Accrediting Focused Courses Gill Dolbear – Vice-Chair of CASE CASE Update Day 2016 Accrediting Focused Courses Gill Dolbear – Vice-Chair of CASE

Philosophy & Principle Aim of CASE The primary role of the Consortium is to accredit high quality training programmes and focused courses that promote best ultrasound practice and ensure that ultrasound practitioners are safe and competent to practise, whilst taking into account informed views of service needs (CASE Handbook, 2015)

The Four CASE Principles Reporting should not be separated from scanning In 2015 the Consortium agreed the following four principles should be adhered to with respect to scanning practice and ultrasound education.

The Four CASE Principles Reporting should not be separated from scanning Scanning is a ‘dynamic’ investigation in which the acquisition of suitable images and assessment of them is entirely operator-dependent at the time of the scan. Deficiencies in acquisition cannot be rectified by involving a more skilled practitioner at a later stage. Assessment and interpretation of saved images is recognised as sub-optimal practice although, as with all image interpretation, dual reporting can be helpful in increasing specificity In 2015 the Consortium agreed the following four principles should be adhered to with respect to scanning practice and ultrasound education.

The Four CASE Principles Reporting should not be separated from scanning Scanning is a ‘dynamic’ investigation in which the acquisition of suitable images and assessment of them is entirely operator-dependent at the time of the scan. Deficiencies in acquisition cannot be rectified by involving a more skilled practitioner at a later stage. Assessment and interpretation of saved images is recognised as sub-optimal practice although, as with all image interpretation,  dual reporting can be helpful in increasing specificity The risk of patient harm and consequent litigation against any healthcare organisation providing a poor quality service is very high and therefore the need for competence at the point of scanning is paramount In 2015 the Consortium agreed the following four principles should be adhered to with respect to scanning practice and ultrasound education.

The Four CASE Principles Reporting should not be separated from scanning Scanning is a ‘dynamic’ investigation in which the acquisition of suitable images and assessment of them is entirely operator-dependent at the time of the scan. Deficiencies in acquisition cannot be rectified by involving a more skilled practitioner at a later stage. Assessment and interpretation of saved images is recognised as sub-optimal practice although, as with all image interpretation,  dual reporting can be helpful in increasing specificity The risk of patient harm and consequent litigation against any healthcare organisation providing a poor quality service is very high and therefore the need for competence at the point of scanning is paramount Workforce modelling and the development of innovative training routes to meet the demand for sonography services should demonstrate increased efficiency of provision and effectiveness in delivery of diagnosis and treatment to patients In 2015 the Consortium agreed the following four principles should be adhered to with respect to scanning practice and ultrasound education.

Definition of a Focused Course A focused course is a stand-alone course that covers a specific area of clinical specialty for which competence to practice is to be achieved CASE will only accredit such courses where the training and education includes practical clinical skills development for which a formal assessment of competence to practice is included Theory-based short courses lasting from one to a few days are not eligible for CASE accreditation, but may apply directly for individual professional body endorsement See flowchart.

In 2015 the Consortium agreed the following flow chart of the process for dealing with approval and accreditation requests made to CoR and CASE.

Focused Courses Focused Courses are normally developed to address a particular service delivery need in order to ensure that, on completion of training, the practitioner is competent to undertake safe focused ultrasound examinations in a specific, named area of clinical practice Any focused courses accredited by CASE must be in line with the same clinical practice standards found in an M-level programme that CASE accredits. This is to ensure a national standard across all training programmes and courses, albeit in a well-defined and restricted area of practice Cannot have a two-tier system of first and second class scans!

Examples of well-defined and restricted areas of clinical practice Basic Gynaecology & Early Pregnancy First Trimester Screening Third Trimester Pregnancy & Growth (Fetal Surveillance) Trans-vaginal Ultrasound for Infertility Musculoskeletal Ultrasound in Rheumatology (Synovitis) Neonatal Hips Tend to be carried out in a clinic setting rather than the main Ultrasound Department.

Focused Course Titles & Credits CASE will need to be assured at the time of accreditation that the title evidenced on the Focused Course competency certificate, issued on successful completion of the course, reflects the defined area of clinical competency and is otherwise fit for purpose It is also appropriate for institutions to formally award credits; for example, 20 Level 7 credits, to students upon successful completion of a focused course For example, you cannot have a Focused Course which has content relating to MSK ultrasound of the foot and ankle for podiatrists with a general title of MSK Ultrasound. It would need to be titled something like Podiatric MSK Ultrasound or MSK Ultrasound of the Foot and Ankle for Podiatrists.

