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Adler RS. What is the place of ultrasound in MSK imaging? Skeletal Radiol 2024:10.1007/s00256-024-04642-2. [PMID: 38492028 DOI: 10.1007/s00256-024-04642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
During the past four decades, ultrasound has become popular as an imaging modality applied to the musculoskeletal (MSK) system, particularly outside the USA, due to its low cost, accessibility, and lack of ionizing radiation. A basic requirement in performing these examinations is to have a core group of radiologists and ultrasound technologists with expertise in MSK ultrasound. The extent to which ultrasound will be part of the imaging offered by a particular radiology practice or in an academic institution will vary according to expertise, availability, and reimbursements. A brief discussion of the technical capabilities of the current generation of ultrasound scanners will be followed by a description of some of the more prevalent MSK ultrasound imaging applications. The extent to which training to perform these exams within and outside of Radiology plays a role is discussed. Applications that are unique to ultrasound, such as dynamic evaluation of musculoskeletal anatomy and some, US-guided interventions are an important part of MSK imaging. Ultrasound is increasingly important in the assessment of superficial structures, such as tendons, small joints, and peripheral nerves. These applications help to establish the place of ultrasound as an important part of the Radiologists approach to MSK imaging. Outside of radiology, for a variety of clinical subspecialties, ultrasound already plays an integral role in MSK imaging.
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Affiliation(s)
- Ronald S Adler
- Department of Radiology NYU Grossman School of Medicine, 333 East 38Th Street, 6-209, New York, NY, USA.
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2
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Factor S, Albagli A, Bebin A, Druckmann I, Bulkowstein S, Stahl I, Shichman I. Influence of residency discipline and seniority on traumatic musculoskeletal radiographs interpretation accuracy: a multicenter study. Eur J Trauma Emerg Surg 2023; 49:2589-2597. [PMID: 37573536 DOI: 10.1007/s00068-023-02347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Imaging studies are a significant and integral part of the initial assessment of patients admitted to the emergency department. Developing imaging diagnostic abilities early in residency is of paramount importance. The purpose of this study was to evaluate and compare diagnosis accuracy of common musculoskeletal X-rays (XR) between residency disciplines and seniority. METHODS A multicenter study which evaluated orthopedic surgery, emergency medicine (EM), and radiology residents, through a test set of common MSK XR. Residents were classified as "beginner" or "advanced" according to postgraduate year per residency. Residents were asked to answer whether the radiograph shows normal or pathological findings (success rate) and what is the diagnosis ("diagnosis accuracy"). Residents' answers were analyzed and assessed compared to experts' consensus. RESULTS A total of 100 residents (62% beginners) participated in this study. Fifty-four were orthopedic surgeons, 29 were EM residents and 17 were radiologists. The entire cohort's overall success rate was 88.5%. The overall mean success rates for orthopedic, EM, and radiology residents were 93.2%, 82.8%, and 83.3%, respectively, and were significantly different (p < 0.0001). Orthopedic residents had significantly higher diagnostic accuracy rates compared with both radiology and EM residents (p < 0.001). Advanced orthopedic and EM residents demonstrated higher diagnostic accuracy rates compared to beginner residents (p = 0.001 and p = 0.03, respectively). CONCLUSION Orthopedic residents presented higher diagnosis accuracy of MSK imaging compared to EM and radiology residents. Seniority had a positive effect on diagnosis accuracy. The development of an educational program on MSK XR is necessary to enhance the competency of physicians in their daily practice.
