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ACNM Ultrasound Education

Ellen Margles, CNM

NEWS in ultrasound certification for midwives:

The American Registry for Diagnostic Medical Sonography (ARDMS) Midwife Sonography Certification exam will be rolled out this coming spring. Applications are being accepted beginning January 4, 2017 and the exam will be administered from April 4, 2017 through May 4, 2017.

The ARDMS exam was postponed in May 2016 because ARDMS received only a small number of applicants which meant we could not build a fair and defensible exam for midwives. A Midwife Task Force that included several midwives who use ultrasound, midwives who do not use ultrasound, a sonographer and a Maternal-Fetal Medicine sonographer was formed to look at exam eligibility requirements, and other aspects of the assessment that were barriers for midwives to achieve a certification, in order to ensure that the exam was commensurate with midwifery scope of practice.

As a result of the collaboration between ARDMS and the task force, updated eligibility requirements were developed that accurately reflect midwifery scope of practice which should enable more midwives to become eligible to take the exam. With more midwives taking the exam, we’re confident the exam process will meet national certification standards for the midwifery community.

ACNM members can review the updated eligibility requirements, certification process, testing locations, and sign up for exam reminders at www.ARDMS.org/MW.

• Applications are being accepted beginning January 4, 2017 and the exam will be administered from April 4, 2017 through May 4, 2017.
• Visit www.midwife.org/midwife-sonography-certification for information and resources ACNM has available to help you prepare for the examination, including updates about workshops, exam simulations and other materials.
• Watch for updates about the ARDMS Midwife Sonography Assessment program and corresponding education resources in Quickening and Quick eNews.
• Sign-up for the ultrasound Pegasus education programs at www.pegasuslectures.com. ACNM's ultrasound education partner has an online exam simulation program, a comprehensive, modular eCourse to teach ultrasound principles, and it offers hands-on training.
• Be sure to have an ongoing study plan to ensure you are ready to take the 2017 Midwife Sonography Certification exam. See education guidelines and opportunities below.

Background

Expansion of midwifery practice to include ultrasound

The scope of midwifery practice may be expanded beyond the core competencies to incorporate additional skills and procedures that improve care for women and their families. The performance of ultrasound examinations is one skill which can be integrated into midwifery care according the expansion of practice guidelines outlined in Standard VIII of the Standards for the Practice of Midwifery (ACNM, 2011).

In 1996, ACNM published the first clinical bulletin providing guidelines for midwives who expressed an interest in incorporating third trimester ultrasound examinations into their clinical practice. The document was retired in 2009 yet clinical practice has changed in that many midwives are now adding all trimesters of ultrasound examination and gynecologic ultrasound to their clinical practice (ACNM Survey, 2010). ACNM published an updated position statement in 2012 titled “Midwives’ Performance of Ultrasound in Clinical Practice." The statement reviews scope of practice, expansion of practice beyond the core competencies, avenues for practice expansion, reimbursement, licensing and regulation. The statement posits “With appropriate additional training as outlined by ACNM, AIUM, ACOG or AWHONN, midwives may perform ultrasound examinations within the scope of midwifery practice. It is not necessary for midwives to achieve competency in all types of ultrasound; they may tailor their education and training to the specific type of ultrasound examination(s) they wish to perform.”

National guidelines

Expanded guidelines for the performance of all types of obstetric ultrasounds have been published and updates maintained by three professional organizations: The American Institute of Ultrasound in Medicine (AIUM), the American College of Obstetricians and Gynecologists (ACOG), and the Association of Women’s Health, Obstetric, and Neonatal Nursing (AWHONN).

Membership Survey

In August of 2013, a survey was presented to all ACNM members to determine clinician demand. The results of the survey validated a call for action as evidenced in the following:

• 91% of respondents agreed that there is a need for the development of a credential/certificate examination in women's health ultrasound.
• 95% of those in favor of a credential/certificate believe that improved patient care would be the biggest benefit to the midwife community.
• 83% of respondents said they would be interested in obtaining a credential/certificate examination in women's health ultrasound.
• Of these, only 9% felt that their current level of knowledge would be sufficient to take a credentialing/certification examination in ultrasound.

In 2013, the ACNM Board of Directors approved the formation of a joint task force with the American Registry for Diagnostic Medical Sonography (ARDMS) to explore how best to support midwives’ ability to become credentialed and reimbursed for performing ultrasound. Key members of ACNM worked collaboratively with ARDMS to develop a midwife specific test with leadership from Cydney Menihan CNM, RDMS and Diana Dowdy CNM, RDMS.

Ultrasound Education Task Force

The ACNM Board of directors charged a newly formed task force to develop didactic and clinical education opportunities for midwives across the nation. Content objectives for didactic and clinical courses were developed and disseminated. An affiliation between Pegasus Lectures and ACNM was developed to offer midwives on-line didactic education and test review courses.

ACNM encourages an ultrasound educational component that includes the following:

1. Physics and instrumentation relevant to type of exam to be performed (e.g., physics of ultrasound, proper use of machine and transducer selection, ALARA principle).
2. Required elements and components as described by AIUM for a specific exam to be performed (e.g., imaging parameters for each trimester).
3. Required anatomic landmarks defined by AIUM pertinent to type of exam to be performed (e.g., landmarks for biometry).
4. Indications for exam (e.g., indications for POC versus the Standard Examination).
5. Clinical implications of normal and abnormal findings (e.g., documentation, communication, consultation).
6. Ultrasound safety (e.g., output, frequency, length of exams).
7. Components of a complete ultrasound report (e.g., orientation of image, documentation).
8. Client education (e.g., explanation of procedure, communication of results).
9. Additional didactic content can be specific to type of sonograms to be performed (e.g., first-trimester dating vs. cervical length).
   

