Background/Purpose:

Musculoskeletal Ultrasound (MSKUS) is becoming an important component of rheumatology practice. Given increasing appreciation of bedside ultrasound, residency programs are beginning to include ultrasound training in their curriculum. Time and resources are barriers to implementation. We performed a pilot study to assess the feasibility of incorporating introductory MSKUS education into an Internal Medicine (IM) Residency Program.

Methods:

A limited MSKUS curriculum for IM residents was created, with knee ultrasound as focus of our pilot study.  After IRB approval, participants were recruited and consented.  Educational program included reading material; two one hour lectures on anatomy, biophysics and pathology; and a 30 min hands on practicum. A pre and post test for medical knowledge was performed, and a minimum 80 % score was required to proceed.

Residents then received individual technique training on two knees, with identification of effusion as principal objective.  They were supervised for cognitive and technical skill by experienced rheumatology faculty.

An Observed Structured Clinical Exam (OSCE) was performed. Each resident performed MSKUS on two patient knees. Residents were assessed for proper probe placement, machine use and identification of knee effusion. In addition, they were tested on five still images. Feedback questionnaires were completed by residents and faculty. Analysis was performed using paired t-test for pre and post tests and survey results were collated.

Results:

All fifteen enrolled residents completed their training but twelve could complete the OSCE. Pre and post results [TABLE 1] demonstrated significant improvement in knowledge for all three curricular components (p <0.001). Final OSCE scores ranged from 7 to 10 on a 10 point scale. Faculty evaluated all residents’ cognitive and technical skills as excellent or good. All participants rated reading material, orientation and supervision as great or good on the four point Likert scale. Program was thought to be a valuable learning experience by all participants. Although 66.7% participants thought the exposure to patients before OSCE was adequate, others suggested 3 to 20 additional supervised procedures. Based upon resident performance and faculty time commitment, faculty rated overall learning experience as good.

Conclusion:

Our study was a pilot project to assess incorporating introductory MSKUS training into an IM Residency training program, addressing feasibility, perceived value, and observed competence. Based upon our preliminary results, the curriculum is a feasible and time efficient addition to training and was considered valuable by both faculty and residents. Further studies are needed to assess methods to reinforce core training for all residents, offer advanced curriculum for a subset of interested residents, and assure MSKUS for IM residents complements their ultrasound training in other subspecialties.

 

Table 1: Outcomes Data Analysis (Paired t- test)

Variable	Pretest Values		Posttest Values		p-value
	Mean	SD	Mean	SD
Pre-Post Total (20)	6.45	1.62	17.48	1.13	<0.001
Biophysics (12)	3.88	1.32	11.13	0.63	<0.001
Pathology (4)	0.97	0.90	3.07	0.68	<0.001
Anatomy (4)	1.60	0.92	3.28	0.50	<0.001

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/basic-musculoskeletal-ultrasound-curriculum-among-internal-medicine-residents-a-pilot-study/