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Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Assaf Albagli
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alex Bebin
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Druckmann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Radiology, Tel Aviv Medical Center, 6423906, Tel Aviv, Israel
| | - Shlomi Bulkowstein
- Division of Orthopedics, Soroka University Medical Center, Beer-Sheva, P.O. Box 151, 84101, Beer-Sheva, Israel
- Affiliated to the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ido Stahl
- Division of Orthopedic Surgery, Rambam Healthcare Campus, 3109601, Haifa, Israel
- Affiliated to the Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Haifa, Israel
| | - Ittai Shichman
- Division of Orthopedic Surgery, Tel Aviv Medical Center, 6 Weitzman St., 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Malhotra G, Hansford BG, Felcher C, Wuerfel KA, Yablon CM. Fluoroscopic-guided procedures of the lower extremity. Skeletal Radiol 2023; 52:855-874. [PMID: 35930079 PMCID: PMC9362560 DOI: 10.1007/s00256-022-04139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
This article reviews the literature and the authors' experiences regarding the performance of lower extremity fluoroscopically guided procedures from the hip to the toes. An overview of injections and aspirations, their indications, risks, and complications are provided, focusing on anesthetics, corticosteroids, and contrast agents. A variety of approaches to each joint and the associated pearls and pitfalls of each approach will be discussed.
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Affiliation(s)
- Gunjan Malhotra
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Barry G. Hansford
- grid.5288.70000 0000 9758 5690Department of Radiology, Oregon Health & Science University, 3181 SW Jackson Park Rd., Portland, OR 97239 USA
| | - Cindy Felcher
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Kristie A. Wuerfel
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Corrie M. Yablon
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
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Simon MJK, Regan WD. Utilization of MRI in surgical decision making in the shoulder. BMC Musculoskelet Disord 2022; 23:588. [PMID: 35717178 PMCID: PMC9206361 DOI: 10.1186/s12891-022-05541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background The aim of this study is to evaluate both the utility of MRI scans and reports used in the current practice routine of shoulder surgeons and their surgical decision-making process. Methods Ninety-three shoulder-specialised orthopaedic surgeons of the Canadian Shoulder and Elbow Society (CSES) Orthopaedic Association were surveyed in 2020 anonymously online to help identify the use of MR-imaging and reports in managing shoulder disorders and surgical decision process. Results Thirty out of 93 (32.25%) CSES fellowship-trained orthopaedic surgeons participated. Respondents request MRI scans in about 55% of rotator cuff (RC) pathology and 48% of shoulder instability cases. Fifty percent of patients with potential RC pathology arrive with a completed MRI scan prior first orthopaedic consult. Their surgical decision is primarily based on patient history (45–55%) and physical examination (23–42%) followed by MRI scan review (2.6–18%), reading MRI reports (0–1.6%) or viewing other imaging (3–23%) depending on the shoulder disease. Ninety percent of surgeons would not decide on surgery in ambiguous cases unless the MR-images were personally reviewed. Respondents stated that shoulder MRI scans are ordered too frequently prior specialist visit as identified in more than 50% of cases depending on pathology. Conclusions The decision-making process for shoulder surgery depends on the underlying pathology and patient history. The results demonstrate that orthopaedic surgeons are comfortable reviewing shoulder MRI scans without necessarily reading the MRI report prior to a surgical decision. MRI scans are becoming an increasingly important part of surgical management in shoulder pathologies but should not be used without assessment of patient history and or physical examination.
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Affiliation(s)
- Maciej J K Simon
- Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany. .,Department of Orthopaedics, University of British Columbia, Chan Gunn Pavilion, Allen McGavin Sports Medicine Clinic, 2553 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada.