Clinical component:

By the completion of the clinical component, each midwife will be able to perform OB/GYN ultrasounds by successfully visualizing each anatomic structure and obtaining the necessary measurements in the following areas: physics and instrumentation relevant to the exam being performed. Task force member Anthony Lathrop adapted a rubric for members to document hands-on competency achievement and include in their ultrasound education portfolio. A complimentary copy of this rubric is available on Shop ACNM.

Clinical instruction will include,

1. Required elements and components as described by AWHONN, ACOG or AIUM for the type of exam to be performed.
2. The required anatomic landmarks as described by ACOG or AIUM pertinent to the type of exam to be performed.
3. Indications for type(s) of exam(s) being performed.
4. Clinical implications of normal and abnormal findings,
5. Ultrasound safety.
6. Components of a complete ultrasound report.
7. Patient education.8. Process of informed consent regarding the scope and limitations of the various ultrasounds performed.
8. Process of informed consent regarding the scope and limitations of the various ultrasounds performed.

Other educational venues have adopted midwifery specific learning objectives:

University of Colorado https://www.regonline.com/builder/site/Default.aspx?EventID=1775001

Gulf Coast Ultrasound: https://www.gcus.com/cme/?specialty=obgyn

Professional Education Center https://www.proedcenter.com/ultrasound-training2.html

Thomas Jefferson University http://www.jefferson.edu/university/jmc/departments/radiology/jurei/cme_courses/limited_ultrasound.html

Task Force Members

Thomas Chappel,CNM, MSN, Clarendon Health Systems, Manning, South Carolina

Terri Clark, CNM, PhD, FACNM, Graduate Nurse-Midwifery Track Lead, Seattle University

Carolyn Gegor, CNM, MS, FACNM, Former Program Director, Midwifery Program, Georgetown University

Ira Kantrowitz-Gordon, CNM, PhD, Program Director, University of Washington

Faith Harris, CNM, APN, MSN Advocate Health Care, Chicago Illinios

Ann Konkoly, CNM,MSN University Hospitals, Cleveland, Ohio

Anthony Lathrop, CNM, PhD, RDMS, Indiana University Health

Cydney Afriat Menihan, CNM, RDMS, (ex-officio advisor to the task force), past-chair, Perinatal Productions

Sarah Morrow, CNM, MSN, Three Lower Counties Community Services, Salisbury, MD

Vanessa Robbins-North, MSN, CNM, WHNP, 31st Medical Group, Aviano, Italy

Kathy Watkins CNM MSN, Family Birth Center, Great Falls, MT

Kristen Ostrem-Niemcewicz (Task Force Chair), CNM, DNP University of New Mexico

Venay Uecke CNM, MSN Gallup Indian Medical Center, Gallup New Mexico

Staff Liaisons

Eileen Ehudin Beard, CNM, MS, FNP, FACNM Senior Practice Advisor

References

Textbooks available on SHOP ACNM

Gill, K (2013). Davies: Ultrasound in Obstetrics and Gynecology. A practitioners Guide. 4^th ed.

Miele, F. (Director). (2016). Introducing Ultrasound into your practice: Why and How to Prepare [Video]. 

Menihan, C. & Kopel, E. (2014). Point-of-Care Assessment in Pregnancy and Women’s Health: Electronic Fetal Monitoring and Sonography.

Introducing Ultrasound into your practice: Why and How to Prepare, f

Resources to guide practice

ACNM (2012) Position Statement:Midwives’ Performance of Ultrasound in Clinical Practice, retrieved from http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000228/Ultrasound%20position%20statement%20June%202012.pdf.

ACNM (2011)Standards for the Practice of Midwifery, retrieved from http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000051/Standards_for_Practice_of_Midwifery_Sept_2011.pdf.

ACOG (2009; Reaffirmed in 2014).Ultrasonography in pregnancy. Practice Bulletin 101, retrieved from http://www.acog.org/~/media/Practice%20Bulletins/Committee%20on%20Practice%20Bulletins%20--%20Obstetrics/pb101.pdf?dmc=1&ts=20140828T1112546585.

AIUM (2013)AIUM Practice Guideline for the Performance of Obstetric Ultrasound Examinations, retrieved from http://www.aium.org/resources/guidelines/obstetric.pdf.

Articles

Lathrop, A., & Blackburn, M. (2011). Learner Portfolios and Hands‐On Workshop to Facilitate and Evaluate Nurses’ Learning in Obstetric Ultrasound. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 40(5), 654-661.

Menihan, C. A. (2000). Limited sonography in collaborative midwifery practice. Journal of Midwifery & Women’s Health, 45(6), 508-516.

Shaw‐Battista, J., Young‐Lin, N., Bearman, S., Dau, K., & Vargas, J. (2015). Interprofessional Obstetric Ultrasound Education: Successful Development of Online Learning Modules; Case‐Based Seminars; and Skills Labs for Registered and Advanced Practice Nurses, Midwives, Physicians, and Trainees. Journal of Midwifery & Women’s Health, 60(6), 727-734.

Toolkit

The ACNM New Mexico Affiliate has developed a toolkit to guide members on expanding their practice following Standard VIII of the ACNM Standards for the Practice of Midwifery.

Older documents

ACNM (1996).Limited Obstetrical Ultrasound in the Third Trimester(Clinical Bulletin No. 1) Washington, D.C.

ACNM (2010) Position Statement:Midwives’ Performance of Ultrasound in Clinical Practice, retrieved from http://ultrasound.wikispaces.com/file/view/ACNM+US+Position+2010.pdf.

For more information, please contact ACNM Senior Practice Advisor Eileen Ehudin Beard, CNM, MS, FNP, FACNM at (240) 485-1842 or ebeard@acnm.org.