Background/Purpose: Ultrasound guided synovial biopsy (UGSB) is a minimally invasive, safe and effective tool to obtain synovium for clinical and research purposes. Described in Europe in 1997, UGSB was introduced to US rheumatologists in 2015 via the NIH-AMP program. Logistical barriers, learner confidence and the lack of a critical mass of trained rheumatologists to assist new learners have impeded the adaptation of UGSB in the USA. UGSBy, a collaborative group of four USA-based rheumatologists who completed the 2015 NIH-AMP program, was formed to develop a network of rheumatologists skilled in UGSB. In 2022, UGSBy partnered with the Ultrasound School of North American Rheumatologists (USSONAR) and conducted 3 courses in the USA to expand the workforce of USGB trained rheumatologists. An emphasis on patient safety was an integral feature of these courses. This study was conducted to determine the effectiveness of these courses in allowing learners to integrate knowledge with acquisition of skills in UGSB.

Methods: Three courses were conducted (1:15 students, 2:16 students, 3:14 students). Each course consisted of didactic and hands-on cadaver training. Instructor to learner ratio was 1:4. Musculoskeletal ultrasound competence was a course prerequisite which was defined as prior certification and/or documented course completion in basic-advanced musculoskeletal ultrasound. Serial surveys were deployed at the course completion (T0) and every 3 months after (T3, T6…). Learner confidence was assessed with the L-SES, a validated learning self-efficacy scale (L-SES) for Clinical Skills, consisting of 12 five-point Likert scale (strongly disagree-strongly agree) based questions to measure three domains: cognitive (Cog), affective (Aff) and psychomotor (Psy). The L-SES has been shown to directly correlate with academic achievement and effective learning strategy use.

Results: Learners from the first course reported positive mean L-SES in the cognitive domain (Cog=3.85, Aff=2.9, Psy=2.9, n=5) at T6. Learners from the second course demonstrated a positive mean LES in all three domains at T0 (Cog=4.4, Aff=3.7, Psy=3.84, n=16); at T3 the cognitive and psychomotor domains had a positive L-SES (Cog=3.9, Aff=2.9, Psy=3.25, n=4). A learner from the first course performed a first biopsy 5 months after the course.

Conclusion: Integration of knowledge with skill acquisition in UGSB is important in determining the quality of education received in these courses. Learners in these courses report a positive L-SES. Further analysis with serial data will explore (1) serial changes in L-SES, (2) the relationship between adaptation UGSB and L-SES, and (3) impact of the presence of a colleague in the same practice situation who is skilled in UGSB and time to adaptation of UGSB after training.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-guided-synovial-biopsy-course-achievement-of-learner-self-efficacy/