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Schmidt WA, Schäfer VS. Diagnosing vasculitis with ultrasound: findings and pitfalls. Ther Adv Musculoskelet Dis 2024; 16:1759720X241251742. [PMID: 38846756 PMCID: PMC11155338 DOI: 10.1177/1759720x241251742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/10/2024] [Indexed: 06/09/2024] Open
Abstract
Rheumatologists are increasingly utilizing ultrasound for suspected giant cell arteritis (GCA) or Takayasu arteritis (TAK). This enables direct confirmation of a suspected diagnosis within the examination room without further referrals. Rheumatologists can ask additional questions and explain findings to their patients while performing ultrasound, preferably in fast-track clinics to prevent vision loss. Vascular ultrasound for suspected vasculitis was recently integrated into rheumatology training in Germany. New European Alliance of Associations for Rheumatology recommendations prioritize ultrasound as the first imaging tool for suspected GCA and recommend it as an imaging option for suspected TAK alongside magnetic resonance imaging, positron emission tomography and computed tomography. Ultrasound is integral to the new classification criteria for GCA and TAK. Diagnosis is based on consistent clinical and ultrasound findings. Inconclusive cases require histology or additional imaging tests. Robust evidence establishes high sensitivities and specificities for ultrasound. Reliability is good among experts. Ultrasound reveals a characteristic non-compressible 'halo sign' indicating intima-media thickening (IMT) and, in acute disease, artery wall oedema. Ultrasound can further identify stenoses, occlusions and aneurysms, and IMT can be measured. In suspected GCA, ultrasound should include at least the temporal and axillary arteries bilaterally. Nearly all other arteries are accessible except the descending thoracic aorta. TAK mostly involves the common carotid and subclavian arteries. Ultrasound detects subclinical GCA in over 20% of polymyalgia rheumatica (PMR) patients without GCA symptoms. Patients with silent GCA should be treated as GCA because they experience more relapses and require higher glucocorticoid doses than PMR patients without GCA. Scores based on intima-thickness (IMT) of temporal and axillary arteries aid follow-up of GCA, particularly in trials. The IMT decreases more rapidly in temporal than in axillary arteries. Ascending aorta ultrasound helps monitor patients with extracranial GCA for the development of aneurysms. Experienced sonologists can easily identify pitfalls, which will be addressed in this article.
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Affiliation(s)
- Wolfgang A. Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Lindenberger Weg 19, Berlin 13125, Germany
| | - Valentin S. Schäfer
- Department of Rheumatology and Clinical Immunology, Clinic of Internal Medicine III, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
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2
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Lake S, Brydges R, Penney C, Wilson D, Sweezie R, Bagovich M, Bong D, Barr S, Stroud L. Online vs in-person musculoskeletal ultrasound course: a cohort comparison study. Ultrasound J 2024; 16:30. [PMID: 38819664 PMCID: PMC11143147 DOI: 10.1186/s13089-024-00375-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Point-of-care musculoskeletal (MSK) ultrasound (US) courses are typically held in-person. The COVID-19 pandemic guidelines forced courses to switch to online delivery. To determine this impact, we conducted an observational cohort study, comparing homework completion and image quality between an Online and a historical In-person cohort. METHODS The In-person (n = 27) and Online (n = 24) cohorts attended two learning sessions spaced six months apart. The course content was the same, while the process of delivery differed. As homework, participants submitted US images biweekly for up to five months after each session. Expert faculty provided written feedback to all participants, and two independent reviewers rated the image quality for a subset of participants in each group who had completed at least 70% of their homework (In-person, n = 9; Online, n = 9). Participants self-reported their satisfaction through post-course evaluation. RESULTS 63% of In-Person and 71% of Online cohort participants submitted their homework images. We observed no differences in the mean amount of homework images submitted for In-person (M = 37.3%, SD = 42.6%) and Online cohorts (M = 48.1%, SD = 38.8%; p > 0.05, Mann-Whitney U Test). At course end, the cohorts did not differ in overall image quality (p > 0.05, Wilcoxon Signed-rank Test). All participants reported high levels of satisfaction. CONCLUSIONS A convenience sample of participants attending a basic MSK US course in-person and online did not differ statistically in homework completion, quality of submitted US images, or course satisfaction. We add to literature suggesting online learning remains a viable option post-pandemic.
