Guidance

Education and training

Updated 19 February 2024

Applies to England

For naming conventions used throughout this guidance and other general information, please see the handbook overview.

Providers should make sure there are adequate numbers of appropriately trained staff in place to deliver the screening programme.

All providers are responsible for making sure staff receive sufficient time to complete minimum training requirements. This is to maintain an effective screening workforce and includes continuing professional development (CPD).

Providers should make sure training is completed and recorded. There should be a system in place to assess ongoing competence.

In line with professional regulatory bodies, healthcare professionals have a responsibility to make sure their practice is up-to-date in line with national guidance.

1. E-learning resources

Below is a summary of the e-learning resources with recommended completion timescales. These resources are relevant to specific healthcare professionals involved in the NHS Fetal Anomaly Screening Programme (FASP).

These resources are available on the e-Learning for Healthcare (e-LfH) website.

1.1 All staff

All staff involved in the NHS FASP may be interested in:

• ‘Introduction to population screening’
• ‘Antenatal and newborn screening e-learning module’

1.2 Maternity staff

Recommended e-learning and completion timescales for maternity based staff involved in the offer of the NHS FASP are:

• ‘Screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome’, recommended every 24 months
• ‘Non-invasive prenatal testing – evaluative roll out’, required once
• ‘Unit 5 20-week screening scan’ in the ‘Antenatal and newborn screening e-learning module’, recommended every 24 months

1.3 Screening laboratory staff

Recommended e-learning and completion timescales for screening laboratory based staff are:

• ‘Screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome’, recommended every 24 months

The NHS FASP recommends a representative from each screening laboratory attends:

• the annual NHS FASP biochemistry meeting
• DQASS training (at least every 2 years)

1.4 Ultrasound practitioners

Any ultrasound practitioner performing NHS FASP screening or diagnostic ultrasound scans should hold, as a minimum, one of the following:

• Certificate or Diploma in Medical Ultrasound (CMU/DMU) of the College of Radiographers (CoR)
• Post Graduate Certificate in Medical Ultrasound (PgCert) approved and validated by a higher institute of education and accredited by the Consortium for the Accreditation of Sonographic Education (CASE) or equivalent; the qualification should be relevant to obstetric ultrasound practice
• Royal College of Obstetricians and Gynaecologists (RCOG)/Royal College of Radiologists (RCR) Diploma in Obstetric Ultrasound, Advanced Training Skills Module (ATSM) or Subspecialty Training in Maternal Fetal Medicine

Ultrasound practitioners who participate in the NHS FASP must complete the e-learning resource ‘First trimester resource for sonographers’ every 12 months. The screening support sonographer (SSS) (see section 3 in Quality assurance) should maintain a record of this training.

All SSS and deputy SSS must complete the SSS resource every 2 years. All new SSS and deputy SSS must complete the SSS resource when they start in the role.

Recommended e-learning and completion timescales for ultrasound practitioners involved in the offer of NHS FASP are:

• ‘Screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome’, recommended every 24 months
• ‘Non-invasive prenatal testing – evaluative roll out’, required once
• ‘20-week screening scan resource for ultrasound practitioners’, recommended every 24 months
• ‘Fetal cardiac e-learning’, recommended every 24 months

2. Ultrasound training requirements for the combined test

Providers are responsible for assessing the competence of each practitioner before they scan independently.

Competence to undertake ultrasound scans for the combined test must be assessed by:

• reviewing the ultrasound practitioner’s DQASS NT feedback plot
• reviewing ultrasound images

Both components are essential.

Trainee ultrasound practitioners must complete 2 training parts, as described below, to gain competence in ultrasound scans for the combined test.

2.1 Training part 1: e-learning resources

There are 3 e-learning resources on screening for trisomy 21 (T21), trisomy 18 (T18) and trisomy 13 (T13). These resources should be completed prior to starting practical training. The resources are:

• ‘Screening for Down’s syndrome, Edwards’ syndrome and Patau’s syndrome’
• ‘Non-invasive prenatal testing – evaluative roll out’
• ‘First trimester screening resource for ultrasound practitioners’

2.2 Training part 2: practical training process

Practical training is overseen by the SSS.

When practical training starts the trainee will not initially require a unique DQASS identity code as the trainee will not be the responsible practitioner (see information on DQASS identity codes in information on the Down’s syndrome screening quality assurance support service). This is because the trainee will be observing and gaining hands-on experience before becoming more proficient at measuring the NT and CRL.

Once the SSS is satisfied the trainee can achieve NT and CRL measurements with minimal guidance from a qualified member of staff, a DQASS identity code is required.

The trainee should use their DQASS identity code on the screening request form when their measurements are used. It is not necessary for the supervising practitioner to use their DQASS identity code, unless they have remeasured the NT and/or CRL.

The training process should take no longer than 6 months. The training code ‘T’ will remain valid during this time. If training is not completed within 6 months then the reasons should be recorded by the SSS and DQASS contacted if an extension is required.

The trainee’s individual NT feedback plot is sent to the SSS with the usual 6-monthly DQASS report.

This is the step-by-step process that should be followed.

