April 2004 | Vol. 22/No. 4

SVU Submits Comments to ARDMS on Prerequisite 2

In October 2003 the American Registry of Diagnostic Medical Sonographers (ARDMS) requested comments from the sonography profession, including educators and related societies such as SVU, on one of the ARDMS eligibility pathways, Prerequisite 2. The ARDMS Certification Committee has been conducting a review of Prerequisite 2, and is preparing a recommendation to the ARDMS Board of Directors. The ARDMS Certification Committee is evaluating whether this prerequisite should be retained in its current form or, if revised, what accrediting agency or agencies and their characteristics, and what reasonable, objective factors describing quality diagnostic medical sonography/diagnostic cardiac sonography/vascular technology education programs, should be listed in Prerequisite 2. Deadline for submitting comments to ARDMS on Prerequisite 2 was March 31, 2004 .

Following are SVU’s official comments on Prerequisite 2 that were submitted to ARDMS.

ARDMS 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?

SVU COMMENT: Any accrediting body should first be recognized by the United States Department of Education (USDE), or the Council for Higher Education Accreditation (CHEA); or, in the case of the Canadians, the Canadian Medical Association (CMA). This recognition requires accountability and helps ensure the quality of these accrediting bodies.

Although there are programs that have institutional accreditation, SVU believes that institutional accreditation alone does not assess the quality of a specific program. Instead, institutional accreditation assesses more the financial, operational, and administrative viability of an institution. Therefore, SVU believes that sonography/vascular technology/echocardiography programs should also be required, under Prerequisite 2, to have programmatic accreditation through either the JRC-DMS or the JRC-CVT. This accreditation helps assure that a program will teach educational courses specific to sonography/vascular technology/echocardiography, will assess outcomes of the program, and require a set number of clinical hours for the student.

Programmatic accreditation, which is overseen by professionals in the field of ultrasound/vascular technology/echocardiography, is extremely important to assure the student that they are receiving appropriate courses in the didactic portion of their education, and a number of clinical hours that will allow them to be competent at the completion of their education. Although peer review is not perfect, it does guarantee that the content of a program is current and appropriate to what is required by the profession as a whole. This type of oversight can only be accomplished through a programmatic accrediting agency, not institutional accreditation. In the long run, programmatic accreditation will hopefully have a positive impact on patient care.

ARDMS 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?

SVU COMMENT: As stated in Question #1, any programmatic accrediting agencies should be first recognized by the USDE or CHEA in the United States , and in Canada by the CMA. This assures accountability of the accrediting agency. Any accrediting agency being considered by the ARDMS should abide by similar standards. Also, these should be accrediting agencies that are a known entity with solid credibility. These accreditors should also be familiar with the field of sonography, vascular technology and echocardiography. Also, the input from sonographers, vascular technologists, echocardiographers, and physicians is critical and should be welcomed by accrediting body.

Clinical hours in the training of new sonographers, vascular technologists, and echocardiographers is an incredibly important component part of their training. It is critical that any programmatic accrediting body understand the huge impact “hands-on” experience plays in the training of the student. As now determined by the ARDMS Prerequisite #1, a student is required to have a minimum of 1680 contact hours, most of which are clinical hours. SVU feels that these are the minimal numbers of hours a student should have to be proficient in any single area of ultrasound due to the vast amount of knowledge necessary to perform proficiently. If additional specialties are pursued, additional hours would be necessary.

The effectiveness of programmatic accreditation is directly related to those individuals who participate in the process. That is why it is extremely important that those individuals developing the standards for ultrasound programs and subsequently are responsible for accrediting these programs through the accrediting agency, be professionals in the field of ultrasound. These should include sonographers, vascular technologists, echocardiographers, and physicians who are involved in the various fields of ultrasound (i.e. Radiologists, Vascular Surgeons, Cardiologists, etc.). Currently these individuals are recommended by the professional organizations representing the various fields of ultrasound (SVU, SVS, SDMS, AIUM, ASE, ACR).

