Background/Purpose: The Los Angeles County Medical Center-University of Southern California Rheumatology fellowship program has incorporated MSUS in its curriculum since 2009. Apart from didactics with hands-on workshops, cadaver-based simulation, a weekly 4-hour musculoskeletal ultrasound clinic (MSUSc) was incorporated with an early rheumatoid arthritis (ERA) clinic to teach knowledge and skills (MSUS-KS). The MSUSc was also established to address MSUS needs of patients which could not feasibly be done during other clinics. The objective of this study was to assess the utilization of a dedicated MSUSc by fellows as part of curricular program evaluation.

Methods: A sampling of 50 charts seen at the MSUSc July 2009-May 2013 was done. Charts were reviewed mainly for: reasons for referral, pre-existing diagnoses, anatomic sites evaluated, intervention (synovitis evaluation, guided injection) and outcomes (pain resolution, diagnosis change) were noted. A Likert-scale based survey by current and graduate fellows was done to determine effectiveness of MSUSc teaching, and effectiveness of the overall curriculum. Review of electronic portfolios (ePFs) was done to assess evidences of learning.

Results: Majority of the patients were seen within a week’s time from date of referral from a fellow continuity clinic. The most common pre-clinic diagnoses were: RA (35), psoriatic arthritis, OA (2 each), gout, pseudogout, vasculitis, mixed connective tissue disease, entrapment neuropathy (1 each), and tendinopathy (3). Majority of referrals were for initial diagnostic evaluations (29), treatment monitoring (10), mass evaluation (1), therapeutic injections without prior attempt (9).  Of cases referred for initial diagnostic evaluation, 9 were injections without prior attempts, 8 were diagnostic scans followed by injection based on scan findings. Scans for RA initial diagnostic ultrasound were more common and included fingers (15), wrist (11), knee (11), and elbow joints (7). Majority of scans for synovitis showed positive power Doppler (23). Of 11 tendinopathy evaluations, positive doppler (3), and tendon tears (3) were noted. Of 20 patients that had injections, 80% reported pain relief. Overall 38% of patients had a change in treatment based on the ultrasound findings or procedure.

Of 15 fellows surveyed, 11 responded. 90% were agreeable regarding MSUSc provision of adequate patients, and efficient opportunities for procedures. All noted better understanding of MSUS indications and limitations. There were 50% neutral-disagree responses regarding overall confidence in doing MSUS, pathology identification. Immediate attending feedback and self-directed learning were cited as MSUSc advantages. All ePFs showed mainly procedure logs and journal article reviews as evidence of MSUS learning with most of procedures done during MSUSc.

Conclusion: This is an initial attempt to assess the effectiveness of learning MSUS-KS through various teaching approaches including experiential learning in a MSUSc and its applicability towards patient care. Feedback obtained from fellows can be used to improve curricular content and guide proper competency-based assessments.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/experiential-learning-in-musculoskeletal-ultrasound/