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Affiliation(s)
- Shirley Lake
- Division of Rheumatology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N3M5, Toronto, ON, Canada.
| | - Ryan Brydges
- Department of Medicine, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Chris Penney
- Division of Rheumatology, University of Calgary, Calgary, Canada
| | | | | | - Maria Bagovich
- Division of Rheumatology, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4N3M5, Toronto, ON, Canada
| | - David Bong
- University of Barcelona School of Medicine, Barcelona, Spain
| | - Susan Barr
- Division of Rheumatology, University of Calgary, Calgary, Canada
| | - Lynfa Stroud
- Department of Medicine, University of Toronto, Toronto, Canada
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Carstensen SMD, Just SA, Pfeiffer-Jensen M, Østergaard M, Konge L, Terslev L. Solid validity evidence for two tools assessing competences in musculoskeletal ultrasound: a validity study. Rheumatology (Oxford) 2024; 63:765-771. [PMID: 37307078 DOI: 10.1093/rheumatology/kead286] [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: 02/10/2023] [Revised: 04/21/2023] [Accepted: 05/19/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES Musculoskeletal ultrasound (MSUS) is increasingly used by rheumatologists in daily clinical practice. However, MSUS is only valuable in trained hands, and assessment of trainee competences is therefore essential before independent practice. Thus, this study aimed to establish validity evidence for the EULAR and the Objective Structured Assessment of Ultrasound Skills (OSAUS) tools used for assessing MSUS competences. METHODS Thirty physicians with different levels of MSUS experience (novices, intermediates, and experienced) performed four MSUS examinations of different joint areas on the same rheumatoid arthritis patient. All examinations were video recorded (n = 120), anonymized, and subsequently assessed in random order by two blinded raters using first the OSAUS assessment tool followed by the EULAR tool 1 month after. RESULTS The inter-rater reliability between the two raters was high for both the OSAUS and EULAR tools, with a Pearson correlation coefficient (PCC) of 0.807 and 0.848, respectively. Both tools demonstrated excellent inter-case reliability, with a Cronbach's alpha of 0.970 for OSAUS and 0.964 for EULAR. Furthermore, there was a strong linear correlation between the OSAUS and the EULAR performance scores and the participants' experience levels (R2 = 0.897 and R2 = 0.868, respectively) and a significant discrimination between different MSUS experience levels (P < 0.001 for both). CONCLUSIONS MSUS operator competences can be assessed reliably and valid using either the OSAUS or the EULAR assessment tool, thereby allowing a uniform competency-based MSUS education in the future. Although both tools demonstrated high inter-rater reliability, the EULAR tool was superior to OSAUS. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT05256355.
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Affiliation(s)
- Stine Maya Dreier Carstensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, The University of Copenhagen, Copenhagen, Denmark
| | - Søren Andreas Just
- Section of Rheumatology, Department of Medicine, Svendborg Hospital-Odense University Hospital, Svendborg, Denmark
| | - Mogens Pfeiffer-Jensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet Glostrup, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, The University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, The University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Copenhagen University Hospital-Rigshospitalet Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, The University of Copenhagen, Copenhagen, Denmark
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4
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Neubauer R, Recker F, Bauer CJ, Brossart P, Schäfer VS. The Current Situation of Musculoskeletal Ultrasound Education: A Systematic Literature Review. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1363-1374. [PMID: 36941182 DOI: 10.1016/j.ultrasmedbio.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/16/2023] [Accepted: 02/13/2023] [Indexed: 05/11/2023]
Abstract
As a radiation-free and dynamic imaging tool, musculoskeletal ultrasound improves diagnostic and therapeutic safety. With its growing application, the demand for training opportunities rises rapidly. Therefore, this work was aimed at mapping the current state of musculoskeletal ultrasonography education. A systematic literature search was conducted in January 2022 in the medical databases Embase, PubMed and Google Scholar. By use of specifically selected keywords, matching publications were filtered; then abstracts were screened independently by two authors and the inclusion of each publication was checked against pre-defined criteria according to the PICO (Population, Intervention, Comparator, Outcomes) scheme. Full-text versions of included publications were reviewed, and relevant information was extracted. Finally, 67 publications were included. Our results revealed a wide variety of course concepts and programs that have been implemented in different disciplines. Musculoskeletal ultrasonography training especially addresses residents in rheumatology, radiology and physical medicine and rehabilitation. International institutions, such as the European League Against Rheumatism and the Pan-American League of Associations for Rheumatology, have suggested guidelines and curricula to promote standardized ultrasound training. The development of alternative teaching methods incorporating e-learning, peer teaching and distance learning on mobile ultrasound devices and the determination of international guidelines could facilitate overcoming the remaining obstacles still to be passed. In conclusion, it can be stated that there is a broad consensus that standardized musculoskeletal ultrasound curricula would improve training and facilitate the implementation of new training programs.
