in another room; I will have to catch up with him tomorrow morning when we’re back to do it all again.

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