Background/Purpose: There is growing adoption of dedicated musculoskeletal ultrasound (MSUS) training in rheumatology fellowships. However, the lack of established ACGME MSUS training requirements and competencies leaves curricular development and implementation to the discretion of individual programs. Our current MSUS curriculum is geared towards 1^st year fellows with 6 weekly lectures and hands on sessions in late summer. Subsequent training occurs via periodic participation in dedicated MSUS clinics run by attendings.  A survey of our 2^nd year fellows indicated that our current MSUS curriculum did not adequately prepare them to operate US machines or confidently scan patients independently. A survey of our 1^st year fellows indicated a strong desire for MSUS training in fellowship with goal of Musculoskeletal Ultrasound Certification in Rheumatology (RhMSUS), indicating a need to adjust our curriculum to better meet the needs of our trainees.

Methods: We designed and implemented additional voluntary hands-on MSUS training sessions for 1^st year fellows from January to May 2024. Sessions were one hour long, held weekly and fellow run. They were held following our mandatory division-wide lectures to minimize barriers to attendance. We focused on basic ultrasound machine operation, technical scanning skills, and identification of normal anatomy. Joints covered included fingers, toes, wrists and knees over 13 sessions.  An observed hands-on final examination was performed to demonstrate basic proficiency in utilizing MSUS to identify normal anatomy.

Results: Seven sessions were attended by at least one fellow, with all five fellows attending at least one session. Six sessions were not attended by any fellows. Two fellows attended three or more sessions. Three pre-training quizzes were completed for the finger and toe joints at the first session and no post-training quizzes were completed due to lack of consistent attendance. Two of the three fellows that completed the hands-on final examination demonstrated adequate proficiency to independently perform ultrasound examinations.

Conclusion: Due to poor attendance, objective evaluation of the effectiveness of the sessions was not possible. An anonymous follow up survey completed by 4 participants indicated unanimously that “lack of time and clinical demands” were the greatest barriers to attending more sessions. Interestingly, all participants continued to indicate a goal of developing MSUS proficiency and RhMSUS certification, confirming an ongoing need for additional curricular development.

Despite the lack of fellow participation, the process was constructive, demonstrating that voluntary fellow run MSUS training is not a viable intervention to supplement our current US curriculum. Additionally, the survey indicated a strong fellow preference for a more longitudinally structured curriculum to enhance US skill and knowledge retention. This has led our faculty to restructure our curriculum for AY 2024-2025.  There is also consideration for establishing required MSUS competency standards to ensure futures fellows obtain the basic knowledge and skills needed to incorporate MSUS into their clinical practice post-fellowship.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-fellow-driven-voluntary-initiative-in-musculoskeletal-ultrasound-training-interest-does-not-equal-attendance/