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Affiliation(s)
- Ricarda Neubauer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.
| | - Claus Juergen Bauer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Valentin Sebastian Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
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5
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Mulder TA, van de Velde T, Dokter E, Boekestijn B, Olgers TJ, Bauer MP, Hierck BP. Unravelling the skillset of point-of-care ultrasound: a systematic review. Ultrasound J 2023; 15:19. [PMID: 37074526 PMCID: PMC10115919 DOI: 10.1186/s13089-023-00319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The increasing number of physicians that are trained in point-of-care ultrasound (POCUS) warrants critical evaluation and improvement of current training methods. Performing POCUS is a complex task and it is unknown which (neuro)cognitive mechanisms are most important in competence development of this skill. This systematic review was conducted to identify determinants of POCUS competence development that can be used to optimize POCUS training. METHODS PubMed, Web of Science, Cochrane Library, Emcare, PsycINFO and ERIC databases were searched for studies measuring ultrasound (US) skills and aptitude. The papers were divided into three categories: "Relevant knowledge", "Psychomotor ability" and 'Visuospatial ability'. The 'Relevant knowledge' category was further subdivided in 'image interpretation', 'technical aspects' and 'general cognitive abilities'. Visuospatial ability was subdivided in visuospatial subcategories based on the Cattell-Horn-Carroll (CHC) Model of Intelligence v2.2, which includes visuospatial manipulation and visuospatial perception. Post-hoc, a meta-analysis was performed to calculate pooled correlations. RESULTS 26 papers were selected for inclusion in the review. 15 reported on relevant knowledge with a pooled coefficient of determination of 0.26. Four papers reported on psychomotor abilities, one reported a significant relationship with POCUS competence. 13 papers reported on visuospatial abilities, the pooled coefficient of determination was 0.16. CONCLUSION There was a lot of heterogeneity in methods to assess possible determinants of POCUS competence and POCUS competence acquisition. This makes it difficult to draw strong conclusions on which determinants should be part of a framework to improve POCUS education. However, we identified two determinants of POCUS competence development: relevant knowledge and visuospatial ability. The content of relevant knowledge could not be retrieved in more depth. For visuospatial ability we used the CHC model as theoretical framework to analyze this skill. We could not point out psychomotor ability as a determinant of POCUS competence.
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Affiliation(s)
- Tessa A Mulder
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Tim van de Velde
- Department of Neuropsychology, Leiden University, Leiden, The Netherlands
| | - Eveline Dokter
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tycho J Olgers
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Martijn P Bauer
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Beerend P Hierck
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Innovation of Medical Education, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Sciences-Anatomy and Physiology, Veterinary Medicine Faculty, Utrecht University, Utrecht, The Netherlands
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Development of an Objective Structured Clinical Examination Checklist and a Post-Education Questionnaire for Musculoskeletal Ultrasound Training Focusing on Volar Wrist and Carpal Tunnel Syndrome. JOURNAL OF ACUPUNCTURE RESEARCH 2022. [DOI: 10.13045/jar.2022.00038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The objective structured clinical examination (OSCE) is used in the colleges of Korean Medicine, but few studies have validated the OSCE evaluation criteria or post-education questionnaires. Diagnostic ultrasound is used in Korean medicine treatment including acupuncture, acupotomy, and pharmacopuncture to increase the safety and efficacy of treatment. We aimed to develop and validate a OSCE checklist and questionnaire for diagnostic musculoskeletal ultrasound training.Methods: A OSCE checklist and rubric for diagnostic ultrasound training, and questionnaire was developed using literature research. Eight expert panelists verified each draft item in a single-round survey. Items with a content validity ratio (CVR) < 0.75 were excluded or modified to reflect the experts’ opinions.Results: The OSCE checklist and rubric for diagnostic ultrasound training focusing on volar wrist and carpal tunnel syndrome included: 15 items revised according to CVR and expert opinions, the pre-examination procedure, structures to be identified by ultrasound, scans with 2 diagnostic criteria for carpal tunnel syndrome, an explanation of the exam results, and the post exam procedure. The questionnaire consisted of 15 items, including the overall evaluation of training, the effect of the OSCE, and the perception of the ultrasound. All 6 self-evaluation items were not revised, as they had a CVR of ≥ 0.75.Conclusion: An ultrasound OSCE for scanning the volar wrist and diagnosing carpal tunnel syndrome was developed using 15 validated tasks, 15 survey questions about ultrasound training, and 6 questions for selfevaluation. These results may be used in the future for education in diagnostic ultrasound.
