Self‐directed learning of basic musculoskeletal ultrasound among rheumatologists in the United States

Abstract

Objective. Because musculoskeletal ultrasound (MSUS) is highly user dependent, we aimed to establish whether non-mentored learning of MSUS is sufficient to achieve the same level of diagnostic accuracy and scanning reliability as has been achieved by rheumatologists recognized as international experts in MSUS. Methods. A group of 8 rheumatologists with more experience in MSUS and 8 rheumatologists with less experience in MSUS participated in an MSUS exercise to assess patients with musculoskeletal abnormalities commonly seen in a rheumatology practice. Patients' established diagnoses were obtained from chart review (gout, osteoarthritis, rotator cuff syndrome, rheumatoid arthritis, and seronegative arthritis). Two examining groups were formed, each composed of 4 less experienced and 4 more experienced examiners. Each group scanned 1 predefined body region (hand, wrist, elbow, shoulder, knee, or ankle) in each of 8 patients, blinded to medical history and physical examination. Structural abnormalities were noted with dichotomous answers, and an open-ended answer was used for the final diagnosis. Results. Less experienced and more experienced examiners achieved the same diagnostic accuracy (US-established diagnosis versus chart review diagnosis). The interrater reliability for tissue pathology was slightly higher for more experienced versus less experienced examiners ( ‫؍‬ 0.43 versus ‫؍‬ 0.34; P ‫؍‬ 0.001). Conclusion. Non-mentored training in MSUS can lead to the achievement of diagnostic accuracy in MSUS comparable to that achieved by highly experienced international experts. Reliability may increase slightly with additional experience. Further study is needed to determine the minimal training requirement to achieve proficiency in MSUS.

A blended learning approach to palpation and ultrasound imaging skills through supplementation of traditional classroom teaching with an e-learning package

“…The usefulness of e-learning to develop ultrasound examination competencies was previously reported (Filippucci et al, 2007;Muller et al, 2008); however, to our knowledge, this is the first prospective randomized study to explore the effectiveness of e-learning to develop palpation and musculoskeletal ultrasound examination skills. Our findings were similar to those obtained by other reputed educational strategies for the acquisition of ultrasound imaging skills, including peerassisted (Knobe et al, 2010) and expert-mentored (Kissin et al, 2010) learning.…”

Evaluation of E-Learning as an Adjunctive Method for the Acquisition of Skills in Bony Landmark Palpation and Muscular Ultrasound Examination in the Lumbopelvic Region: A Controlled Study

“…The acquisition of USI skills by musculoskeletal manual practitioners 2,37,38 has been studied with several learning strategies including peer-assisted 39 or expert-mentored 40 and computer-assisted learning (CD-ROM). 41 In our study, the e-learning group displayed superior development in most aspects of ultrasound skills in comparison with the conventional learning (control) group, confirming a previous study on knee area.…”

Reply

“…Our concern instead is with the more superficial crash courses in MSUS that might be sponsored by individual institutions or private educational outfits or are held at national and international meetings, where participants may believe, after purchasing the required equipment, that they are legitimate MSUS practitioners. This view, to a large extent, could be supported by a superficial and erroneous reading of a Boston study, in which American and international MSUS-trained rheumatologists participated, where for defined findings in each of the regions routinely explored by MSUS, it made little difference whether the rheumatologist had had extensive or limited training (5). In defense of more experienced ultrasonographers, this study may not have been able to demonstrate the nuanced differences that enable those with more experience to confidently analyze a finding that strays from the routine or well-defined.…”