Guidance

Clinical skills trainer and internal quality assurance lead: training guidance

Updated 8 January 2025

Applies to England

Overview

The main aim of the NHS Abdominal Aortic Aneurysm (AAA) Screening Programme is to reduce aneurysm-related mortality through the early detection, appropriate monitoring and treatment of aortic aneurysms. The NHS AAA Screening Programme invites men for an abdominal ultrasound scan during the year (1 April – 31 March) they turn 65. The screening scans are performed by qualified screening technicians who follow a scanning protocol developed by the NHS AAA Screening Programme. This requires measurement of the aorta in transverse and longitudinal planes.

Clinical skills trainers (CSTs) and internal quality assurance (IQA) leads are qualified and experienced ultrasound practitioners in the NHS Abdominal Aortic Aneurysm Screening Programme [footnote 1]. They are employed by local screening services to provide training, clinical supervision, support, and development to screening technicians.

To help provide a safe, and effective AAA screening service, it is important that screening technicians who perform the AAA scans are trained to a high standard and receive annual competency assessments. The CST and IQA lead is essential for this function.

This document provides guidance on the qualifications and experience required for the CST and IQA lead role and outlines their responsibilities.  In some local screening services, the IQA lead and CST roles may be performed by the same person in a combined role.

For new CSTs/IQA leads, an induction and orientation framework including a training record are provided.  Local sign off is required when completed. They must retain copies of their induction and orientation record, and a record must also be kept by the service.

Requirements for the role

Individuals undertaking this role must:

  • have a Consortium for the Accreditation of Sonography Education[footnote 2] (CASE) accredited postgraduate award including either vascular or abdominal module

or

have full accreditation as a vascular scientist from The College and Society for Clinical Vascular Science[footnote 3] of Great Britain and Ireland (SVT) and continue to maintain this accreditation

or 

be a General Medical Council[footnote 4] (GMC) registered and practicing clinical radiologist who performs diagnostic vascular or abdominal ultrasound

or

have undertaken the NHS Scientist Training Programme and have successfully completed a MSc in clinical science in the specialism of vascular science

  • have a minimum of two years post qualification ultrasound experience with evidence of continuing professional development
  • have experience of independent reporting of ultrasound examinations
  • have experience in scanning abdominal aortic aneurysms
  • maintain competency in scanning abdominal aortas
  • have experience of mentoring, teaching, and assessing
  • maintain own continuing professional development (CPD).

Recognition of overseas qualifications

The NHS AAA Screening Programme acknowledges that NHS Trusts recruit and appoint vascular scientists and sonographers that have qualifications obtained overseas. The NHS AAA Screening Programme cannot determine the equivalence of overseas qualifications. Therefore, if these individuals are to be considered for the role of CST/IQA lead this would be a decision and responsibility of the host Trust. They must additionally complete the induction and training as set out in this document.

CST and IQA lead responsibilities

In addition to any other responsibilities and duties outlined in the CST’s or IQA lead’s job description, issued by the local screening service, they are responsible for:

  • clinical training and supervision of new and qualified screening technicians, supporting them to work within their scope of practice[footnote 5], following the NHS AAA Screening Programme national guidelines and protocols
  • carrying out competence assessments of trainee screening technicians at the specified assessment gateways[footnote 6] as per national guidance
  • reviewing the quality of ultrasound images taken by screening technicians as described in the published internal quality assurance framework[footnote 7] and providing documented feedback
  • carrying out clinic observations of screening technicians at least once every 6 months and providing documented feedback
  • carrying out annual scanning competence assessments[footnote 8] of screening technicians and providing documented feedback
  • providing update and CPD sessions to screening technicians including individual recovery training sessions where required
  • supporting and advising screening technicians if they encounter problems or technical malfunctions with the ultrasound equipment
  • making sure that ultrasound machines are tested and checked in line with Abdominal aortic aneurysm screening ultrasound equipment guidelines[footnote 9]
  • advising on the recruitment process for new screening technicians
  • undertaking accurate abdominal aortic aneurysm ultrasound scanning for the local AAA screening service, if required.

IQA leads may undertake all the duties above, but this can be dependent on local polices.

CST and IQA leads and assessor qualification

An assessor evaluates and guides learners in their workplace[footnote 10] while they study the health screener diploma (HSD). To provide the level 3 HSD, all local AAA screening services should have at least one individual working towards (or completed) a level 3 certificate in assessing vocational achievement (CAVA). This is to support and assess trainee screening technicians working through the HSD. Local screening services should decide who is best placed to hold this qualification. CSTs or IQA leads can undertake the assessor role.

For contingency planning, local screening services should consider having access to more than one person who holds the qualification.

CSTs and IQA leads acting as expert witnesses

An expert witness is someone who has specialised knowledge on a particular area. You can call on an expert witness to give their expertise and opinion on the knowledge and ability related to a learner’s performance at work and provide evidence to support the assessment process.