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Soni NJ, Nathanson R, Andreae M, Khosla R, Vadamalai K, Kode K, Boyd JS, LoPresti CM, Resop D, Basrai Z, Williams J, Bales B, Sauthoff H, Wetherbee E, Haro EK, Smith N, Mader MJ, Pugh J, Finley EP, Schott CK. Development of a multisystem point of care ultrasound skills assessment checklist. Ultrasound J 2022; 14:17. [PMID: 35551527 PMCID: PMC9096739 DOI: 10.1186/s13089-022-00268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Many institutions are training clinicians in point-of-care ultrasound (POCUS), but few POCUS skills checklists have been developed and validated. We developed a consensus-based multispecialty POCUS skills checklist with anchoring references for basic cardiac, lung, abdominal, and vascular ultrasound, and peripheral intravenous line (PIV) insertion. Methods A POCUS expert panel of 14 physicians specializing in emergency, critical care, and internal/hospital medicine participated in a modified-Delphi approach to develop a basic POCUS skills checklist by group consensus. Three rounds of voting were conducted, and consensus was defined by ≥ 80% agreement. Items achieving < 80% consensus were discussed and considered for up to two additional rounds of voting. Results Thirteen POCUS experts (93%) completed all three rounds of voting. Cardiac, lung, abdominal, and vascular ultrasound checklists included probe location and control, basic machine setup, image quality and optimization, and identification of anatomical structures. PIV insertion included additional items for needle tip tracking. During the first round of voting, 136 (82%) items achieved consensus, and after revision and revoting, an additional 21 items achieved consensus. A total of 153 (92%) items were included in the final checklist. Conclusions We have developed a consensus-based, multispecialty POCUS checklist to evaluate skills in image acquisition and anatomy identification for basic cardiac, lung, abdominal, and vascular ultrasound, and PIV insertion. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00268-4.
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Affiliation(s)
- Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA. .,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Mark Andreae
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rahul Khosla
- Veterans Affairs Medical Center, Washington, DC, USA.,George Washington University, Washington, DC, USA
| | | | - Karthik Kode
- Department of Medicine, University of Hawai'i at Manoa John A. Burns School of Medicine, Honolulu, HI, USA
| | - Jeremy S Boyd
- Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charles M LoPresti
- Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Dana Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA.,Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jason Williams
- Section of Hospital Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.,Division of Hospital Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Brian Bales
- Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harald Sauthoff
- Medicine Service, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Erin Wetherbee
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.,Pulmonary, Critical Care, and Sleep Apnea, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Natalie Smith
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Michael J Mader
- Research Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jacqueline Pugh
- Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Erin P Finley
- Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.,Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Christopher K Schott
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Health Care Systems, Pittsburgh, PA, USA
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Carstensen SMD, Velander MJ, Konge L, Østergaard M, Pfeiffer Jensen M, Just SA, Terslev L. Training and assessment of musculoskeletal ultrasound and injection skills-a systematic review. Rheumatology (Oxford) 2022; 61:3889-3901. [PMID: 35218339 DOI: 10.1093/rheumatology/keac119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/17/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine how residents are trained and assessed in musculoskeletal ultrasound (MSUS), MSUS-guided and landmark-guided joint aspiration and injection. Additionally, to present the available assessment tools and examine their supporting validity evidence. METHODS A systematic search of PubMed, Cochrane Library, and Embase was conducted in accordance with the PRISMA guidelines and studies published from January 1, 2000 to May 31, 2021 were included. Two independent reviewers performed the search and data extraction. The studies were evaluated using the Medical Education Research Quality Instrument (MERSQI). RESULTS 9,884 articles were screened, and 43 were included; 3 were randomized studies, 21 pre- and post-test studies, 16 descriptive studies, and 3 studies developing assessment tools. The studies used various theoretical training modalities e.g. lectures, anatomical quizzes and e-learning. The practical training models varied from mannequins and cadavers to healthy volunteers and patients. The majority of studies used subjective "comfort level" as assessment, others used practical examination and/or theoretical examination. All training programs increased trainees' self-confidence, theoretical knowledge, and/or practical performance, however few used validated assessment tools to measure the effect. Only one study met the MERSQI high methodical quality cut-off score of 14. CONCLUSION The included studies were heterogeneous, and most were of poor methodological quality and not based on contemporary educational theories. This review highlights the need for educational studies using validated theoretical and practical assessment tools to ensure optimal MSUS training and assessment in rheumatology.
