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11. Letters to the Editor

Dear Editor... 

Following the featured article “Does a “qualified” Vascular Scientist need the AVS qualification?” submitted by AVS' Alison Charig and Ellie Blaxland, I received the enclosed response from Ryan Ward, STP Graduate and SVT Trainee Representative on Education Committee.

STP’s trainee perspective 

From the perspective of someone who is now applying for the AVS practical exam having completed the STP several years ago, I do think the AVS still holds a crucial place in the certification of what one might call a “qualified” vascular scientist. 

I also however, feel that that the debate surrounding AVS, whilst a worthwhile regular reflection on whether it reflects current practice, often quickly becomes tribal and divisive with little room for discussion. 

There is no doubt in my mind that almost all vascular ultrasound practitioners in the UK would agree that the stringent requirements necessary to obtain AVS ensures that whomever holds the qualification is extremely competent. The AVS qualification therefore acts as a nationally accepted currency, a known and recognised quantity of competence that reassures a potential employer of what they can expect. 

However the debate is clearly in the suggestion that the reverse is true; the omission of AVS therefore makes you incompetent, or “unqualified”. This suggestion, which many consider to be rude or insulting, is one of the reasons this debate can become so divisive or emotive. 

Some individuals continue to train via the AVS and STP pathway in centres where the access to varicose veins are extremely low. These can be individuals who are extremely experienced and competent in all other aspects of vascular ultrasound, but who will never obtain AVS without further time at another hospital. Other than planning for future employment in a different trust, what incentive do these otherwise competent individuals have to pursue AVS? 

A counter argument would be that without external assessment via the theory and practical exams, what is believed to be self-competence might actually be bad practice, habits and incorrect knowledge. This may not necessarily be true, but the potential for harm without peer review is so great, that it is this reason at least for me why I feel the AVS not only has a place, but a duty in ensuring safe and competent national practice. 

There is considerably more depth to this debate which I have not attempted to dive into, however my opinion is that the AVS most certainly still holds a place as a sign of verified competence which all self-conscious vascular practitioners should aspire to. However I also feel there should be more acceptance and understanding on why potentially competent individuals may not wish to pursue the AVS qualification, and how this does not necessarily make then “unqualified” without it. 

Lastly, I would like to add a brief comment to the AVS/non-STP/”traditional” training route v STP debate. Having personally completed the STP and observed my colleagues training on the AVS pathway over the past two years, it is plain to see that the AVS route is superior in advancing practical scanning skill, purely due to the uninterrupted time to practical experience trainees can commit too. However it is also clear that the structure of the STP is superior in advancing academic judgement and knowledge in a timelier manner when compared to the practical focused AVS route. I believe all of the above is fairly agreed upon. 

Few would deny that the job is almost entirely practically scanning in nature, hence why many feel the AVS is superior as it fast tracks progress in this domain. However the delay in practical experience via the STP route is quickly compensated after several years post-graduation, leaving both trainees in the same position having just taken different routes to get there. Furthermore, what is often not highlighted enough is the need for academic experience if we wish to develop our profession. Not only is this important to allow us to participate and lead our own research to improve our services, but also to maintain interest in our field of expertise. 

The opening paragraph to this article highlighted that the number of AVS staff is approximately 260 and has remained stable over the past several years, despite a regular new influx of trainees. The elephant in the room is that this could and likely is partially related to a declining interest for the job once practically competent. All careers require frequent stimulation if they want to preserve the expertise of the senior and experienced staff, and the only way to succeed in this is to provide extra avenues to explore; whether this be management, professional committees, or research. In conclusion, I feel that both training schemes should co-exist and offer different advantages in different time frames, but having the exposure and encouragement to engage in research might go somewhere towards reducing AVS staff who leave the professional and subsequently increasing AVS total numbers. 

If you have any comments or questions relating to featured articles in the newsletter send your “Letters to the Editor” for inclusion in the next publication. Please email