Committee Chair

Rausch, David W.

Committee Member

Hinsdale, Bernard; Ellis, Jennifer T.; Toreno, Felicia


Dept. of Education


College of Health, Education, and Professional Studies


University of Tennessee at Chattanooga

Place of Publication

Chattanooga (Tenn.)


The past two decades have demonstrated sonographer work-related musculoskeletal disorder (WRMSD) rates between 80.0 to 90.4%. A surprising revelation made by sonographers was that educators were not perceived as the primary providers of ergonomics instruction. For these reasons, a mixed methods study was performed, involving a causal-comparative component with a longitudinal perspective, a quasi-experimental element, and limited observations and interviews. The study followed four years of sonography graduates through the early career scan period, comparing transmissional, transactional, and transformational learning results. The study’s goal was to determine whether transformative ergonomics learning in a collaborative and reflective environment could demonstrate a significant difference in the reduction of negative scan habits associated with reported musculoskeletal disorders (MSDs), compared to transmissional and transactional learning. Testing revealed that a typical early career sonographer was unaware of the high percentage of musculoskeletal injuries (MSIs) in the field, nor readily perceived personal risks despite possessing knowledge of other injured sonographers. Nevertheless, nearly three-fourths of the study’s subjects described work-related MSD complaints before the five year career period, with shoulders, neck, wrist, and back areas being most common among both general and cardiac sonographers. Determining early scan risk behaviors that coincide with early pain reports and working toward preventative corrective actions may, in fact, reduce the likelihood of such future WRMSD complaints. Photoplethysmography (PPG) recordings during challenging maneuvers demonstrated additional benefit toward the reduction of negative scan behaviors; while transformational learning demonstrated significant benefit in both reducing negative scan behaviors and increasing positive behaviors. Transformational learners expressed more empowerment toward reducing personal risk susceptibility through collaborative recognition and corrective action planning measures. Transformational learners also cited positive attitudinal impact in peer collaboration, while demonstrating a noticeable change in MSI personal risk ratings at the conclusion of learning. The study also revealed that, despite ergonomics learning, early career sonographers did not respond as readily to corrective feedback until personally experiencing an MSI. However, transformational learners demonstrated much greater responsiveness to corrective feedback than did the other learning classifications. This higher transformational level of learning provided evidence toward reduction of WRMSDs among sonographers through responsiveness of corrective action planning.


Ed. D.; A dissertation submitted to the faculty of the University of Tennessee at Chattanooga in partial fulfillment of the requirements of the degree of Doctor of Education.




Work -- Physiological aspects; Human engineering; Musculoskelatal system -- Wounds and injuries; Occupational diseases -- Prevention


Ergonomics; Instruction; Sonographer; Learning; Transformational; Transformative

Document Type

Doctoral dissertations




xxxi, 467 leaves