If the CST or IQA lead does not hold the assessor qualification, they must be an expert witness.

This is so they can observe and confirm that the trainee screening technician has achieved the required AAA specific units and competencies towards achieving the HSD.

The CAVA qualified assessor makes an informed judgement about the evidence provided by the expert witness to demonstrate a trainee screening technician’s competence.

The requirements and responsibilities of the role of CST or IQA lead remain the same if the CST or IQA lead is an expert witness.

Annual study days

The NHS AAA Screening Programme hosts an annual study day for CSTs and IQA leads. This can be virtual or face-to-face. The purpose of this event is to:

  • share best practice ideas
  • enable CSTs and IQA leads to benchmark their practice
  • enable CSTs and IQA leads to benchmark their screening technicians’ practice
  • present case studies
  • learn from incidents
  • highlight and discuss contemporary issues in ultrasonography that affect the NHS AAA Screening Programme
  • enable information sharing with screening technicians as part of annual competency assessments and technician feedback.

It is expected that all CSTs and IQA leads to attend an annual study day. Quality Assurance Advisors will liaise with services directly if a CST/IQA lead is not booked to attend one of these sessions.

CST and IQA Lead induction and training

Induction and training must be completed for all new CSTs and IQA leads undertaking this the role within the local AAA screening service.

Local services should support CSTs and IQA leads with the time they require to acquire the knowledge and understanding of NHS AAA Screening Programme required for the role. The induction and training should be completed within 12 weeks, some of which can be done virtually.

Confirmation of completion and sign off by the local service manager and clinical director is required when all elements are completed.

Appendix

The following elements make up the induction and orientation framework. Local services can include other elements appropriate to them.

Completion of e-learning module

The CST e-learning module is available on e-Learning for Healthcare Hub[footnote 11]. To access this e-Learning for Health Hub, CSTs need to register with a work email address. There are 6 units in the CST e-learning module, all of which the CST must complete:

  • What is screening?
  • The NHS Abdominal Aortic Aneurysm Screening Programme
  • Principles of AAA screening and treatment
  • Principles of ultrasound for AAA screening
  • Giving feedback and handling difficult conversations
  • Introduction to population screening.

Unit 1 – Date completed:         ………………………………………

Unit 2 – Date completed:         ………………………………………

Unit 3 – Date completed:         ………………………………………

Unit 4 – Date completed:         ………………………………………

Unit 5 – Date completed:         ………………………………………

Unit 6 – Date completed:         ………………………………………

Spend sufficient time with an experienced CST and or an IQA lead (who can be from a neighbouring service) to discuss and gain an understanding of the CST and IQA lead role

Including:

  • Accessing NHS AAA Screening Programme guidance on GOV.UK
  • NHS AAA Screening Programme standards and pathway themes
  • Screening test and results – no aneurysm, small, medium, or large aneurysm
  • Aneurysms that have grown by more than 1cm in 1 year
  • Surveillance pathways
  • Education and training of screening technicians
  • Clinical guidance and scope of practice for screening technicians
  • Internal quality assurance guidance
  • Management of non-visualised aortas
  • Management of incidental findings.
CST/IQA name for completion
CST/IQA signature for completion
Date completed for completion
Experienced CST/IQA name for completion
Experienced CST/IQA signature for completion
Date completed for completion
Experienced CST/IQA local service name for completion

Spend sufficient time with the local screening service co-ordinator/manager to discuss and gain an understanding of the NHS AAA Screening Programme

Including:

  • commissioning of the local service by NHS England
  • governance and clinical oversight of the local service
  • information governance including the storage and safe transfer of person-identifiable data
  • the screening pathway
  • the role of the nurse specialist within the local service
  • management of incidental findings
  • management of non-visualisation of the aorta
  • pathway standards and themes
  • risk management and failsafe processes
  • internal quality assurance
  • the role of screening quality assurance service (SQAS) and quality assurance of NHS AAA Screening Programme
  • the management and reporting of screening safety incidents.
CST/IQA name for completion
CST/IQA signature for completion
Date completed for completion
Local service coordinator/manager name for completion
Local service coordinator/manager signature for completion
Date completed for completion

Sufficient time for demonstration of ultrasound equipment

Wherever possible, this should be done at the CST/IQA lead’s own local service. If this is not possible, a neighbouring screening service that uses the same make of ultrasound machine/s could be used. Quality assurance of ultrasound equipment as per national guidance[footnote 9] should also be demonstrated.