ARDMS 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 sonographer/diagnostic cardiac sonographer/vascular technologists before listing or addition by ARDMS?

SVU COMMENT: Minimum standards are presently recommended by the JRC/DMS and the JRC/CVT by the consensus of the professionals who participate in these two groups. A programmatic accrediting agency should require that a sonography, vascular technology, or echocardiography program adhere to minimum standards recommended by a similar group of professionals. The successes of these programs should be measured by a specific set of outcomes. These could include, but should not be limited to the ability of the student to become credentialed by the ARDMS. In addition to successfully passing their boards, students should demonstrate proficiency in their ability to perform a scan or complete a test accurately and consistently. Identification of pathology and the ability to understand a patient’s presentation and history is equally important.

These outcomes can only be accomplished if there is close integration of the didactic education and the clinical experience-meaning that what is taught in the classroom is relevant to the student when doing their clinical rotation. The clinical experience needs to include a wide variety of examinations and significant exposure to pathology. This can only be accomplished at a clinical site off campus. Scanning or performing studies on normal subjects is not adequate. The clinical sites need to be given a clear set of standards and goals, and periodic visits are critical. Feedback from the students on their clinical experience is extremely helpful.

Programmatic accreditation should also evaluate how well an institution adheres to requirements of the institutional accrediting body such as it’s administration, financial support, record keeping, admission requirements, etc.

ARDMS 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:

1. Systematic evaluation of student educational experience including competency assessment;
2. Regular instructional feedback to students;
3. An established set of standards for clinical instructors and supervisors;
4. Regular evaluation of each clinical site including, but not limited to, assessing its value in providing a worthwhile educational experience; and
5. An adequate instructor/clinical site ratio to properly implement the program curriculum?

SVU COMMENT: The answer to all the above questions should be YES.

1. Using various methods and tools, students should be assessed for progress in the program and in the competencies for each area of study.
2. Students should receive ongoing feedback on how well they are performing, and about areas in which they are weak or are in need of additional attention.
3. Minimal standards for clinical instructors should be certification in the areas of specialty in which they are instructing. If possible, the laboratory should be accredited in each specialty in which they test. If the program is a Bachelor of Science, ideally the clinical instructor should have a Bachelor’s degree. The same is true if the program awards an Associate degree, the clinical instructor should ideally have a minimum of an Associate degree.
4. Regular evaluation of clinical sites is necessary to ensure to student is receiving good clinical instruction. In addition to the student’s progress being evaluated, the student should be given the opportunity to evaluate the clinical site after each clinical rotation. Student evaluations, especially negative feedback, should be taken very seriously and investigated by the clinical coordinator. Assessment of the clinical site should include the volume and the variety of exams being performed during each rotation. This will give some insight into the clinical experience of the student.
5. SVU believes that a 1:1 ratio is necessary for the student to have an adequate clinical experience. Because our profession is so operator dependent, a greater ratio would significantly limit the clinical experience.

ARDMS 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?

SVU COMMENT: SVU recommends that no revisions be made to ARDMS Prerequisite #2 at this time. The requirement of programmatic accreditation should be maintained. The programmatic accrediting body, after initial assessment by the ARDMS, should periodically be reviewed for compliance.

If an agency that has been recognized by the ARDMS does not adhere to the minimal educational standards outlined above, or does not continue to included a significant number of clinical hours in closely monitored clinical setting, SVU would recommend that the ARDMS should not continue to list this programmatic agency. As stated throughout this document, not only does the quality of the didactic portion of a student’s education need to be of a high standard, but the clinical experience equally needs to remain strong in both variety and exposure to pathology.

In addition, any programmatic agency should periodically review their standards with input by appointees from the professional organizations. The ARDMS should make sure that this process is ongoing, so the standards reflect the changes in our profession. Also, the ARDMS should ensure that the clinical hours required are appropriate to the volume of knowledge and the changes in instrumentation the students are required to know.

SVU Executive Committee
March 23, 2004