Implementing the Multilevel System of Practice in Ultrasound in Romania

Prof. Ioan Sporea, MD, PhD, President of the Romanian Society of Ultrasound in Medicine and Biology (SRUMB)

Some years ago, following the efforts of the Educational and Standards Committee of EFSUMB, a unified European system for the evaluation of performance in the field of ultrasound was born. This guideline was a difficult target to achieve, since it implies standardization of practice of ultrasonography across Europe.

This Multilevel System of Practice (MSP) obtained the approval of the Board of Directors of EFSUMB, thus becoming an official document of the society.

From my point of view, as a member of the Committee that conceived this document, and in my position of President of the Romanian Society of Ultrasound (SRUMB), these guidelines are a good instrument that should be used by every National Society in which a stratification of the level of practice is wanted. In the same time, these guidelines allow every specialty which uses ultrasound in daily practice, to make their own, specific, modifications.

In Romania, we started to implement the Multilevel System one and half years ago, but only at the level of the National Society of Ultrasound, without the help of any other regulatory institutions (like the Social Security Health System or the Ministry of Health, both directly involved in the management of the Public Health System in Romania). We asked to all the members of the Romanian Society of Ultrasound, by e-mail and through the Romanian Journal of Ultrasound (the official journal of our society), to apply for a level of practice (depending of their experience), the application form being available on our web-site. In the first year, only a small number of people applied for a level. Every application form was evaluated by a Committee of the Romanian Society of Ultrasound, who accepted or not to grant the level of practice desired by the applicant. After approval, a Certificate of the Level of Practice (with a nice design) was sent to the applicant.

After more than a year of intense advertising of the Multilevel System of Practice, we were a little disappointed by the small number of applicants. This year, the National Board of our Society and me personally, made a special effort for the promotion. In this moment, only 13 % of members of SRUMB, were evaluated through the Multilevel System and received a classification. It is a paradox that even people who can achieve level III (experts) did not make an application. On the other side, individuals with long experience in the field of ultrasound, but who do not perform more sophisticated procedures, would not like to be granted only level I of expertise. Personally, I tried on many occasions (General Assembly of SRUMB, editorials in the National Journal of Ultrasound, on the web-site of the Society), to explain to the members that the Multilevel System can be an instrument to encourage people to permanently increase their level of practice. This material was written in order to show how difficult can be to implement this system inside a National Society, without the help of regulatory authorities. Probably, if the Multilevel System of Practice would be mandatory in order to obtain reimbursement from the Social Security Health System, in a very short period of time, all the people involved in the practice of ultrasound would be evaluated.

I believe that sharing the experience of implementing the Multilevel System with other national societies of ultrasound, is the best way to find the course to be taken in the future.