Background/Purpose: Rheumatology musculoskeletal ultrasound (MUS) certification has been established and MUS teaching is rapidly being incorporated into U.S. rheumatology fellowship training programs. Similarly, MUS use by physiatrists is growing, and exposure to MUS and rheumatology teaching is now mandatory in physical medicine and rehabilitation (PM&R) residency programs. At this time, no standardized rheumatology MUS curriculum is required, but competency criteria are currently under discussion.

Methods: We describe the implementation of a novel, collaborative rheumatology/physiatry MUS training program at a single academic center. The program was developed by a rheumatology MUS expert in conjunction with the program directors of both rheumatology fellowship and PM&R residency to adequately expose fellows to MUS, and fulfill both rheumatology and MUS training requirements for residents. A self-assessment survey of the participating fellows and residents was obtained post-implementation, using a 3-point Likert formatted scale (1=no knowledge to 3= extensive knowledge).

Results: All 1st year rheumatology fellows (n=2) were required to participate in a twice monthly ½ day faculty-mentored, MUS clinic over one year. For 2^nd year rheumatology fellows with a demonstrated interest in MUS (n=1), additional training included: longitudinal, weekly, faculty-mentored MUS clinics, participation in the USSONAR program, and MUS research. All PGY-3 PM&R residents (n=9) were required to participate in a 1-month rotation of faculty-mentored MUS clinics, 3 days per week. All rheumatology fellows and PM&R residents (n=12) participated in an introductory MUS lecture to review basic knobology, image acquisition, and reasonable use of MUS. Every other month, hands-on sessions reviewed anatomy and scanning protocols. Both groups had access to US equipment for self-directed learning. In the clinic, fellows/residents evaluated patients referred for musculoskeletal pain in a one-stop approach where MUS and guided injections may be performed, as indicated. All fellows and residents completed the survey (Table 1). Post-curriculum, 100% of participants felt they had adequate exposure to MUS and adequate MUS knowledge/ability. Ten of the 12 (84%) trainees participated in self-directed learning. The average range of MUS exams performed by all participants was 11-20; MUS-injections also ranged from 11-20. Six of the 12 trainees (50%) participated in MUS research activities.

Conclusion: Implementation of a collaborative MUS training program is beneficial to the education of both rheumatology fellows and PM&R residents. Improvement in MUS knowledge and ability was shown in both groups. A combined program can adequately fulfill the educational and research needs for both specialties, especially when the number of trained MUS instructors may be limited.

Table 1. Post-Implementation Survey (3-point Likert Scale)