Where's the baby?

Heather Venables, Diagnostic Imaging, University of Derby

Background and purpose

In ultrasound training, image orientation and the ability to link 2D image interpretation with 3D anatomy is key. Ultrasound looks easy when performed by an expert. However, the hand-eye coordination and spatial awareness required to complete a scan often come as ‘a bit of a shock’ to novice sonographers. This is particularly true in obstetrics where we image a moving target. This can result in a rapid drop in confidence and significant anxiety. 

There is evidence that students cope with this uncertainty by mimicking expert behaviours. This may include transducer position, patient position and ‘image grabbing’. This frequently results in feedback from mentors that the student “….just doesn’t get it”.

Review of work by Meyer and Land (2003) identifies the importance of threshold concepts in education. Where students fail to grasp key concepts, they may find themselves in a ‘stuck place’ where they are aware that they are failing to progress but, are unable to articulate why.


We use simulation activities to ‘unpick’ student understanding of image acquisition. This helps them move from image grabbing to a logical and systematic approach building on good 3D spatial awareness rather than mimicking of observed behaviours.

We have developed a simple card game that is enables students to identify misconceptions around image scan planes and orientation that may result in an inability to interpret fetal position and situs.


Students and mentors report rapid improvement in scan technique and confidence once essential threshold concepts are grasped. This is frequently described by students and their trainers as a ‘penny drop’ moment.


This simple, low-cost intervention may help facilitate early identification of students who are struggling with image orientation and fetal lie. A better understanding of threshold concepts enables us to develop targeted learning and assessment activities.

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