| | - William D Regan
- Department of Orthopaedics, University of British Columbia, Chan Gunn Pavilion, Allen McGavin Sports Medicine Clinic, 2553 Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada
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Weiss PF, Brandon TG, Bohnsack J, Heshin-Bekenstein M, Francavilla ML, Jaremko JL, Liao L, McHugh A, Oberle EJ, Rumsey D, Srinivasalu H, Stoll ML, Chauvin NA. Variability in Interpretation of Magnetic Resonance Imaging of the Pediatric Sacroiliac Joint. Arthritis Care Res (Hoboken) 2021; 73:841-848. [PMID: 32277735 DOI: 10.1002/acr.24206] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/31/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is pivotal in the assessment of early sacroiliitis in children. We aimed to evaluate the agreement between local radiology reports and central imaging reviewers for active inflammation and structural damage at the sacroiliac (SI) joints. METHODS Eight hospitals each contributed up to 20 cases of consecutively imaged children and adolescents with juvenile idiopathic arthritis and suspected sacroiliitis. Studies were independently reviewed by 3 experienced musculoskeletal pediatric radiologists. Local assessments of global impression and lesions were coded from the local radiology reports by 2 study team members. Test properties of local reports were calculated using the central imaging team's majority as the reference standard. RESULTS For 120 evaluable subjects, the median age was 14 years, half of the cases were male, and median disease duration at the time of imaging was 0.8 years (interquartile range 0-2). Sensitivity of local reports for inflammation was high, 93.5% (95% confidence interval [95% CI] 78.6-99.2), and specificity was moderate, 69.7% (95% CI 59.0-79.0), but positive predictive value (PPV) was low, 51.8% (95% CI 38.0-65.3). Twenty-seven cases (23%) had active inflammation reported locally but rated normal at the central reading, 19 (70%) with subsequent medication changes. The sensitivity of local reports detecting structural damage was low, 45.7% (95% CI 28.8-63.4), and specificity was high, 88.2% (95% CI 79.4-94.2); PPV was low, 61.5% (95% CI 40.6-79.8). CONCLUSION Substantial variation exists in the interpretation of inflammatory and structural lesions at the SI joints in children. To reliably identify pathology, additional training in the MRI appearance of the maturing SI joint is greatly needed.
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Affiliation(s)
- Pamela F Weiss
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | | | - Merav Heshin-Bekenstein
- University of California, San Francisco and Dana Children's Hospital of Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Michael L Francavilla
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Lester Liao
- University of Alberta, Edmonton, Alberta, Canada
| | - Anne McHugh
- Stanford University, Stanford, California, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Edward J Oberle
- Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, Ohio
| | - Dax Rumsey
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Nancy A Chauvin
- Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania
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Pediatric magnetic resonance imaging training versus job-readiness: using education research tools to re-align. Pediatr Radiol 2021; 51:1732-1737. [PMID: 33772642 DOI: 10.1007/s00247-021-05047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 02/08/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fellows begin MRI training with variable experience and expertise. To better serve patients, pediatric radiology fellows should gain competence in MRI that enables seamless transition to independent practice. OBJECTIVE We implemented a needs assessment survey and conducted a focus group discussion to identify knowledge gaps and inform creation of a curriculum for pediatric body MRI. MATERIALS AND METHODS We electronically distributed a comprehensive anonymous needs assessment survey in October 2016 to current fellows and recent (<5 years) graduates from Accreditation Council for Graduate Medical Education (ACGME)-accredited pediatric radiology fellowships, with follow-up in January 2017. We conducted a focus group discussion among current fellows at our institution in October 2017 to inform a better understanding of the results. RESULTS Eighty-one pediatric radiologists (8 fellows/73 attendings) completed the survey (24%); 5 current fellows participated in the focus group. The technical issues most commonly identified with limited or no instruction during training included setting up an MR service, accessory equipment (coil) selection and MRI field inhomogeneity correction. Areas needing increased attention and inclusion within the curriculum included coil choice/patient positioning (n=42, 52%), contrast agents (n=40, 49%), field strength (n=33, 41%) and strategies for motion correction (n=33, 41%). Most fellows were uncomfortable with setting up an MR service (n=57, 70%), correcting field inhomogeneity (n=56, 69%) and improving image quality (n=50, 62%). The focus group showed consensus that there was insufficient MR training in residency to prepare them for fellowship. The group also preferred shorter lectures and streaming via video education/tutorials. CONCLUSION While traditional instruction emphasizes image interpretation, trainees in pediatric radiology need a curriculum that also emphasizes technical and non-interpretive aspects of MRI.