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Affiliation(s)
- Stine M D Carstensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet Glostrup Valdemar Hansens Vej 17, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
| | - Marie Juul Velander
- Section of Rheumatology, Department of Medicine, Svendborg Hospital-OUH Baagøes Allé 15, Svendborg, Denmark
| | - Lars Konge
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet Glostrup Valdemar Hansens Vej 17, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Pfeiffer Jensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet Glostrup Valdemar Hansens Vej 17, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Andreas Just
- Section of Rheumatology, Department of Medicine, Svendborg Hospital-OUH Baagøes Allé 15, Svendborg, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet Glostrup Valdemar Hansens Vej 17, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chen YT, Chou R, Kohler M, Eng C, Borg-Stein J. In-person versus virtual musculoskeletal ultrasound education during the coronavirus disease 2019 pandemic: A single-center study. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Tawfik EA, Cartwright MS, Grimm A, Boon AJ, Kerasnoudis A, Preston DC, Wilder‐Smith E, Axer H, Hobson‐Webb LD, Alfen N, Crump N, Shahrizaila N, Inkpen P, Mandeville R, Sakamuri S, Shook SJ, Shin S, Walker FO. Neuromuscular ultrasound competency assessment: Consensus‐based survey. Muscle Nerve 2021; 63:651-656. [DOI: 10.1002/mus.27163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Eman A. Tawfik
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine Ain Shams University Cairo Egypt
| | - Michael S. Cartwright
- Department of Neurology Wake Forest School of Medicine, Medical Center Blvd Winston‐Salem North Carolina USA
| | - Alexander Grimm
- Department of Neurology University Hospital Tuebingen Tuebingen Germany
| | - Andrea J. Boon
- Department of Physical Medicine and Rehabilitation Mayo Clinic Rochester Minnesota USA
| | - Antonios Kerasnoudis
- Department of Neurology St Luke's Hospital Thessaloniki Greece
- Department of Neurology St Josef Hospital, Ruhr University Bochum Bochum Germany
| | - David C. Preston
- Neurological Institute, University Hospitals, Cleveland Medical Center Case Western Reserve University Cleveland Ohio USA
| | - Einar Wilder‐Smith
- Department of Neurology Kantonsspital Lucerne Switzerland
- Department of Neurology University of Berne Bern Switzerland
| | - Hubertus Axer
- Hans Berger Department of Neurology Jena University Hospital Jena Germany
| | - Lisa D. Hobson‐Webb
- Department of Neurology, Neuromuscular Division Duke University School of Medicine Durham North Carolina USA
| | - Nens Alfen
- Department of Neurology and Clinical Neurophysiology Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center Nijmegen The Netherlands
| | - Nicholas Crump
- Department of Neurology Austin Health and University of Melbourne Heidelberg Australia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Peter Inkpen
- Division of Physical Medicine and Rehabilitation University of British Columbia British Columbia Vancouver Canada
| | - Ross Mandeville
- Department of Neurosciences University of California San Diego School of Medicine La Jolla California USA
| | - Sarada Sakamuri
- Department of Neurology and Neurological Sciences Stanford University Stanford California USA
| | - Steven J Shook
- Neuromuscular Center, Neurologic Institute Cleveland Clinic Cleveland Ohio USA
| | - Susan Shin
- Department of Neurology Mount Sinai School of Medicine New York New York USA
| | - Francis O. Walker
- Department of Neurology Wake Forest School of Medicine, Medical Center Blvd Winston‐Salem North Carolina USA
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Design and Implementation of a Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents: Pilot Data on Improvement of Palpation Accuracy in Physical Examination. Am J Phys Med Rehabil 2020; 99:1177-1183. [PMID: 32487974 DOI: 10.1097/phm.0000000000001487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Studies have shown that physical medicine and rehabilitation residents have poor surface anatomy palpation accuracy, suggesting that new methods of teaching musculoskeletal (MSK) examination need to be found. This study describes the design of a novel MSK ultrasound course that integrated ultrasonography skills with palpation skills. Ultrasound was used to teach, validate, and refine physical medicine and rehabilitation residents' palpation of MSK structures. Surface anatomy palpation is intimately related to ultrasonography as clinicians should use palpation to guide their ultrasound examination rather than purely follow an algorithm. This study assessed whether the ultrasound course improved physical medicine and rehabilitation resident palpation accuracy at 12 upper limb structures. Palpation accuracy was tested at the beginning of their residency training and retested several weeks after completion of the ultrasound course's upper limb component, to assess retention of skill. There was significant improvement (P < 0.05) in 9 of 12 sites from pretesting to posttesting. Mean postcourse palpation accuracy was within 1 cm for 8 of 12 structures. This study demonstrates that an integrated MSK ultrasound and palpation curriculum improves palpation accuracy at multiple MSK structures and this improvement is retained. Physical medicine and rehabilitation residencies should consider integrating palpation skills into their ultrasound curriculum to improve the caliber of their trainees.
