This Healthcare Science Week, Professor Martin Stout, Specialist Advisor to the British Society of Echocardiography, looks to the future of our profession.
As we celebrate Healthcare Science Week once again in 2024, I want to outline the significant changes that we have seen in the training and development of echocardiographers. I want to not only highlight those changes but also share my thoughts on how these changes have impacted training, education and career progression in the United Kingdom. I would also like to share my thoughts on what the future may hold for echocardiographers going forwards.
I was lucky enough to be involved in the implementation of the new academic programmes for healthcare science training from the inception in around 2011-2012 and remain involved from a national, Higher Education Institute (HEI) and local departmental perspective. I have seen these changes first-hand as lead Editor for cardiac science-based curricula, Programme Lead for Scientist and Higher Scientist Training at an HEI and as a clinical lead within a busy tertiary hospital trust.
Modernising Scientific Careers (MSC) was mooted by Professor Sue Hill and her team for inception in 2010. It was designed to formalise training at four main levels for the healthcare science workforce to create a clear and coherent career structure. These include Associate/Assistant, Practitioner (PTP), Scientist (STP) and Higher Specialist (HSST) to introduce roles at undergraduate, postgraduate and doctoral level. I have noticed several benefits since the inception of MSC from traditional training pathways and these include a coherent and common approach to career development, a flexible and modular career pathway, alignment of career pathways with other health professionals, combining specialism specific training with more generic elements such as leadership, research and professional conduct and the ability to contribute to newer clinical pathways and innovation. Indeed, there are now over 50 specialisms falling into the areas of life science, physical science, physiological science and informatics.
My own personal experience with this new initiative began in around 2012 when I was fortunate enough to develop a combined role between the Cardiology department at Manchester University NHS Foundation Trust and Manchester Metropolitan University. This role allowed me to be at the forefront of the introduction of the cardiac science related training from an academic perspective as the Academic Programme Lead. Much of my work centred around the development of scientist training at postgraduate level (leading to a MSc in cardiac science) as well as the development of new programmes as they emerged (Higher Specialist Scientist Training at doctoral level). There is no doubt that it has taken a while, and there is still work to do, with respect to understanding how the training programmes integrate into our workforce and to what scientists at different levels can offer employers. I hope that I can convince you of these benefits and provide some examples of how I see the work of a scientist compared to the traditional roles from the past.
I have always had a major bugbear throughout my own career with the term cardiac technician. Disappointingly, I still hear this term often even now and it shows a disregard to how we as echocardiographers operate in modern clinical practise. I have been keen from the onset to ensure students are aware of their potential when it comes to echocardiography and wider cardiology practise. From a diagnostic testing and echocardiographic perspective, we are much more than ‘technicians’. This implies we get images of the heart and formulate a technical report to be interpreted clinically by a medical doctor. It implies that outside of pressing buttons and getting nice images of the heart we have no further role to play in the pathway of the patient. There is no doubt in my mind that implementing MSC has allowed us all to enhance our roles and become more integrative to the wider clinical pathways of our patients.
I think that echocardiographers today are capable of understanding and should understand the complete patient pathway with respect to specific cardiovascular disease. Newer models of training have facilitated a more in-depth understanding of the patient as a whole. Not just the particular cardiac pathway relating to for example valve disease, heart failure or coronary disease, but also how other pathology outside of cardiology can impact our patient’s care or effect the results/interpretation of the investigations we perform. There is increasing knowledge of the importance of research and audit. Novel research to fill gaps in the literature, being performed in the most effective, efficient and scientifically sound ways to improve the delivery of our care to patients. Effective audit of the services we deliver to drive constant improvements to the pathways our patients take and ensure that the results we provide are robust, answer clinical questions succinctly but can also provide tailored advice to a patient as an individual. There is also a much better understanding and utility of leadership models, allowing echocardiographers to communicate better with patients, peers and executive staff, improve working conditions, horizon scan and develop new initiatives and roles within their own institutions and the wider landscape.
We now have, more than ever, echocardiographers with the ability to advance their practice beyond the traditional scope. They oversee their own clinics in sub-specialist areas such as valve disease, coronary disease, heart failure, cardio-oncology, cardiac rhythm disorders and acute medicine. They utilise their skills and experience to take concise clinical history from patients, perform clinical examination, understand pathology and patient pathway to ensure diagnostic reports are tailored to the patient as an individual, communicate results to the patients and peers, suggest alternative approaches best suited for a diagnosis, understand the advantages and limitations of diagnostics and treatment approaches, can suggest and inform treatment based on the interpretation of the most up to date evidence and transform their roles in a way that makes the healthcare we deliver most effective and efficient.
Of course, there is still much to do from a national perspective to promote the role we as echocardiographers can play in our own institutions. There is much to do to promote the equivalence process for those of us who have not undertaken the newer training routes to ensure that we can keep pace with the ever-changing healthcare landscape and ensure our patients remain safe. We need to share our resources and best practice, as well as help each other achieve our full potential and gain the recognition we deserve from leaders so that we can develop our roles and provide opportunities to expand our workforce, improve staff well-being/morale and reduce the numbers of echocardiographers leaving our profession. With the correct training/education together with our own vast experience and role models, we are not ‘technicians’ or ‘button-pressers’. We are echocardiographers with significant knowledge and expertise in our field. I will leave you with a final message and a challenge I will give to myself and one to you as echocardiographers. My challenge is to ensure that nationally within the BSE and wider circles, echocardiographers are championed for their full potential. My challenge for you is to keep advancing your roles and sharing these good practices with others so that echocardiographers and our wonderful workforce are equipped for the future.