Background/Purpose: The Accreditation Council for Graduate Medical Education and the American Board of Internal Medicine have initiated the development of milestones for internal medicine (IM) residency training that would facilitate objective documentation of resident achievement of competence in six dimensions of practice. Milestones for IM subspecialties are now in development. Musculoskeletal ultrasound (MSUS) in Rheumatology is at its infancy, and not yet a fellowship requirement. However educators and fellows are encouraged to undergo training to acquire knowledge, skills and attitudes (KSA) in this field. The American College of Rheumatology has recently approved initiation of MSUS certification examination. The objective of this study was to develop milestones in the six dimensions of general practice in relation to usage of MSUS in Rheumatology.
Methods: A core group of educators (3 program directors, 1 associate program director) who are members of the Ultrasound School of North American Rheumatologists (USSONAR) adopted the 5-level Dreyfus model of skill acquisition as a framework for defining milestones and to describe progression of a learner: novice (level 1), advanced beginner (2), competent (3), proficient (4), expert (5). Level 3 is the minimum level considered competent to independently practice MSUS. A search of the medical and educational literature was done in order to define competency-specific KSA needing assessment, and to characterize for each level a behaviorally-based narrative description. The milestones were vetted by the group every two weeks by Skype and email over a period of six weeks. Consensus was reached so that each narrative description represented a continuum of training and practice that logically progressed in acquisition of KSA.
Results: Frameworks for the competencies of Medical Knowledge (MK) and Patient Care (PC) have been developed. While still related to general IM milestones, the milestones defined were more focused on MSUS-related KSA. The content areas content for each competency were clarified. For MK, core knowledge related to correlations between anatomy, pathology and MSUS image acquisition and interpretation were emphasized along with basic principles on usage of MSUS in general, performance of MSUS-guided procedures, and documentation of findings. For PC, the area of concern was the incorporation of MSUS as a tool to aid clinical skills and reasoning, and to assist in the delivery of patient-centered care. Using the 5-level Dreyfus model, a sequence of behavioral descriptions were provided that describe the development of a learner from a novice stage (level 1) to that of an expert (level 5). A review and summary of relevant literature and references were also developed.
Conclusion: The MSUS in Rheumatology milestones in the dimensions of MK and PC provide an initial and significant step towards a meaningful assessment of outcomes for rheumatologists who want to achieve minimum through higher levels of competency in MSUS. The core group hopes to soon develop milestones for the other competencies and subcompetencies, with further plans to validate these milestones across different training programs.
Disclosure:
K. D. Torralba,
None;
J. B. Higgs,
None;
A. C. Cannella,
None;
G. S. Kaeley,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/from-novice-to-expert-competency-milestones-for-musculoskeletal-ultrasound/