CST/IQA name for completion
CST/IQA signature for completion
Date completed for completion
Experienced CST/IQA name for completion
Experienced CST/IQA signature for completion
Date completed for completion
Experienced CST/IQA local service name for completion

Spend sufficient time with the local screening service co-ordinator/manager to demonstrate use of the Screening Management and Referral Tracking (SMaRT) system functions required to undertake the CST or IQA lead role

This must include:

  • how to search for patients, including screening history, comments and flags and alerts
  • how to use and complete the image QA tab/section
  • how to use the image viewing software
  • how to search for images (satisfactory, action completed, action required)
  • how and when to feedback comments to screeners.
CST/IQA name for completion
CST/IQA signature for completion
Date completed for completion
Local service coordinator/manager name for completion
Local service coordinator/manager signature for completion
Date completed for completion

Observation of a screening clinic run by a qualified and experienced screening technician. The CST/ IQA lead should observe as many individuals being scanned to satisfy themselves that they understand the NHS AAA Screening Programme scanning protocols.

CST/IQA name for completion
CST/IQA signature for completion
Date completed for completion
Experienced ST name for completion
Experienced ST signature for completion
Date completed for completion
Experienced ST local service name for completion

Shadow an experienced CST at a 6-monthly clinic observation of a screening technician

This should include:

  • completion of the observation form by the CST
  • feedback to the screening technician by the CST
  • opportunity with the CST to reflect on the observation and feedback given to the screening technician.
CST/IQA name for completion
CST/IQA signature for completion
Date completed for completion
Experienced CST name for completion
Experienced CST signature for completion
Date completed for completion
Experienced CST/IQA local service name for completion

Spend sufficient time with an experienced CST or IQA lead for demonstration and discussion of how image review for internal quality assurance is carried out

This must include:

  • random image quality assurance
  • requested image quality assurance
  • referrals and changes in surveillance intervals from a small to a medium size AAA
  • examples where action is or was required, including the outcome
  • incidental findings
  • aneurysms that have grown by more than 1cm in 1 year
  • when to request a re-screen
  • how and when to feedback comments to screeners.
CST/IQA name for completion
CST/IQA signature for completion
Date completed for completion
Experienced CST/IQA name for completion
Experienced CST/IQA signature for completion
Date completed for completion
Experienced CST/IQA local service name for completion

Spend sufficient time with an experienced CST to discuss and gain an understanding of the screening technician annual competence assessment requirement

This should include:

  • planning and preparing to undertake the assessment
  • the assessment criteria
  • undertaking the assessment and completing the assessment form
  • providing feedback to the screening technician
  • action planning and screening technician recovery training.
CST/IQA name for completion
CST/IQA signature for completion
Date completed for completion
Experienced CST name for completion
Experienced CST signature for completion
Date completed for completion
Experienced CST/IQA local service name for completion
CST/IQA name for completion
CST/IQA signature for completion
Date completed for completion
Vascular nurse specialist name for completion
Vascular nurse specialist signature for completion
Date completed for completion

Self-directed learning on inequalities in screening

Identifying and addressing health inequalities is a legal duty for all screening services.

The NHS population screening inequalities strategy[footnote 12] sets out how NHSE and its partners aim to tackle screening inequalities.

CSTs and IQA leads should seek to understand:

  • legislation on health inequalities
  • causes of inequalities
  • barriers that can make it difficult for people to access screening
  • national and local resources to reduce inequalities

Observation of a local screening service programme board meeting

This should be completed within the first year the CST or IQA lead is in post and can be signed off separately to the rest of the training document, but a record of attendance must be retained for records and EQA review.

Date completed: ………………………………..

Scenarios for professional discussion and reflection

The aim of the example scenarios is to contribute to consolidation of learning and understanding of the NHS AAA Screening Programme. It is recommended that it would be useful for the CST or IQA leads to discuss these scenarios with an experienced CST/IQA lead after completing all the other elements of the induction and orientation framework.

Scenarios for discussion

  • You are aware that a screening technician has a non-visualisation rate which is double that of the other screening technicians. How would you explore this and what action might you take?
  • A screening technician requests that you review and quality assure an image they have taken as they have concerns about the quality and measurements. How would you review and respond to this request using the IT (SMaRT) system?
  • During random image quality assurance, you notice that a screening technician has not placed the measurement callipers in the correct position to measure aortic diameter on 2 out of 8 images. What would you do?
  • At an annual competency assessment, a screening technician selects the wrong pre-set for the scan and has difficulty imaging the aorta indicating this is a case of non-visualisation. What immediate actions would you take? What would you record as the outcome of the assessment and what further actions would you take?
  • What are the potential consequences of delaying image quality assurance for screen positive aneurysms for more than 21 days?
  • What factors do you need to consider when providing feedback to a screening technician on performance that does not meet the required standard?

Confirmation of completion of induction and orientation

I confirm that I have completed all the elements of the induction and orientation framework and have acquired the knowledge and understanding required for the clinical skills trainer role.

CST/IQA name for completion
CST/IQA signature for completion
Date for completion

I confirm that the local AAA service is satisfied that the CST/IQA lead named above has the knowledge, skill and understanding required for the role.

Local service coordinator/manager name for completion
Local service coordinator/manager signature for completion
Date for completion
Director/clinical lead name for completion
Director/clinical lead signature for completion
Date for completion