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Torralba KD, Cannella AC, Kissin EY, Bolster MB, Salto LM, Higgs J, Samuels J, Nishio MJ, Kaeley GS, Evangelisto A, De Marco P, Kohler MJ. Musculoskeletal Ultrasound Instruction in Adult Rheumatology Fellowship Programs. Arthritis Care Res (Hoboken) 2020; 72:859-870. [PMID: 28777891 DOI: 10.1002/acr.23336] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 08/01/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Musculoskeletal ultrasound (MSUS) in rheumatology in the US has advanced by way of promotion of certifications and standards of use and inclusion of core fellowship curriculum. In order to inform endeavors for curricular integration, the objectives of the present study were to assess current program needs for curricular incorporation and the teaching methods that are being employed. METHODS A needs-assessment survey (S1) was sent to 113 rheumatology fellowship program directors. For programs that taught MSUS, a curriculum survey (S2) was sent to lead faculty. Programs were stratified according to program size and use of a formal written curriculum. RESULTS S1 (108 of 113 respondents; response rate 96%) revealed that 94% of programs taught MSUS, with 41% having a curriculum. Curricular implementation was unaffected by program size. Formal curricular adoption of MSUS was favored by 103 directors (95.3%), with 65.7% preferring such adoption to be optional. S2 (74 of 101 respondents; response rate 73%) showed that 41% of programs utilized a formal curriculum. Multiple teaching strategies were used, with content that was generally similar. Use of external courses, including the Ultrasound School of North American Rheumatologists course, was prevalent. Fewer barriers were noted compared to past surveys, but inadequate time, funding, and number of trained faculty still remained. Lack of divisional interest (P = 0.046) and interest of fellows (P = 0.012) were noted among programs without a formal curriculum. CONCLUSION MSUS is taught by a significantly larger number of rheumatology fellowship programs today. Multiple teaching strategies are used with common content, and barriers still remain for some programs. Most program directors favor inclusion of a standardized MSUS curriculum, with many favoring inclusion to be optional.
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Affiliation(s)
| | | | | | - Marcy B Bolster
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jay Higgs
- San Antonio Uniformed Services, San Antonio, Texas
| | | | | | | | - Amy Evangelisto
- Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey
| | - Paul De Marco
- Georgetown University School of Medicine, Washington, DC
| | - Minna J Kohler
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Widener BB, Cannella A, Martirossian L, Kissin EY. Modern Landscapes and Strategies for Learning Ultrasound in Rheumatology. Rheum Dis Clin North Am 2019; 46:61-71. [PMID: 31757287 DOI: 10.1016/j.rdc.2019.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ultrasound in rheumatology is gaining increasing acceptance in the field, with its use expanding beyond the musculoskeletal system to image rheumatic disease pathology of the vasculature, salivary glands, and lungs. Fellows in training and practicing clinicians are seeking ways to attain training and competency assessment. These standards are evolving, but no uniform mechanism for training exists. Although clinicians in practice find a wide array of resources available for self-directed education in ultrasound in rheumatology, a consensus-based and publicly available training curriculum can further enhance and standardize learning. This article discusses ultrasound in rheumatology education opportunities, competency assessment, and certification pathways.