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Lopez-Ben R, Coumas J. Fluoroscopy versus sonography for image guidance in peripheral MSK intervention. Skeletal Radiol 2016; 45:1721-1722. [PMID: 27704148 DOI: 10.1007/s00256-016-2496-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 02/02/2023]
Affiliation(s)
| | - James Coumas
- Charlotte Radiology, 1701 East Blvd, Charlotte, NC, 28203, USA
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Survey of current trends in postgraduate musculoskeletal ultrasound education in the United States. Skeletal Radiol 2016; 45:475-82. [PMID: 26748645 DOI: 10.1007/s00256-015-2324-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/23/2015] [Accepted: 12/22/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine current trends in postgraduate musculoskeletal ultrasound education across various medical specialties in the United States. MATERIALS AND METHODS A survey regarding musculoskeletal ultrasound education was sent to all program directors for diagnostic radiology and physical medicine rehabilitation residency programs, as well as adult rheumatology and sports medicine fellowship programs in the United States. The survey, sent in July 2015, queried the presence of formal musculoskeletal ultrasound training, the components of such training and case volume for trainees. RESULTS Response rates were 23, 25, 28 and 33% for physical medicine and rehabilitation, radiology, rheumatology and sports medicine programs, respectively. Among respondents, musculoskeletal ultrasound training was present in 65% of radiology programs, 88% of sports medicine programs, 90% of rheumatology programs, and 100% of physical medicine and rehabilitation programs. Most programs utilized didactic lectures, followed by hands-on scanning. The majority of programs without current training intend to implement such training within 5 years, although radiology programs reported the lowest likelihood of this happening. Most program directors believed that musculoskeletal ultrasound education is important for their trainees, and is of greater importance than it was 10 years ago. Case volume was lowest for radiology trainees and highest for sports medicine trainees. CONCLUSION Among respondents, the majority of diagnostic radiology programs offer musculoskeletal ultrasound training. However, this experience is even more widespread in other medical specialties, and hands-on training and experience tend to be greater in other specialties than in radiology.
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Resident-Perceived Benefit of a Diagnostic and Interventional Musculoskeletal Ultrasound Curriculum: A Multifaceted Approach Using Independent Study, Peer Teaching, and Interdisciplinary Collaboration. Am J Phys Med Rehabil 2016; 94:1095-103. [PMID: 26098924 DOI: 10.1097/phm.0000000000000337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Musculoskeletal ultrasound (MSUS) training is now a required component of physiatry residency, but formal curriculum guidelines are not yet required or established. The authors' objective was to assess the educational value of a collaborative residency MSUS training program. The authors designed a structured MSUS training curriculum for residents based on the authors' experience and previous literature. Twenty-five residents participated in this MSUS curriculum designed by faculty and chief residents. Resident volunteers were trained by the faculty as "table trainers" who taught their peers in small groups. Hands-on MSUS training sessions were led by a Physical Medicine and Rehabilitation faculty MSUS expert. A Likert scale-formatted questionnaire assessed resident-perceived value of the curriculum. Response rate was 96% (22 of 23). Self-reported MSUS knowledge comparing precurriculum and postcurriculum implementation resulted in significant improvement (P = 0.001). Peer teaching was highly valued, with 86% of residents rating it "very" or "extremely" beneficial (mean [SD] score, 3.9 [1.1]). Self-guided learning, by supplemental scanning and reading, was rated "beneficial" or "very beneficial" by 73% of residents (3.0 [0.7]). The authors' successful pilot program may serve as a teaching model for other residency programs.
