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Support of ARDMS Prerequisite #2From: Terry J. DuBose (duboseterryj@uams.edu)Thu Nov 13 09:56:45 2003
Folks, changes in sonographic education continue. Right now, the ARDMS is reevaluating which accrediting agencies should be recognized for programmatic accreditation in sonography. Some agencies do not evaluate sonographic specific education activities, but only look at administrative, financial, and student records. The JRC-DMS/CAAHEP programmatic accreditation is the only one, at this time, that actually looks at the integration of lecture courses and clinical education. I hope you agree, if not, please disregard this long message. The ARDMS currently is accepting public comments on what accreditations should be used. Of course, I think that the programmatic accreditation, which has been the only one accepted for the last 30 years (JRC-DMS/CAAHEP) should remain the gold standard. Everyone should look at the call for public comment and write a letter to the ARDMS in support of Prerequisite #2 … if not then those unaccredited programs that do not require real medical clinical rotations may end up getting recognized. Please make your colleagues & educators aware of this. Here is the Web site for the call for Public Comment: http://www.ardms.org/ardms/ARDMSCommentDocument.pdf For those outside America, you may be interested to know that the ARDMS is currently considering offering certifying examinations globally, so this may also have some effect on you. What follows are my comments. This should not be copied as a comment letter, but is to help everyone understand the points at issue. Thanks, Terry QUESTION #1: Before an agency is listed or added by ARDMS to Prerequisite 2, should the accrediting agency be required to demonstrate, as an initial matter, that it has received or presently receives programmatic recognition for the scope of diagnostic medical sonography/ diagnostic cardiac sonography/vascular technology programs (in contrast to "institutional" or general "allied health" scope) from the U.S. Department of Education or otherwise for a U.S. agency, or from the Canadian government or recognition agency for a Canadian agency? CAAHEP, which is listed in Prerequisite 2, was granted programmatic recognition in some areas by the U.S. Department of Education. CAAHEP also has had extensive accreditation experience in diagnostic medical sonography/ diagnostic cardiac sonography/vascular technology programs. Following recognition, however, CAAHEP did not renew its application and is not now recognized by the U.S. Department of Education, but has other recognition, for programmatic diagnostic medical sonography/ diagnostic cardiac sonography/vascular technology programs. Question #1 comment: A profession must involve several different levels of validation; including programmatic accreditation process, educational programs themselves, and individual certifications. Each level needs to be held to some independent standard to assure the best outcomes from sonography and the best possible health care for the public. Historically, medicine has required peer review, oversight, and validation for journal publication, hospital, laboratory, and programmatic accreditations, and individual certifications. Each process is independent from the others, which keeps the system honest. While peer review is not a perfect system, it has come to us through history, and appears to be the best way of assuring quality at all levels. This system is probably best served by having each area separate and independent from the others. In the case of sonography, journals obtain their own peer review before publication, the JRC-DMS/CAAHEP validates programmatic accreditations for DMS education, various organizations perform laboratory accreditations, JCAHO accredits hospitals, and the ARDMS certifies individual sonographers. The JRC-DMS, while using outcomes as a part of accreditation, does not accredit the certifying body of the ARDMS, nor should the ARDMS become the accrediting or validating body for programmatic accreditation. Keeping each level of the profession independent helps to assure a minimum of “cronyism” or the development of an “old boy and girl” network. While institutional, general allied health, and U.S., Dept of Education accreditations are important for certain funding, student loans, and other administrative issues, they do not review the specific clinical educational activities of sonography students; and as such, this type of recognition or accreditation, while important, has little to do with the specific didactic and clinical education of sonographers. This is an important issue because sonography is the most operator dependent diagnostic modality in modern medicine. The cognitive knowledge, psychomotor skills, and independent judgment required in sonography are extraordinary; and the psychomotor scanning skills are extremely difficult to assess using a written examination. For this reason the programmatic accreditation and the educational programs become the “gatekeepers” for verifying the scanning skills of the programs’ graduates. Any accrediting body should be required to show how they will document that the programs accredited are assuring that the students are receiving a valid clinical education of sufficient length and variety of cases, including pathology, and assessing the graduates’ psychomotor scanning skills. QUESTION #2: Please provide any comments you may have concerning initial recognition and, if any, subsequent recognition of a U.S. agency for the scope of programmatic diagnostic medical sonography/diagnostic cardiac sonography/ vascular technology by the U. S. Department of Education or otherwise, and the benefits of experience in programmatic accreditation of diagnostic medical sonography/diagnostic cardiac sonography/vascular technology programs? The ARDMS Certification Committee considers instructional standards important to the quality and relevance of education and training. Question #2 comment: The primary consideration of programmatic sonographic education is the integration of didactic and appropriate clinical education of adequate length and varity. If the programmatic accreditation process does not assure that the students get adequate “transducer” time, then they can not assure the graduates have the psychomotor scanning skills required. This is best evaluated in site-visits by experienced sonographers who understand the requirements of the profession. The clinical education needs to be long enough to provide the required experience, and the clinical sites should have adequate case loads and varieties of examination types to assure the graduates have a broad education for the specialties they are studying and ARDMS examinations for which they are preparing. The JRC-DMS has long required that major clinical education centers in the General Concentration (ABD, OB/GYN, and P&I) should have a minimum of 1500 cases per year, with at least 30% of those being OB/GYN. The students are not required to participate in all 1500, but that number per year insures adequate exposure during the time they are in clinic. The currently recommended program length for the General Concentration is 18 months, with an additional 6 months for each added specialty. Using the ARDMS Prerequisite #1 as a guideline, it appears that programmatically accredited education should