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Affiliation(s)
- Benjamin B Widener
- 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; Omaha Veteran's Affairs Medical Center, Omaha, NE, USA
| | - Amy Cannella
- Omaha Veteran's Affairs Medical Center, Omaha, NE, USA; UNMC Rheumatology, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA
| | - Linett Martirossian
- Division of Rheumatology, Boston University Medical Center, 72 East Concord Street, Evans 506, Boston, MA, USA
| | - Eugene Y Kissin
- Division of Rheumatology, Boston University Medical Center, 72 East Concord Street, Evans 506, Boston, MA, USA.
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Curran ML, Hayward K, Mehta J. Online Resources for Enhancing Clinical Knowledge and Skills. Rheum Dis Clin North Am 2019; 46:37-60. [PMID: 31757286 DOI: 10.1016/j.rdc.2019.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
"E-learning" refers to instruction occurring via digital media and ideally uses an engaging and learner-centered approach. Advantages of e-learning methods include (1) they can enable consistent messages, (2) they may use novel instructional methods, and (3) they enable documentation of usage and assessment. This article discusses principles for and challenges to developing e-learning materials. The authors provide a collection of available e-learning materials used to teach adult and pediatric rheumatology developed by individuals, professional societies, and private companies. Finally, they discuss challenges to using e-learning materials.
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Affiliation(s)
- Megan L Curran
- Section of Rheumatology, Children's Hospital of Colorado, University of Colorado School of Medicine, 13123 East 16th Street, Box 311, Aurora, CO 80045, USA.
| | - Kristen Hayward
- Division of Rheumatology, Seattle Children's Hospital, University of Washington, School of Medicine, 4800 Sand Point Way Northeast, M/S MA.7.110, Seattle, WA 98105, USA
| | - Jay Mehta
- Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, CTRB 10109, Philadelphia, PA 19104, USA
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Kim HS, Kim HR, Kim BY, Kim YS, Jung YO, Choi SJ, Kim HO, Hwang J, Lee S, Kim HA, Bang SY, Chai JY, Park SH, Yoon CH. Standardized, musculoskeletal ultrasonographic reference values for healthy Korean adults. Korean J Intern Med 2019; 34:1372-1380. [PMID: 29722248 PMCID: PMC6823555 DOI: 10.3904/kjim.2016.397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/29/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND/AIMS To define standard reference values for musculoskeletal ultrasonography (MSUS) in Korea. METHODS A total of 251 healthy adults were recruited for this study. Ultrasonography was performed by experienced rheumatologists who had undergone four appropriate training programs in Korea. A General Electric LOGIQ electronic ultrasound device fitted with a 12 MHz linear transducer was employed. Mean values ± standard deviations (SDs) were defined as standard reference values. Intraclass correlation coefficients was employed to evaluate the extent of inter- and intraobserver agreement when MSUS measurements were made. RESULTS The 251 study participants included 122 males. Mean subject age was 28.6 years. The average bone-to-capsule distance of the right-side second and third metacarpophalangeal (MCP) joints were 0.68 and 0.72 mm respectively, and those of the left-side joints 0.62 and 0.68 mm. The cartilage thicknesses of the rightside second and third MCP joints were 0.55 and 0.55 mm, and those of the leftside joints were 0.55 and 0.56 mm, respectively. The bone-to-capsule distances of the right and left wrists were 0.80 and 0.82 mm. In 12.4% of participants (31/251), the erosion score of the humeral head was 1.71. In the right-side knee joint, mean cartilage thicknesses of the medial and lateral condyles were 1.86 and 2.03 mm in longitudinal scans. High overall interobserver agreement was evident after appropriate training that included instruction on standard MSUS methodology. CONCLUSION We defined standard reference values for MSUS in healthy Korean adults. The reliabilities of interobserver agreements were high after appropriate training program.
