Abstract
It was my great fortune to join a delegation from Inteleos/American Registry for Diagnostic Medical Sonography (ARDMS) and fly to China to visit with the Chinese Ultrasound Doctors Association (CUDA). I was happy to be invited back to Beijing, China, as I traveled there in 2012 as the chair of ARDMS to sign official government documents that set in motion the development of the Chinese Registered Physician in Vascular Interpretation (C-RPVI) examination (see Figure 1). When I visited in 2012, for this official purpose, I toured many hospitals in Beijing, such as Peking University Hospital and General Hospital #1. These very high-level facilities are steeped in tradition, and with medical students as my guides, I discovered the rich history of the culture of Chinese medicine, the use of ultrasound for diagnosis, and treatment. In the six years that have passed, much has changed, with even more advances and an intense desire to provide high-quality health care to over 1.4 billion Chinese people. 1 They use a phrase that connotes their population challenge, “See people, see a mountain!”
Evans and Cyr signing the 2012 agreement for developing the Chinese Registered Physician in Vascular Interpretation examination with the Chinese Ultrasound Doctors Association.
To understand the people and the many changes in society, it is important to appreciate their tremendous history. Much of the interest in certifying medical professionals comes from their past traditions. The Ming dynasty (1368–1644) was dominated by imperial rule, but a great emphasis was placed on art and academic publications. 2 This continued into the Qing (Ch’ing) dynasty (1644–1912), with an interest in growing learned scholars and also certifying their academic achievement. 2 To this end, the emperor provided certification examinations that were graded and certificates awarded from his Hall of Supreme Harmony. This hall is one of the successive buildings within the Forbidden City. Successful candidates received the imperial seal of approval on their examinations, to officially permit them to provide services to the public. This makes our certification process seem a lot less stressful! This all came to an end when the emperor’s rule was overthrown by Chinese people, and this was the beginning of the Republic of China (1912–1949). 2 This was an unsuccessful government that led to a Japanese occupation of the country and secret experiments that killed many innocent Chinese men, women, and children. 3 Another uprising, highly motivated by these murders, led to the current government, which is the People’s Republic of China (1949–present). 2 Chairman Mao, who was the leader of the Communist Party, equalized power across the culture, but in many ways, the emphasis on education was sacrificed. With Mao’s passing, modernization and opportunities for capitalism allowed many Chinese people to progress through compulsory education, ending at grade 9. Upon completing ninth grade, students can now test for entrance to high school and an eventual university education.4,5 This growth in a highly educated workforce, coupled with a need for health care, makes the use of medical ultrasound an attractive career option.
As part of my trip back to Beijing, I was able to reconnect with many Chinese ultrasound doctors who I had met previously. At that time, many had taken the Registered Vascular Technologist (RVT) or RPVI examination and used it to further their career in China. It was an honor and privilege to lecture at the 2018 Summit on Sino-American Ultrasound Strategy and Clinical Vascular Symposium. I was joined by Michael Lilly, MD, RVT, RPVI, from the University of Maryland, and Dave Stolte, MBA, RDCS, RDMS, chair of Inteleos. The goal of this summit was to provide an information exchange and continue to build even stronger relationships with the members of CUDA. After this educational session, I flew on with Dr. Lilly and met Traci Fox, EdD, RT(R), RDMS, RVT, in Chengdu providence. In Chengdu’s West China hospital, we provided lectures and met the new Chinese sonography students (see Figure 2). I greeted a brand-new class of aspiring Chinese sonographers and was told that given their success, eight more schools would open across the country.
Evans and Cyr with the new sonography students at the 2018 West China Hospital education meeting.
Over my two trips to this amazing country, I have met so many dedicated physicians who truly believe that ultrasound can make a difference in expediting the diagnosis and treatment of various diseases. The paramount issue is to provide more education, clinical training, and certification to meet the crushing medical demand of Chinese patients. I am so thankful to witness the birth of our occupation in China. I also hope that CUDA members understand not only the importance of expanding their reach but also nurturing those new Chinese sonographers who will be on the front lines, providing care to patients. Some of this can be attributed to the annual growth rate of imaging physicians, which is only 4%. 6 As always, I cannot escape my concern for the tremendous exposure to work-related musculoskeletal disorders among the members of CUDA, which Joan Baker noted during her trips to China. The need to scan more patients quickly and detect chronic disease among patients, who have waited for care, is indeed a formidable issue. It has been stated that in most public Chinese hospitals, the patient only gets 5 to 10 minutes with a physician and they talk to 100 to 150 patients per day. 6 Is there a way to assist them in finding “supreme harmony”? As we are asked to provide guidance, education, and ultimately certification to doctors and sonographers in China, we need to underscore the known risk for exposure to injury.7,8 This is our chance to provide pivotal relationships and leadership to CUDA and their new Chinese sonographers. Are we up to this very important task?
The Journal of Diagnostic Medical Sonography thanks Kathryn E. Zale, MS, RDMS, RVT, for serving as interim Associate Editor from November through December 2018. The journal editors greatly appreciate her service and for helping to keep the peer-review process running smoothly.