1. Practical training starts.
2. Trainee able to achieve NT and CRL measurements with minimal guidance from the supervising practitioner.
3. SSS informs DQASS of the new trainee’s details to obtain a DQASS identity code.
4. DQASS issues unique DQASS identity code matched to an ultrasound department with the suffix ‘T’ to indicate a practitioner in training. For example, 123456T.
5. SSS informs screening laboratory of trainee’s details.
6. SSS and trainee jointly review images using the image review tool spreadsheet which accompanies this guidance.
7. SSS reviews images of nuchal translucency (NT) and crown rump length (CRL) measurements (see section 4.3 in Screening for Down’s syndrome, Edward’s syndrome and Patau’s syndrome, taken independently by the trainee under supervision.
8. SSS reviews these images against the NHS FASP criteria described in section 6.4 of Screening for Down’s syndrome, Edward’s syndrome and Patau’s syndrome, using the image review tool. If the SSS has no concerns, proceed to the next step. If the SSS has concerns, additional support and training should be given before reassessing new images.
9. Trainee collects at least 25 paired NT and CRL measurements.
10. SSS reviews these measurements using the diagnostic plot self-assessment tool (download the diagnostic self-assessment tool spreadsheet). When this tool shows the estimated bias is less than 0.30mm and spread is consistent with Fetal Medicine Foundation (FMF) reference curve, SSS sends the 25 paired measurements to DQASS.
11. DQASS confirms new measurements are within NHS FASP criteria for bias and spread.
12. SSS provides feedback to the trainee, including:

• confirmation that bias is less than 0.30mm
• confirmation spread is consistent with the FMF reference curve
• outcome of image review
• confirmation trainee is competent to start screening under supervision

13. SSS records the support provided, all actions and the outcome. They may use the template for trainee ultrasound practitioners performing combined screening that accompanies this guidance.
14. Trainees must continue to use the training code ‘T’ and have supervised practice until they have gained their obstetric ultrasound qualification.

Trainees should use their own DQASS identity code on the biochemistry form if their measurements are used.

It is not necessary for the supervising practitioner to use their DQASS identity code, unless they have remeasured the NT and/or CRL.

The training process should take no longer than 6 months. The training code ‘T’ will remain valid during this time. If training is not completed within 6 months, then the reasons should be recorded by the SSS and DQASS contacted if an extension is required.

2.3 Guidance to be followed before qualified ultrasound practitioners participate in combined screening

This applies to:

• new staff including those who may have worked elsewhere but are new to the department
• agency and bank staff who are new to the department
• practitioners who have had a break in service and are returning to work
• new staff from overseas who will first need a unique DQASS identity code

The SSS should inform DQASS and the screening laboratory of the following:

• name of new or agency staff member
• DQASS identity code
• previous place of work

The level of support required will vary depending on the practitioner’s previous experience in screening and how long they were not at work.

Any required support is discussed and agreed on an individual basis between the ultrasound practitioner and SSS. The following should be discussed as part of the induction process:

• NHS FASP e-learning ‘first trimester screening resource for ultrasound practitioners’ completed in the last 12 months
• practical scan sessions during the induction period
• review of images using the image review tool
• ultrasound equipment and scan environment
• the ultrasound practitioner’s most recent NT feedback plot issued by DQASS within the last 6 months (this will provide current feedback on bias, spread and throughput, and it is the responsibility of the ultrasound practitioner to provide this report)

To make sure ultrasound practitioners meet the requirements for combined screening the following step-by-step guide should be followed alongside the local induction process.

1. SSS and practitioner discuss and agree the practical and theoretical support required.
2. SSS and practitioner must review the practitioner’s most recent DQASS NT feedback plot. If issued within the last 6 months and no concerns identified, steps 8 to 10 are not required. If issued within the last 6 months and concerns are identified, all steps and any outstanding action plans must be completed. If issued more than 6 months ago, all steps must be completed (this also applies if no DQASS report is available).
3. SSS informs DQASS of practitioner’s name, DQASS identity code and previous place of work.
4. SSS informs screening laboratory of practitioner’s name and DQASS identity code.
5. Practitioner starts supported practical scan sessions.
6. SSS and practitioner review images of NT and CRL measurements taken by the practitioner.
7. SSS reviews these images using the image review tool. If the SSS has no concerns, proceed to the next step. If the SSS has concerns, additional support and training should be given before reassessing new images.
8. Practitioner collects at least 25 paired NT and CRL measurements.
9. SSS reviews these measurements using the diagnostic plot self-assessment tool (download the diagnostic self-assessment tool spreadsheet). When this tool shows the estimated bias is less than 0.30mm and spread is consistent with Fetal Medicine Foundation (FMF) reference curve, SSS sends the 25 paired measurements to DQASS.
10. DQASS confirms new measurements are within the NHS FASP criteria for bias and spread.
11. SSS provides feedback to the practitioner, including:

• confirmation estimated bias is less than 0.30mm
• confirmation spread is consistent with the FMF reference curve
• outcome of image review
• confirmation the practitioner can start combined screening independently

Documentation is the responsibility of the SSS. Two induction templates accompany this guidance.

3. Ultrasound training requirements for 20-week screening scan

To perform the 20-week screening scan, ultrasound practitioners must first complete the following e-learning resources:

• ‘20-week screening scan resource for ultrasound practitioners’
• ‘fetal cardiac e-learning’