EFSUMB Minimum Training Recommendations

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General Comments: 
In general terms we should endorse the comments in the introduction regarding proper costing and funding of training, the time commitment of the trainer and the trainee and to take a view on who is appropriate to conduct the competency assessment at the end of training. This competency assessment should not be performed by the trainer. All these modules require that trainees attend an appropriate theoretical course.

1.  Gastroenterological Ultrasound
There are some specific areas that seem to be missing for examples spleen (splenic masses, trauma and infarction), liver (no mention of infection or trauma) and gallbladder (adenomyomatosis and porcelain gallbladder not included).

a) We do not necessarily believe that ultrasound controlled biopsies is necessary for every Level 1 practitioner.
The levels expected for bowel ultrasound are perhaps outside those normally practised in the UK.
Finally, some specific procedures, i.e., EUS, RFA, PEI and laser ablations probably not appropriate for level 1. 

2.  Breast
We would typically assess biopsy competence over at least 30 cases and not 10 as has been suggested and we would suggest a succession rate of at least 80% with definitive diagnosis. 
500 cases a year are perhaps a little too many in maintenance of skills in the UK. This should probably be revised downwards. 

3.  Vascular Ultrasound 
In general we have agreed with the vascular module. The Level 2 attainment should include dialysis vascular access pre-assessment and also we would consider that assessment of permanent haemodialysis access fistulas and grafts should be included. We would also regard it necessary to measure volume flow in permanent haemodialysis access. We should be able to recognise normal and abnormal appearances including stenosis, thrombosis, aneurysms and pseudoaneurysms. Would it be possible to recognise changes in haemodynamics as a result of a steal.

4.  Nephrology
In general we are satisfied with the contents of the nephrological section

5.  Gynaecology
In general we are satisfied with the gynaecological section although some of the numbers are perhaps a little too high to achieve for the United Kingdom. 

6.  Obstetrics
Foetal Biometry must include head circumference. 

We consider that at the end of the training the trainee should be able to perform a systematic abdominal ultrasound examination of the pregnant uterus placenta, amniotic fluid and foetus; to optimise and correctly orientate the ultrasound image; to obtain accurate measurements of the foetal biparietal diameter, head circumference, femur length and abdominal diameter or circumference. 

They should be able to evaluate foetal anatomy recognising a number of structures discriminating between normal and abnormal - the structures include the skull, the brain, the midline echo in the brain, cavum septi pellucidum, the cerebellum, cisterna magna, cerebral ventricles, the neck, the thorax, four chamber view of the heart plus the outflow tracts, the stomach, the umbilical cord insertion, the kidneys, urinary bladder, spine and extremities where possible. It may also be desirable to recognise features of the face. 

The trainee should have good ability to communicate both normal and abnormal findings to the pregnant women and finally to be able to complete a proper report.

November 2009