require at least 1680 contact hours of education, the majority of which should be clinical, and probably more since Prerequisite #1 has been in place a number of years and the sonographic body of knowledge and instrumentation has greatly expanded. Accredited DMS specific programs (under Prerequisite #2) should be expected to require at least as much, if not more, sonographic education than Prerequisite #1. Given the current body of knowledge that must be covered, it is time to require a minimum of 1680 clinical hours (probably more now days) with the didactic education being in addition to the clinical education. Accredited programs should integrate the didactic and clinical education for the best learning experiences. It is almost impossible learn sonography by simply reading and studying from a book without the clinical scanning skills being integrated throughout the program. It can be compared to learning to swim by only reading a book… one must get in the water to learn to swim… waiting until the boat is sinking to try swimming would not be wise. QUESTION #3: What should an accrediting agency require of a program to demonstrate concerning the process by which its instructional standards are developed and their quality and relevance to the current, on-the-job work of diagnostic medical /diagnostic cardiac sonographer/ vascular technologists before listing or addition by ARDMS? The ARDMS Certification Committee believes there is considerable value in the integration of classroom coursework with the clinical experience component. Question #3 comment: The programmatic accrediting body should require the DMS programs to demonstrate the processes which are required by institutional accreditation. These include the administration, admissions, financial support, record keeping and other administrative educational tasks. In addition DMS programs should demonstrate the time and variety of cases in which the students are exposed in clinic. They should be able to show that the sequencing of clinical experiences is integrated and supportive of the didactic education. Using the ARDMS Prerequisite #1 as a guideline, it appears that programmatically accredited education should require at least 1680 hours of education, the majority of which should be clinical, and probably more since Prerequisite #1 has been in place a number of years and the sonographic body of knowledge and instrumentation has greatly expanded. Accredited DMS programs should be expected to require at least as much, if not more, sonographic education than Prerequisite #1. Given the current body of knowledge that must be covered, it is time to require a minimum of 1680 clinical hours, with the didactic education being in addition to the clinical education. Even this may need to be expanded to a full two years given the complexity of modern sonography, but it certainly should not be reduced; and may need to be a four year Bachelor’s degree to be adequate. QUESTION #4: Before an agency is listed or added by ARDMS to Prerequisite 2, should the agency or agencies listed or added by ARDMS demonstrate the following: a) systematic evaluation of student educational experience including competency assessment; b) regular instructional feedback to students; c) an established set of standards for clinical instructors and supervisors; d) regular evaluation of each clinical site including, but not limited to, assessing its value in providing a worthwhile educational experience; and e) an adequate instructor/clinical site ratio to properly implement the program curriculum? Question #4 comment: The simple answer to the above is yes, yes, yes, yes, YES! Specifically, the following is offered: a) Students should be tested and assessed for progress in the program and competencies specific to the sonographic specialties they are studying. b) “regular instructional feedback to students” concerning their progress is a normal part of any valid educational experience. Students will not know what to do to improve if they are not given feedback and guidance. c) Clinical instructors should be certified by the ARDMS in the specialties that they are teaching. This IS an educational prerequisite (#2) to sit for the ARDMS examinations, and the Clinical Instructor should hold the same credential or higher. Bachelor of Science DMS programs require the faculty to have a Bachelor’s degree or higher, where as a two year Associate Degree program may only require the faculty to have an Associate’s degree. The ARDMS should expect no less of the faculty preparing students for the ARDMS examinations. d) Regular evaluation of the clinical sites should be conducted, to include student evaluations of the clinical instruction upon completion of their rotation(s) at each clinical education site. The clinical site should be evaluated for the case volume and variety in order to provide adequate clinical experiences to the student(s), as well as the effectiveness of the clinical faculty. e) Because sonography is very operator dependent the student/clinical instructor ratio should be 1:1. This has long been an expectation of the JRC-DMS and to have more than one student with a clinical instructor will lower the quality of the instruction. Some students will be more aggressive and others more retiring; their experiences may become competitive and will not result in the best education. QUESTION #5. In addition to the issues noted above, are there any revisions to the current language of Prerequisite 2 you would recommend? Are there circumstances under which you believe an agency, once listed by ARDMS now or in the future, should not continue to be listed by ARDMS? Are there other factors you feel ARDMS should consider during this review process? Question #5 comment: The primary consideration of any Prerequisites for the ARDMS examinations should be the end result on the health care of the public and the quality of sonography provided by ARDMS certified sonographers. A determination of how long or how quickly one can learn entry level skills required of a modern sonographer will need to be made. The bodies of knowledge and instrumentation have expanded greatly since these prerequisites were implemented, and they need to be expanded to allow adequate time and clinical settings in which to learn the required academic subjects and clinical skills. The experience of the JRC-DMS has been that the General Concentration of ABD and OB/GYN plus the requisite Physics and Instrumentation should be at least 18 months, though there are still some older programs that require only 12 months. This may be inadequate considering the rapid growth of sonography in the last few years. Two full years may be the minimum for adequate sonographic education at this time. Once an accrediting agency is recognized by the ARDMS, they should be expected to maintain the same or a higher level of educational excellence. If they do not maintain that level of education, then their recognition by the ARDMS should be removed.
-- Terry J. DuBose, M.S., RDMS, FSDMS, FAIUM Assistant Professor & Director, Diagnostic Medical Sonography Program University of Arkansas for Medical Sciences, CHRP 4301 West Markham St. Mail Slot #563 Little Rock, Arkansas, 72205 USA 501-686-6510 DuBoseTerryJ@UAMS.edu http://www.io.com/~dubose/ http://www.uams.edu/chrp/dms/default.asp http://www.obgyn.net/us/panel/panel.htm
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