Cultivating Competency in Cardiac Sonography: Aligning Entrustable Professional Activities With Industry Expectations

Echocardiography education involves the teaching and assessment of multiple competencies to ensure work-ready graduates. To connect these competency standards to professional practice, it is important that the industry expectation around specific entrustable professional activities (EPAs) is determined. In Australia, echocardiography examinations are eligible for Medicare reimbursement when performed by sonographers listed on the Australian Sonographers Accreditation Registry (ASAR), either as an Accredited Medical Sonographer or as an Accredited Student Sonographer. A key criterion for acceptance onto the registry is the completion of, or active enrolment in, an accredited cardiac sonography course. Eligible courses apply for accreditation and are assessed by ASAR against their Standards for Accreditation of Sonographer Courses. This study sought to investigate the existing cardiac EPAs and provide insights into the industry's expectations for graduate cardiac sonographers in Australia.

Using an anonymous online survey tool, an invitation to participate was circulated via professional sonography groups and social media platforms. Accredited Medical Sonographers, Accredited Student Sonographers or interested stakeholders (academic, employer, medical specialist) working in Australia or New Zealand were invited to complete the survey. Survey questions were structured around the existing EPAs and knowledge items described in published sonography competency documents. Participants were asked if each individual EPA should be considered appropriate at the threshold of graduation, or at a higher level following a period of working in the profession.

There were 211 cardiac sonographers who completed the survey. The majority of respondents (148 of 211, 72.2%) indicated that the current EPAs should be updated. At 80% agreement, the following EPAs were considered essential for the graduate: left ventricular structure and function, right ventricular structure and function, atrial size, valvular disease, systemic hypertension, cardiomyopathies, diseases of the aorta, coronary artery disease, pulmonic hypertension, and basic congenital heart disease. This list is more extensive than the current ASAR-endorsed EPAs, and the findings in this research will guide the revision of current ASAR-endorsed EPAs for graduate-level cardiac sonography.

The results of this study show Accredited Medical Sonographers completing a cardiac sonography course in Australia should be entrusted to perform a wide range of examinations however, greater alignment between educational providers, ASAR and industry is still required.