Continuing Medical Education for Sonographers

The need for continuing medical education (CME) in medicine was first officially recognized in the United States in 1907 when Dr J. C. McCormack, who was commissioned by the American Medical Association (AMA) to research the poor quality of doctors in the field of medicine, reported that the training these individuals received in medical school was very limited. Fueled by the nation’s rapid westward expansion in the early 20th century, many substandard for-profit medical schools were created that were not accredited, did not have a standardized curriculum, and offered very little clinical training. In addition to limited academic and clinical education, there was not a formal system in place within the medical community that required postgraduate education to maintain clinical skills and to keep pace with rapid clinical and technological updates. ¹

Although Dr McCormack’s report highlighted the many inadequacies in medical education, it was the publication of The Flexner Report in 1910 that galvanized the medical profession into action to reform physician training. With support from the Carnegie Foundation for Advancement of Teaching, Mr Abraham Flexner visited all of the 155 medical schools in the nation and wrote an extensive report on their many shortcomings. ² In this report, Flexner stated that “for twenty-five years past there has been an enormous overproduction of uneducated and ill trained medical practitioners. This has been in absolute disregard of the public welfare and without any serious thought of the interests of the public.” ³ Another important aspect of Flexner’s report was the concept of postgraduate education, the forerunner of continuing medical education, or CME.

Even as medical schools gradually standardized their training programs for physicians, it was not until the mid-1930s that the idea of continuing medical education actually began to be addressed. ⁴ In 1934, the American Board of Urology became the first professional medical organization to require mandatory postgraduate education for urologists. ¹ As the requirement for continuing medical education was slowly being instituted by other educational and professional institutions in the field of medicine, the AMA became actively involved by forming several committees to research, recommend, and help implement continuing medical education programs throughout the nation. ² Most of these educational events were provided by faculty at the many medical schools throughout the country. Various reading assignments, seminars, and interprofessional communications were, and continue to be, the primary means of getting information to practitioners. ⁵

As allied health became an increasingly important component of the health care system in the mid-to-late 20th century, various professional organizations within allied health, including sonography, also adopted CME requirements for their members. For example, the American Nurses Association produced the first set of guidelines for continuing education (CE) in the early 1970s and accredited the first CE program for nurses in 1976. ⁶ The American Society of Radiologic Technologists (ASRT) instituted a mandatory CE system in 1995, and the Nuclear Medicine Technology Certification Board (NMTCB) adopted mandatory CE requirements in 2006.^7,8 Sponsored lectures, professional meetings, seminars, CME courses, and articles in professional journals (along with an associated CME test) were the most common formats used to deliver CME content to members of these professional organizations. In the mid-1990s, Dr Rebecca Hall proposed a unique way for sonographic clinical instructors to earn CME credits for clinical instruction, which the Society of Diagnostic Medical Sonography (SDMS) approved. ⁹ This system, which as far as the authors know is unique in allied health, recognizes the significant amount of time and effort clinical instructors put into training sonography students. Teaching sonography students in the clinical setting requires the instructor to remain up-to-date on his or her knowledge of anatomy, physiology, pathology, scanning protocols, and instrumentation. It takes a tremendous amount of dedication and skill for an instructor to work with sonography students while still taking care of the primary patient care duties in today’s busy clinical environment. In a Journal of Diagnostic Medical Sonography (JDMS) symposium on clinical instruction, Marveen Craig eloquently described the role of sonographic clinical instructors as “those patient individuals who guide the hands, eyes, and minds of students brimming with classroom theory but totally deficient in the art and science of patient scanning.” ¹⁰ Being afforded the ability to earn CMEs for this difficult task is a tangible reward much appreciated by clinical instructors, especially when many hospital budgets have eliminated funds for staff to attain CME credits needed to maintain their certification as sonographers.

For many years, the SDMS limited the number of CMEs awarded for clinical instruction to four each calendar year. However, in recognition of the hard work and dedication required to teach sonography students, and to encourage more clinical sites to accept sonography students, the SDMS recently increased the number of annual CMEs that sonography programs accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) can award to six. In addition, the SDMS CME Management System has simplified even further the process for diagnostic medical sonography (DMS) program directors (who must be a member of the SDMS) who wish to award their clinical instructors with CME credit for clinical instruction. This can now all be completed online, and there is no fee charged for this process if the program is CAAHEP accredited. ¹¹

The data collection process related to clinical instruction can be time-consuming, especially for sonography and other allied health programs that use paper forms. This can also be an issue for larger programs with multiple clinical sites and clinical instructors. Several electronic data collection systems are available to make this task easier to complete. For example, FISDAP (Field Internship Student Data Acquisition Project) is an online data management system developed specifically for Emergency Medical Sciences training programs. ¹² DataArc is a biomedical education database service provider for various allied health educational programs. ¹³ Typhon Group offers the Allied Health Student Tracking (AHST) system for any educational program associated with allied health. ¹⁴ For DMS programs that use the Trajecsys Report System, the process is even simpler in that the system builds the CME roster for the program director. ¹⁵ A program director using this online student clinical records system only needs to verify that the roster is accurate and then upload it into the SDMS CME Management System. Once the SDMS CME Management System verifies the status of the personnel submitted with the roster, it will e-mail information on how to obtain a copy of the approved CME certificate to each eligible sonographer. In addition, the CMEs awarded to the clinical instructors who are members of the SDMS are also transferred into the SDMS CME Tracker System.

The requirement for health care professionals to maintain their certification by completing a specified amount of postgraduate education has a long history in the United States. Although the need for continuing education for physicians was extensively documented in the 20th century, it took many years for the various professional organizations associated with medicine, including allied health, to accept, develop, and implement viable continuing medical education programs. The SDMS recognized the value of clinical instruction in maintaining one’s knowledge of sonography and instituted a system of awarding CME credit for teaching sonography students. Recent advances in computer data management have enabled the SDMS to simplify the process for sonography program directors to submit their clinical instructors for CMEs. Several electronic data collection systems also make the process easier when it comes to preparing the CME roster for submission to the SDMS CME Management System. Although there are many avenues for sonographers to obtain CMEs, earning these credits through clinical instruction is a very satisfying and rewarding option.