The Accreditation Process The accreditation process for a focused course is broadly similar to that of a full programme and only differs in some details In particular, there may not be a formal validation event, and a visit to the institution/organisation offering the course may not always be necessary. In many cases it may be sufficient to conduct a ‘virtual’ approval process by electronic communication alone Student and stakeholder feedback may be required even if no formal meeting occurs. In the case of a formal validation meeting, a secretariat to minute proceedings is normally arranged by the course faculty

Application for Accreditation The focused course leader applies to CASE, using the appropriate current form from the website, to indicate that they wish to seek CASE accreditation for their focused course The course documentation will be scrutinized at the next CASE Committee meeting and a decision as to whether the course satisfies the conditions for CASE validation and accreditation will be made Where a focused course does not meet the criteria for entry into the accreditation process, an explanation will be given and advice may be offered to enable a successful application to be made. For example, this may be because the proposed focused course is too broad in terms of subject matter or lacks practical clinical competency training and assessment

Application for Accreditation Where a focused course does meet the criteria for entry into the accreditation process CASE will appoint a Lead Accreditor and a Co-accreditor. The Lead Accreditor will contact the Focused Course Leader and liaise with them to agree a way to proceed. In particular, they will indicate whether a formal meeting/event is required and what form it should take The expertise of the appointed Lead Accreditor and Co-accreditor normally reflects the clinical content of the focused course  

Information required for the accreditation of a new Focused Course The information required will, as a minimum, need to include:   a definitive Focused Course Document evidence of institution and/or service approval (if appropriate) to develop and deliver the Focused Course to reflect current service provision evidence from stakeholders of a service need to train sonographers (if appropriate) evidence of support for student funding (where appropriate) evidence of clinical support for the clinical skills-based training

Information required for the re-accreditation of a Focused Course The information required for re-accreditation of a focused course will include:   A critical appraisal of current delivery to include the views of the focused course team, current and past students and trainees, practice educators or mentors, clinical assessors, service managers and other stakeholders Any intermediate changes that have been made since the original validation and accreditation, a critical appraisal of any major focused course changes that are proposed for the re-validation and any plans for future developments Reports from the external examiner (if applicable) covering the validation and accreditation period, with statements of any action taken in response Information on current and proposed additional resources (including library and technological resources), and staff changes Current Curriculum Vitae for all members of the focused course team A full set of revised focused course documentation (as specified in the CASE Handbook)

Course Dimensions of Clinical Experience The focus needs to be on demonstration of clinical competence and this may differ in different areas of practice. For example, there may be some areas of clinical practice where medical conditions are rare or infrequently encountered. Self-assessment against an experienced practitioner will then be required Two dimensions of clinical experience need to be included as follows……………

Course Dimensions of Clinical Experience Firstly…………... 120 hours of ultrasound clinical skills learning in an appropriate placement, 50 of which must be directly supervised by a named clinical supervisor or mentor; the remaining 70 hours may include student self-directed periods of study related to practice

Course Dimensions of Clinical Experience Secondly…………… A log of practical evidence that includes:   A record of the 120 hours of ultrasound clinical skills learning, of which a minimum of 50 hours must be directly-supervised clinical ultrasound skills development, (these are advisory hours that are recommended to ensure that trainees have adequate time to achieve baseline clinical competence) a minimum of 50 cases which must include an appropriate range and number of abnormal cases; Two assessed assignments, one of which must relate to an abnormal case

Some issues that will need to be considered by the CASE Accreditors What is the specialist clinical area to be covered and are there any limitations to the scope of practice? Does the course title reflect the defined scope of the course? What is the overall duration of the course? What is the amount of face-to-face contact time between the course team and the students (this must be a minimum equivalent of 4 days; however, where blended e-learning is included there must be a minimum of 2 full contact days)?

Some issues that will need to be considered by the CASE Accreditors What are the learning outcomes and content of the focused course? What assessment of theory is used?   How will the core topics of science and technology and professional issues be covered? What practical training is provided? How will the students gain practical/clinical experience? How will the students be assessed to ensure competence to practice?

Focused Course Accreditation Following any formal meeting/event, and after reviewing the documentation, the Lead Accreditor, on behalf of the accreditors, will prepare a formal report on a specific proforma for consideration and action by CASE Committee at its next meeting CASE will then inform the Focused Course Leader of the result of the accreditation process CASE accreditation for a focused course will normally be for 3 years This was previously two years but has now increased to three years.

The Way Forward........... To offer advice and guidance to education providers proposing new clinical topics for Focused Courses To design, develop and implement a CASE Annual Focused Course Monitoring Review (AFCMR) process Need to develop a new, efficient electronic means of collecting and collating the APMR data prior to undertaking this piece of work.

To Summarize....... The main aim of CASE has always been to protect the public by quality assuring a consistently high standard of ultrasound education and training throughout the UK Alongside this, CASE has encouraged creativity in the design and delivery of focused ultrasound courses, whilst at the same time ensuring the quality and consistency of the student experience and the outcome of the education and training The current sonography workforce crisis is driving the need for further innovation and, over the next few years, we will see a new and exciting ultrasound education and training landscape emerge as new focused courses are developed and delivered

References CASE Clinical Competency Guidelines Project (2010) CASE Handbook (2015)