Residents who perform night sonography need more training

Using radiology residents to make up for the shortage of qualified sonographers could undermine medical education and compromise patient care, though some professors consider the nightshift duties essential learning experience. The findings of a Stanford University survey suggest teaching hospitals should reinforce training for residents if they are to perform after-hours ultrasound scanning.

Institutions try various staffing alternatives to provide after-hours ultrasound scanning. Using residents is one. The Stanford study couldn't explain how these institutions choose or implement their graveyard shift staffing, but it rang the alarm bell on implications arising from the increasing shortage of qualified sonographers (Acad Radiol 2006;13 [2]:249-253).

Clinical demand for ultrasound studies after hours is increasing, and hospitals must juggle staffing to meet that demand. Sometimes sonographers work an in-house shift. Sometimes they take call from home and must come in to perform scans.

They are not available in many cases, however, and radiology residents must perform the scans, said principal investigator Dr. Terry Desser, director of the Stanford School of Medicine's radiology residency program.

"If residents are expected to perform the scans, there should be adequate training programs in place to ensure that patient care is not compromised. Documenting the nature and extent of this training is important," Desser said.

Desser and colleagues asked 405 members of the Association of Program Directors in Radiology to fill out the two-part Web-based survey, and 79 responded. The investigators found that in almost one-third of responding programs, radiology residents perform some or all of the after-hours ultrasound scanning. Sixteen percent of respondents used both radiology residents and sonographers to provide coverage, while 13% provided coverage with residents alone. Forty-one percent of respondents provided coverage with on-call sonographers, and 30% used in-house sonographers.

Programs should not discard residents altogether, because their education suffers without nightshift scanning, said Dr. Levon Nazarian, a professor of radiology at Thomas Jefferson University in Philadelphia.

"Residents are at a detriment where they serve in a hospital with 24/7 ultrasound tech coverage," Nazarian said.

Radiology programs have to give residents as much experience as possible if the specialty wants to remain competitive, especially when it is harder to fill the demand for sonographers, he said.

Mr. Abella is assistant editor of Diagnostic Imaging.