The Process Of Moving From Watching To Doing

So how long should you spend in each phase of learning? How long should you be observing before you get to scan a real patient? What exams should you be scanning first? How long should you practice with a sonographer in the room before you begin to perform on your own? When you do start scanning solo, how long should you be given before a sonographer intervenes?
These questions are all ones that students have asked at the beginning of their training. The answer is that everyone is different, every clinical site is unique, and there are no clear cut answers. It is not always helpful to compare yourself and your situation to what is happening with another student, but here is a good layout of how to move from one phase to the next.
During the first few days of the clinical experience, every student is eager to begin scanning. It is important to take the time to observe. As we have discussed before, use this time to learn the flow of the department, exam routines and protocols, and the personalities of the sonographers. Also, be sure to learn the equipment and spend any free time scanning anyone available. Within the first few weeks, you should begin to scan real patients, even if only for a few minutes.
You must realize that learning ultrasound is not a linear process. You will not move forward on each successive exam, accomplishing more on this one than the one before. Every patient is a distinct entity. You may find one patient to be relatively accessible in obtaining good images, and the next extremely challenging. You may do great on every patient one day; then the next you can’t find a thing. Remember this happens to all of us, even those of us who have been scanning for years have been known to meet our match. What you should find is that is as days go by there becomes more and more of the easy patients and less and less of the hard ones (regarding imaging ease); more and more of the good days and less and less of the bad days. Grasping that today you are getting decent images on a patient that you could not have last week is a major boon. This progression sometimes seems maddeningly slow, but it will happen.
When you begin to scan on your own, some things need particular attention. The first is your level of frustration. You are going to get frustrated when learning to scan. That is inevitable. Some of that frustration will just have to be worked through on your own. But there comes the point where your level of exasperation gets in the way of any further progress. Learn how to identify this point and what to do to combat it. One strategy may be to move on to something else. Make a mental note to come back, and continue to another part of the exam. Take a few deep breaths and start fresh. There is nothing worse than getting twenty minutes to accomplish as much as you can only to spend it all on one thing that you still do not have at the end. When this happens, both the student and the patient are on edge, and often the sonographer will just take over and finish the exam. If, when the sonographer enters the room, the student tells them they were having some difficulty on one thing, but have moved on to complete others, the sonographer can take them back and work through the difficult parts together. At this point, the student is feeling pretty good about themselves for the accomplishments they were able to complete and are much more receptive to being guided through what they were not. The experience is better for everyone, the sonographer, the student, and the patient.
Another thing to pay very close attention to is the level of patient comfort and frustration. Patients pick up very well on your struggle, but will often misinterpret it as coldness or feel that they are doing something wrong. It is okay to say to them that you are having difficulty visualizing something. Tell them that, although it is through no fault of their own, you are going to have a sonographer help you with this part later. Since you have already told them that you are a student, this should not be unexpected. You may even say before beginning that you will be getting help with anything difficult and that a sonographer will come in at the end to complete the exam. Almost all people are very accommodating as long as they feel that they are getting an explanation of what is happening to them and around them.
Always remember though that the patient has the right to refuse being scanned by a student. If this happens, do not take it personally. Some people are just uncomfortable with students. Some may feel that they are in too much pain or are just too sick to deal with a student at that moment. They may feel that they are paying for an experienced sonographer. Sometimes they may even change their mind during an exam, asking for someone else to complete it. If this happens, tell them you understand, be pleasant, and get the sonographer for them.
They may not be so direct as to ask, though; they may just start asking questions as to how much longer before you are through.
Be sure to pay attention to the unspoken signals a patient is conveying as well. No matter our age, when we are uncomfortable, either physically or emotionally, almost all of us start to fidget and sigh. If you notice a patient becoming increasingly agitated, talk to them. Ask how they are doing, if you are causing any pain and if they can continue to let you scan. Be mindful of how much physical pressure you are placing on them as you scan. We sometimes become so engrossed in obtaining the perfect image that we forget there is a real live person under our transducer. Certain areas of the body, such as between the ribs, near the xiphoid process or on the anterior neck, are naturally tender when pushed on, and every patient has their particularly vulnerable spots. Every patient also has their distinct tolerance level. Their discomfort may not have anything to do with you, but there are things you can do to help. Place a pillow under the knees of a patient who is complaining of low back pain. Raise their head slightly if they are having difficulty breathing. Ask what they need. Most of the time they will tell you.

Again, it is problematic to put a specific time frame on the learning processes. Everyone must play it by ear, but if you are in a situation where you have been at the clinical site for some time and have still not gotten your hands on a transducer in front of a real patient, you may have to get a little assertive. Start by asking if you may scan for a few minutes after the sonographer is through; then ask if you may begin the exam yourself. Propose time limits and ask them to enter in twenty minutes if you have not come out.
If you are still getting nowhere, it may be necessary to sit down and talk with your clinical supervisor and express your concerns. If your supervisor has a specific plan they should discuss that with you, and maybe both of you will come to a better understanding of your needs. If you have done this and it has not helped, then talk to the clinical coordinator at your school. Do what you need to do to get the proper education, but try not to compare yourself to other students too much. Certainly, if you are well into the clinical time and are doing nothing on your own, but are hearing tales of others who are scanning extensively on their own, you should speak up about the huge disparity. But if you are starting on abdomens and thyroids and another student has been performing obstetrical exams don’t get too alarmed. It should all even out in the end.
It is also important not to move too quickly through each phase. While it may sound like a good idea to just be let loose (most students are eager to scan on their own), that may not get you the direction you need and may result in bad habits. There always seems to be tales of students who are scanning by themselves very early in the program. Sometimes even without a sonographer checking their images or scanning the patient as well. Other students may be concerned about falling behind. Remember the path you are on, and work steadily forward.
I often get worried for the student who has limited direction from experienced sonographers and is thrown to the wolves, so to speak. It may happen when a department is so busy that no one has the time to spend in teaching. Unfortunately, it also happens when sonographers are just not interested in teaching. Again, you may need to be assertive if you find yourself in this situation. Ask for what you need, more scanning time, more direction, better communication. I will discuss in another section about what you may do to get what you need out of a department or sonographer who is just not that willing to help.