Session Title: Medical Education
Session Type: Abstract Submissions (ACR)
Background/Purpose: The Los Angeles County-University of Southern California Rheumatology fellowship program has incorporated musculoskeletal ultrasound (MSUS) in its curriculum since 2009. The following teaching approaches have been used: 1) 8-hour correlative history-physical exam-MSUS didactic and hands-on scanning workshop, 2) twice monthly cadaver-based procedural simulation, and 3) weekly MSUS clinic. We aimed to evaluate the effectiveness of this curriculum in the acquisition and utilization of MSUS-knowledge and skills (MSUS-KS).
Methods: Program evaluation was done through: 1) Likert-scale based survey of current and past fellows (2010-2013, (N=15)), noting satisfaction with organization and content, confidence, and MSUS-KS utilization, 2) written feedback from 3 faculty members regarding challenges faced, 3) MSUS-clinic utilization review via sampling of 50 cases referred and seen by fellows since 2010 (reasons for referral, interventions, patient outcomes); and 4) review of competency-based electronic portfolios (ePFs) for learning evidences. Ultrasound School of North American Rheumatologists (USSONAR) fellow program participation was also considered. Descriptive statistics were used to analyze data.
Results: 11/15 fellows responded to the survey (6 current, 5 graduates; 4 were USSONAR participants). There was a favorable response towards organization and content of the workshop-didactic sessions, and clinic. Suggested improvements included: limiting simulations to once monthly, correlative dissection; and disease-specific (i.e. synovitis) didactics. Immediate feedback from faculty was useful. 10/11 agreed with understanding MSUS indications and limitations, and had an improved understanding of clinical anatomy. There was at least 50% neutral-disagree responses regarding confidence in using MSUS, ability to identify pathology; and amongst graduates, regarding application of MSUS-KS in practice. Faculty cited a learning curve, striking a balance between developing their own MSUS-KS while also achieving confidence and competency in teaching this field. ePFs showed documentation through procedure logs and journal article reviews; USSONAR fellows had more number of evidences. Referrals to MSUS clinic were mainly by fellows sending patients from continuity clinics, and majority were for rheumatoid arthritis disease activity evaluation. 38% of patients had management changes as a result of MSUS findings. 20 patients underwent MSUS-guided injection; 80% had symptom relief at follow-up.
Conclusion: This program evaluation indicates feasibility in the usage of these various teaching approaches as part of a MSUS curriculum. Faculty development and learner participation are vital towards successful implementation; USSONAR participation can complement learning. Feedback can be used to improve curricular content and organization, and assessment. Measures are needed ensure lifelong learning. Although this study involved a limited number of fellows in one program, it provides a realistic view of how to incorporate MSUS into a fellowship curriculum.
K. D. Torralba,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-based-program-evaluation-of-a-musculoskeletal-ultrasound-curriculum/