The 8 Differences I See: Sonography in Nigeria VS Sonography in the UK

In my previous post, I outlined the similarities between the ultrasound practice in Nigeria and in the UK. Just as there are similarities in practice between both regions, there are also numerous differences in the sonography practice between both countries.

And if the goal for you is to move from Nigeria to the UK, then it is crucial to be aware of these differences, to make your transition in the workplace as smooth as possible. It also helps you avoid misunderstandings and conflicts that may arise from cultural and regional differences in the workplace.

See the similarities between Ultrasound practice in Nigeria and in the UK

While there are sonographers that practice in federal government or state-owned hospitals, it does appear like most Nigerian sonographers have majority of their practice in privately owned diagnostic centres and hospitals. In the UK, the opposite is the case as most sonographers majorly work with the NHS, an equivalent to federal government hospitals in Nigeria.

This therefore means that after getting a sonography job in UK, in addition to relocating from one world region to another, most of the sonographers that move from Nigeria to the UK will also have to deal with transitioning from working in a private setting to a government setting.

Which is why in this article on sonography in Nigeria vs sonography in UK, I will be focused on highlighting 8 differences you’re likely to encounter in the NHS when compared with your private ultrasound practice in Nigeria.

1. Discussion of scan findings with patient

In Nigeria, sonographers relatively have more liberty to discuss their scan findings with patients; and it’s not strange to have these sonographers offer suitable advice to patients within their scope of practice, before sending the patients back to their doctors. In the UK however, apart from some pregnancy-related scans, the rule of thumb is that you don’t discuss scan findings with patients, and you don’t offer any unsolicited advice. That’s for the doctors to do.

As you gather more experience in the NHS and become more grounded in the way things work, you will be able to work around this delicate territory of discussing ultrasound scan findings with your patient.

You will become more familiar with some ‘on-the-surface’ result findings that you can briefly communicate to a patient without crossing any red lines, and you will also be more guided on how to communicate this information effectively without going beyond your scope of duties.

The safest bet however, especially for new UK sonographers from overseas is to refer patients back to their doctors to discuss scan findings. Dabbling too deeply into the murky waters of discussing scan results could open too many avenues for avoidable issues at work.

2. Provision of ultrasound reports to patients.

In Nigeria, for most diagnostic centres, the ultrasound scan report is produced, printed and given almost immediately to the patient. Depending on the setting, the patient then takes the report to the doctor, within or outside the hospital.

In the UK (NHS), the opposite is the case. Scan reports when produced are never printed and given to the patient under normal circumstances. And for outpatients, their reports are not gotten immediately either. The patient must get their results from the referring doctors, either from their GP (general practitioner) or from the doctors in the hospital/ward.

Private ultrasound centres in the UK (not directly linked with the NHS) operate much like in Nigeria though. The results are delivered directly to patients after payment, and if they require the scan images, it is put onto a flash drive or sent via email to them.

3. Saving scan images

In line with data protection laws and guidelines, saving of diagnostic scan images is a legal and corporate responsibility in the UK. For record keeping purposes, scan images must be saved or retained for about 8 years up to about 25 years or more.

Full details can be seen here in the Records management code of practice for health and social care.

Potential employers who are unable to meet up with this requirement of record keeping and management may not be able to succeed in setting up an imaging facility or department in the UK.

The contrast in Nigeria is that in some scan centres they save patient’s scan images, and some other centres, they don’t save scan images. The regulations around saving images are not as stringent as in the UK yet, a reality that is likely to change in the future considering the current sonography advances in regulatory practices and technological upgrades ongoing in Nigeria.

So, if you’re moving from a private centre where scanning and saving images is not the routine, its not a big deal. Simply familiarising yourself with the 'save' button on your ultrasound machine is all you need to do. Get comfortable with annotating and saving images that can be compared against national standards, that way you feel more confident when you start your new job in the UK.

You'd thank me for reading this: 5 things I wish I knew before coming to the UK as a Nigerian sonographer

4. Times slots allocated per examination

From my experience back in Nigeria, depending on how busy the scan centre is, sonographers could scan up to 35-40 patients on a normal 9-5pm day. This is largely in part because in some of these centres, saving of images is not an added responsibility, as discussed in no. 3 above.

Not saving images means you scan a lot faster, with less time allocated per examination, and your patient throughput is increased. However, in a slow-paced Nigerian centre, sonographers could scan well under 20 patients in a day.

In the UK, the NHS is considered pretty fast-paced. So in comparison with fast-paced centres in Nigeria, the NHS provides relatively longer time slots per examination.

Except for some minimal variations in local protocols in different NHS Trusts, the usual time allocation per body part scan (examination) is a minimum of 20 minutes.

Excluding unusual circumstances, this is usually sufficient time to scan, save images and report your scans. Locum/agency sonographers may get 15 minutes per examination.

