Guidance

NHS abdominal aortic aneurysm screening programme: CST training handbook

Updated 4 August 2021

The clinical skills trainer (CST) handbook provides information about the role, responsibilities and training for CSTs within the NHS abdominal aortic aneurysm (AAA) screening programme.

Before screening independently within the screening programme, all screening staff who perform AAA screening scans as part of the NHS AAA screening programme should:

• complete the approved competency-based training
• have the recognised accreditation

All training must be aligned to the NHS AAA screening programme standard operating procedures and clinical guidance and scope of practice.

It is essential that screeners who perform scans are trained to the highest standard and competent. This helps to make sure of a safe, efficient and effective service.

It is necessary for them to maintain that high level of competence by ongoing development, regular monitoring of their skills and quality assurance (QA) of the images they take.

CSTs are pivotal in ensuring that screening staff are competent to perform scans. CSTs also need to be competent in providing:

• local training
• support and mentoring to trainee screeners
• workplace assessment of staff

Requirements for CSTs

CSTs must:

• hold a recognised CASE accredited (or equivalent) qualification in sonography and/or full SVT accreditation
• have a minimum of 2 years’ post-qualification experience
• be operating under a local AAA screening programme
• have experience of scanning abdominal aortic aneurysms
• provide evidence of appropriate continuing professional development (CPD)

Assessor qualification

An assessor evaluates and guides learners in their workplace 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 qualification in assessing vocational achievement. This is to support and assess trainee screeners working through the HSD. One such qualification is the certificate in assessing vocational achievement (CAVA). Local screening services should decide who is best placed to hold this qualification. It is recommended that CSTs complete this qualification if they do not have previous experience in teaching, assessing or mentoring.

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

Expert witnesses

An expert witness is someone occupationally competent who can observe a learner’s performance at work and provide evidence to support the assessment process.

If the CST 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 competencies towards achieving the HSD.

When they are satisfied of this, the CAVA qualified assessor (with support from an approved centre internal quality assurer) makes an informed judgement about the evidence provided to demonstrate a trainee screening technician’s competence.

The requirements for, and the responsibilities of the role of CST remain the same if the CST is an expert witness.

Role and responsibilities of the CST

The CST is accountable to the local screening programme director and will be an advanced practitioner who holds a CASE-accredited qualification or full SVT accreditation. They will also have completed the AAA screening programme mandatory training for CSTs.

The CST is responsible for staff training and regular review of staff for QA. The role of lead ultrasound clinician/QA lead is regularly combined into the role of clinical skills trainer.

In line with the job description issued by local screening programmes, the main purpose and dimensions of the role of CST, in addition to their screening and other duties, are:

• to be responsible for the clinical training and supervision of new and existing staff – ensuring they are familiar with scanning techniques and maintain screening programme procedures and high standards

• to act as the main point of contact and supervisor/assessor for the screening technicians while undertaking the required NAAASP qualification – this may require CSTs to an undertake additional assessor qualification

• to perform clinical assessments of trainee screening technicians at the specified ‘assessment gateways’ as per AAA screening programme guidance to ensure trainee technicians complete their portfolio of experience and log book (assessment criteria are provided to support CSTs when performing these assessments)

• to manage and review the work of the screeners at regular intervals as per programme QA framework and instigate further training where necessary

• to plan and provide local training and CPD sessions for screeners, including supervisory sessions as per clinical training requirements

• to offer support and advice to screeners if they encounter problems or unusual findings, particularly associated with conditions in men or technical malfunctions

• to play an important role in the recruitment process for new screeners, including assessing the candidates’ eye-to-hand coordination

• to carry out accurate abdominal ultrasound scanning as part of the local AAA screening programme, if required

Training of CSTs

All CSTs must successfully complete the required training before they provide formal support, training or oversight to trainee technicians within local providers. CSTs must not complete any internal QA of images until they have completed the required training.

CST training overview

The CST training has 3 parts and completion must be documented in this handbook with final sign off from the programme clinical director. The 3 parts are:

• successful completion of the required e-learning units

• half a day shadowing of trained CST/QA lead

• screening management and reporting tool (SMaRT)/data session with co-ordinator

E-learning overview

This will form a significant component of the training for CSTs within the AAA screening programme and must be successfully completed. The units cover :

• the role of the CST
• the AAA screening programme
• principles of screening
• an overview of the clinical knowledge required by the screening technicians undertaking the HSD

The e-learning units are available through Health Education England’s e-Learning for Healthcare Hub. Users need to search for ‘NHS Abdominal Aortic Aneurysm (AAA) Screening Programme’ and find the e-learning units in the ‘AAA clinical skills trainer’ module.

CST shadowing visit overview

CSTs must conduct a 0.5 day shadowing visit with a fully trained CST from their local programme or neighbouring programme. This is to observe the role of a CST in the assessment of the clinical practice of the screening technicians and to develop an understanding of the role of CST.

Several things must be covered during the shadowing visit. These include observing the:

• technician undertaking screening to AAA screening programme protocols
• CST undertaking clinical observations of technicians
• CST providing feedback
• SMaRT for patient management and inputting results

The shadowing visit should also include:

• an opportunity to scan patients under AAA screening programme protocols
• understanding of the AAA screening programme method for measuring the aorta

This is not an assessed session but provides the opportunity for the trainee CST to observe the AAA screening programme and to ask any pertinent questions regarding the role of the CST and screening technicians.

SMaRT training/data session

This session is to ensure that CSTs are aware of the role of the CST in the QA process within the local programme. It should include an overview of SMaRT.

Programme co-ordinators are expected to show the CST the requirements of their role and ensure they are aware of their responsibility within the programme. A run through of the reports that are available and how they are used within the programme should be covered during this session.

This session should take at least 2 hours to make sure the role of CST is adequately demonstrated to the trainee CST.

Clinical director sign-off

CSTs must have final sign-off by the clinical director of the local screening programme. They will need to provide evidence of the completion of the requirements as described in this guidance.

Confirmation of CST training completion

Once the sonographer/accredited vascular scientist has completed the required training they are able to act as a CST within the NAAASP.

CPD points can be applied for upon successful completion of this course. The requirements are:

• appropriate pre-requisite requirements confirmed
• successful completion of the required e-learning units
• half a day shadowing trained CST/QA lead
• IT/SMaRT requirements with co-ordinator
• complete or be working towards the CAVA, where required

The clinical director of the programme must sign the record of CST training completion (see below) following completion of the CST training.

Record of CST training completion

I confirm that (insert name of clinical skills trainer)

has successfully completed:

• e-learning for CSTs
• half a days shadowing with a CST
• IT/data session
• undertaken/completed assessor training (where required)

Date signed: (insert date)

I confirm this is a true and accurate record of my training and that I understand the role and responsibilities of a clinical skills trainer within the NHS abdominal aortic aneurysm screening programme.

Signed: (insert signature)

Date: (insert date)

Name: (insert name)

Designation: Clinical Skills Trainer

I have observed the appropriate evidence for the training and qualifications for the trainee CST as outlined above and am satisfied this individual is competent to act as a clinical skills trainer within the local screening programme.

Signed: (insert signature)

Date: (insert date)

Name: (insert name)

Designation: Clinical Director

Name of local screening programme: (insert name here)

CSTs and local services are advised to retain copies of this sign off for audit purposes.