Background/Purpose: Musculoskeletal
ultrasound has been increasingly recognized as a cost-effective, sensitive diagnostic
bedside tool that rheumatologists can utilize across a wide spectrum of
inflammatory and non-inflammatory diseases.  It is rapidly becoming a
highly requested elective during fellowship, though few curricular components
exist for fellows not enrolled in a dedicated year-long course of training
track.  We report on our newly designed curriculum that features
intermittent, short intense bursts of interactive teaching exercises that
utilize formative assessment, flanking each session as a means to not only
assess effectiveness of learning across several months, but also to reinforce important
concepts from previous weeks and lead to a more durable retention of material
when daily practice is not feasible.

Methods: Six
two-hour teaching sessions were developed over a four month period of time.
Fellows personal goals were assessed initially to guide the curriculum
development. Each session focused on a different joint area and consisted of a
de-identified pre-assessment and cumulative assessment, short framing lecture,
modeling of scanning technique, hands on scanning (with a 1:1 or 2:1
fellow:machine ratio), and post-assessment. All questions were reviewed with
the fellows at the conclusion of every session. The cumulative assessment
consisted of 10 multiple choice questions related to key concepts from prior
sessions and the pre-assessment contained 5 multiple choice questions about the
day’s session. The post-test consisted of 5 multiple choice questions which
covered the sessions’s content. A final assessment was administered about a
month after the last session which consisted of 53 multiple choice questions to
assess retention of knowledge.

Results: Three
rheumatology fellows (two first years, one second year) with at most minimal
experience, participated in the curriculum.  Participants’ personal goals
included understanding the mechanics of ultrasound as well as identifying
normal structures and pathology. A poll after the course revealed that all objectives
were met.  The average score of the six pre-assessments was 43.5% and 85%
on the post-assessments with an average percent improvement of 41.5%. The
cumulative pre-assessments (not including the final assessment) average score
was 71%. The final assessment average was 80%. It was observed that the fellows
scored equally on first order and higher order questioning.

Conclusion:
Effective implementation of a musculoskeletal ultrasound curriculum can be
easily introduced into a training program where routine daily practice is not
possible.  Intermittent, short intense bursts in coordination with
spiraling content review, was shown to be a successful teaching method with
fellows demonstrating durability of knowledge.