As a result of this, a typical 9-5pm day will see you scanning about 20-22 patients in the NHS. This could come off as a relief to you if you are very used to scanning in excess of 30-35 patients a day. So, something to be happy about perhaps😊.

5. Focused scans

This particular one was very shocking to me when I first moved to the UK. When I practiced in Nigeria, outpatient clinical requests like “right flank pain, assessment of the renal tract, ?renal stone”, meant we scanned and reported on the whole abdomen, that's usually what the referring doctors preferred.

But when I moved to the UK, a clinical request like the above example meant a focused renal tract ultrasound; only the kidneys, abdominal aorta (depending on the age) and urinary bladder were scanned.

A focused splenic or gall bladder scan like is done in the UK also wasn’t a thing when I scanned in Nigeria. The referring clinicians would usually want an evaluation of the entire abdomen, even when the clinical request suggested the need for a more focused scan some times.

So, while the UK may be more akin to focused scans where necessary, it does mean that a Nigerian sonographer with a sonography job in UK may find it easier and less tasking than their usual practice where this is concerned. Again, something to be happy about perhaps 😊.

6. Chaperones

In the UK, patients are entitled to having a chaperone present for any examination, which is why most (not all) of the radiology departments in the NHS employ formal chaperones who work alongside the sonographers during scans. These chaperones are often stationed with sonographers during scan sessions for the whole day.

Their titles could be health care assistant (HCA), radiology department assistant (RDA), or any other similar title. They are very helpful with preparation of patients for scans, sorting out some related departmental issues, and also helping to ensure the smooth running of ultrasound lists. They are also invaluable witnesses whenever issues or conflicts arise in the workplace.

Some ultrasound units in the NHS don’t have chaperones, as the funding to employ formal chaperones may be limited in some places.

In Nigeria, bearing in mind that a lot of the scan centres are privately funded, it is unsurprising that the funding for formal chaperones may be limited as well. As such, some ultrasound units operate without formal chaperones stationed in the room at all times during scan sessions. For sensitive examinations like transvaginal scans, the option of a chaperone is often offered to patients. Also, the patients are at liberty to have informal chaperones (such as friends or family) with them.

So, if you aren’t already used to having someone with you all day, then it’s best to prepare yourself mentally for having a chaperone rostered with you the entire day when starting your new sonography job in the UK.

7. Post graduate sonography courses (MSc/PGD/PGC Medical ultrasound).

The PGD and Masters in medical ultrasound in Nigeria and in the UK are quite similar in terms of duration, content and assessment criteria.

However, the Nigerian PGD programme goes a step further than the UK PGD, in that to complete the PGD certification in Nigeria, you must undertake a research methods course and dissertation/project work as well.

In the UK, the PGD in ultrasound programme does not include research methods and dissertation. Rather, to advance from PGD to Masters in ultrasound, that's when you undertake either a 60 unit research methods & dissertation course, or Audit methods & Clinical Audits course. You get to choose whichever one you want between the two.

What this means essentially is that what Nigerian sonographers do as a PGD in Nigeria, would actually be a complete master's degree in the UK- because you did all the clinical courses in addition to research methods and dissertation.

Super helpful post: How to become a UK Sonographer from Nigeria

In a school like the University of Nigeria, Nsukka (UNN), the Masters in Ultrasound is for a duration of approximately 3-5 years part time, and in the UK the Masters in Ultrasound programme is also run for a duration of about 3 years (part time). But unlike in the UK, the MSc in Nigeria is not broken into yearly chunks to achieve PGC, PGD and MSc certificates.

In the UK, after a successful first year of your intended MSc programme, you get a PGC for certain ultrasound subspecialties; after a successful second year, you get a PGD in ultrasound, and after the third year, you get an MSc in medical ultrasound. You don’t have to undertake the three years continuously, you could take breaks in between each qualification.

But in Nigeria, you have to undertake the 3-5 years continuously for an MSc in ultrasound. You don’t get any PGC or PGD qualification if you break your studies at any point in Nigeria.

Do you know what this means for you if you want to get a Masters in ultrasound in the UK? You may never see me again, so save this post and subscribe to get notified as soon as this upcoming information is posted.

8. Pre-booking appointments

Pre-booking ultrasound appointments is a big deal in the UK, in the sense that if patients turned up on the day without a previous appointment, the chances of that patient getting scanned will be very slim. But in Nigeria, pre-booking appointments is not such a big deal. While patients are at liberty to book their scans in advance, a lot of patients who turn up on the day without pre-booking are often fitted in to be scanned.

In conclusion

Cultural and professional differences understandably differ from one world region to another, and these differences can be vast and varied. If you’re intending to relocate from overseas to UK for the purposes of work, it becomes intrinsically important to be aware of the professional differences and similarities in sonography practice that exist across both regions.

This helps you prepare for the cultural, social, and workplace differences that you may encounter in your new environment. It also helps you to avoid misunderstandings and conflicts that may arise from professional or workplace differences.

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