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10
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Glover M, Patel TY. The Radiology Fellowship Arms Race Cannot Be Won. J Am Coll Radiol 2016; 13:461-4. [PMID: 26810635 DOI: 10.1016/j.jacr.2015.11.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 11/16/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Tirath Y Patel
- Department of Radiology, The University of Toledo Medical Center, Toledo, Ohio
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Siddiqui IJ, Luz J, Borg-Stein J, O'Connor K, Bockbrader M, Rainey H, Way D, Colachis S, Bahner DP, Kohler MJ. The Current State of Musculoskeletal Ultrasound Education in Physical Medicine and Rehabilitation Residency Programs. PM R 2015; 8:660-6. [PMID: 26690020 DOI: 10.1016/j.pmrj.2015.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exposure to musculoskeletal ultrasound (MSUS) is now a mandatory component of physical medicine and rehabilitation (PM&R) residency training. However, reports on the extent of the implementation and efficacy of MSUS education are lacking in the literature. OBJECTIVE To determine the extent to which PM&R residencies are implementing MSUS education. DESIGN Cross-sectional. SETTING Institutional. PARTICIPANTS Thirty-six of the 78 United States PM&R residency programs accredited by the Accreditation Council for Graduate Medical Education. METHODS All 78 programs were solicited with an online survey via the residency program director and coordinator in July 2014. The 25 questions on the survey were aimed at determining program MSUS educational characteristics and their effectiveness. MAIN OUTCOME MEASURES Description of teaching methods used for MSUS, residency demographics, characteristics of MSUS faculty expertise, and faculty-perceived competency in MSUS examinations and procedures among residents. Data were analyzed using both descriptive statistics and tests for independence to identify correlations between program characteristics and resident MSUS competency. RESULTS A response was received from 36 of the 78 residency programs (46.2%). Of the 36 residency programs that responded, 97.2% provide exposure to MSUS (a figure that drops to 44.9% when nonrespondents are included); 61% had mandatory MSUS training (28.2% when including nonrespondents); and 44.4% had a formal curriculum (20.5% when including nonrespondents). The most common MSUS educational tools used were lecture (88.9%), outpatient clinic (86.1%), and hands-on workshops (86.1%). Sixty-one percent of responding programs evaluate residents with formal assessment tools. Overall, faculty at 38.8% and 44.4% of programs believed that at least 50% of residents who graduate are competent in diagnostic and interventional MSUS, respectively. These rates were significantly associated with the use of formal assessment. CONCLUSION MSUS education is growing in PM&R, but many programs still have not adopted a formal educational curriculum. Formal assessment to evaluate resident MSUS skills significantly improves faculty-perceived MSUS competency.
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Affiliation(s)
- Imran J Siddiqui
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Regenerative Orthopedics and Sports Medicine, Washington, DC(∗)
| | - Jennifer Luz
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA(†)
| | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA(‡)
| | - Kevin O'Connor
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA(¶)
| | - Marcia Bockbrader
- Department of Physical Medicine and Rehabilitation, Wexner Medical Center, Ohio State University, Columbus, OH(§)
| | - Heather Rainey
- Department of Physical Medicine and Rehabilitation, Wexner Medical Center, Ohio State University, Columbus, OH(∗∗)
| | - David Way
- Department of Physical Medicine and Rehabilitation, Wexner Medical Center, Ohio State University, Columbus, OH(††)
| | - Sam Colachis
- Department of Physical Medicine and Rehabilitation, Wexner Medical Center, Ohio State University, Columbus, OH(‡‡)
| | - David P Bahner
- Department of Emergency Medicine, Wexner Medical Center, Ohio State University, Columbus, OH(¶¶)
| | - Minna J Kohler
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 2C, Boston, MA 02114(§§).
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Sofka CM. Developments and innovations in resident and fellowship education: review article. HSS J 2014; 10:225-9. [PMID: 25264438 PMCID: PMC4171448 DOI: 10.1007/s11420-014-9396-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/23/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medical trainee education has drastically changed over the past 30 years significantly since the inception of the Accreditation Council for Graduate Medical Education (ACGME) in 1981. With an emphasis on patient safety, regulations and oversight from the ACGME have drastically changed the way many programs function with respect to trainee responsibilities, duty hours, and resident supervision. QUESTIONS/PURPOSES The purpose of this review is to summarize significant changes and innovations implemented by the ACGME and their proposed effects on trainee education. While there is an emphasis on musculoskeletal radiology fellowship training, the majority of the regulations and guidelines are applicable to all training programs. METHODS Articles, commentaries, and policies focusing on ACGME requirements were reviewed, with a focus on musculoskeletal radiology. RESULTS Changes in ACGME policies have resulted in significant structural modifications in how training programs are designed, specifically with respect to curriculum standardization, measuring outcomes of trainee performance, and integration of residents and fellows into hospital-based quality improvement and patient safety initiatives. CONCLUSION With an eye to continued training program advancement and improvement, the goal of universal oversight and standardization in medical training remains to produce forward-thinking physicians with an emphasis on lifelong learning, patient care, and quality improvement.
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Affiliation(s)
- Carolyn M. Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 USA ,Weill Cornell Medical College, New York, NY 10035 USA
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