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Affiliation(s)
- Hyun-Sook Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hae-Rim Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Bo Young Kim
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Yun Sung Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Young Ok Jung
- Department of Internal Medicine, Jung’s Rheumatism Clinic, Seoul, Korea
| | - Sung Jae Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyun-Ok Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jiwon Hwang
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Sunggun Lee
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Hyoun-Ah Kim
- Department of Internal Medicine, Ajou University Hospital, Suwon, Korea
| | - So Young Bang
- Department of Internal Medicine, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Ji-Young Chai
- Department of Internal Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Sung-Hoon Park
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Chong-Hyeon Yoon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Chong-Hyeon Yoon, M.D. Division of Rheumatology, Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu 11765, Korea Tel: 82-32-820-3653 Fax: 82-32-820-3653 E-mail:
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Abstract
The Accreditation Council for Graduate Medical Education and the American Board of Physical Medicine and Rehabilitation developed milestones for evaluation of resident physicians that include proper musculoskeletal ultrasound examination of major joints. To date, there have been no published data demonstrating acquisition and retention of these skills and correlation with the milestone evaluation. The investigators developed and implemented a curriculum in musculoskeletal ultrasound examination for Physical Medicine and Rehabilitation residents at a large academic medical center. The investigators chose the following six joints for training and evaluation: ankle, elbow, hip, knee, shoulder, and wrist/hand. The program included: (1) didactic lectures on anatomy and ultrasound technique; (2) peer-led demonstrations of the procedure on a standardized patient (SP); (3) individual practice on standardized patients; (4) faculty observation and feedback; (5) review sessions and additional practice; and (6) assessment of skills in an objective structured clinical examination. From 2013 to 2017, 30 physical medicine and rehabilitation residents were trained and evaluated. The results, based on objective structured clinical examination scores, showed that most residents achieved the appropriate level of competency for their year. A blended, standardized curriculum in musculoskeletal ultrasound instruction with assessment by an objective structured clinical examination can be used to evaluate musculoskeletal ultrasound skills and can help align this education with residency milestones.
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Volland LM, Zhou JY, Barnes RFW, Kruse-Jarres R, Steiner B, Quon DV, Bailey C, Hughes TH, Moore RE, Chang EY, von Drygalski A. Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1569-1581. [PMID: 30371941 DOI: 10.1002/jum.14846] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Musculoskeletal ultrasound (US) is used increasingly to examine hemophilic arthropathy. However, quantitative algorithms to document findings are lacking. We developed and sought to validate a protocol quantifying hemophilic joint abnormalities. METHODS Thirty-one patients with hemophilia were examined serially for 2 years with musculoskeletal US (≈600 joint examinations and ≈6000 images). Based on the spectrum of pathologies, a quantitative algorithm, named Joint Tissue Activity and Damage Examination (JADE), was developed for soft tissue and osteochondral measurements, including power Doppler, using nominal group techniques. To study intra- and inter-rater reliability, 8 musculoskeletal US-experienced hemophilia providers performed anatomic landmark recognition and tissue measurements on 86 images with arthropathic changes, with repetition 1 month later. Twenty-three musculoskeletal US-inexperienced providers performed similar assessments. Inter-operator reliability was established by 6 musculoskeletal US-experienced hemophilia providers, each acquiring images and JADE assessments of 3 hemophilic arthropathic joints. A radiologist and musculoskeletal sonographer functioned as adjudicators. The statistical analysis was performed with the intraclass correlation coefficient (ICC), Fleiss κ, and Cohen κ where appropriate. RESULTS The musculoskeletal US-experienced providers showed excellent intra-and inter-rater reliability for tissue measurements (ICCs, 0.94-0.96). Agreement was good to excellent for landmark recognition (Fleiss κ, 0.87-0.94). Inter-operator reliability was excellent for measurements and landmark recognition (ICC, 0.90; Fleiss κ, 1.0). Agreement with adjudicators was mostly good to excellent. Musculoskeletal US-inexperienced providers showed excellent inter-rater reliability for measurements (ICC, 0.96) and moderate agreement for landmark recognition (Fleiss κ, 0.58). CONCLUSIONS The JADE protocol appears feasible for quantifying hemophilic intra-articular abnormalities. Musculoskeletal US-trained hemophilia providers showed high intra-rater, inter-rater, and inter-operator reliability, supporting JADE as a protocol for clinical management and research.
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Affiliation(s)
- Lena M Volland
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Jenny Y Zhou
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Richard F W Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Bruno Steiner
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Doris V Quon
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Cindy Bailey
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Tudor H Hughes
- Department of Radiology, University of California, San Diego, California, USA
| | - Randy E Moore
- General Musculoskeletal Imaging, Inc, Cincinnati, Ohio, USA
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, California, USA
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Antony KM, Khurshid N, Trampe B, Gupta VK, Iruretagoyena JI, Stewart KS, Shah D. Structured Training for Fetal Diagnostic Skills in a Maternal-Fetal Medicine Fellowship. AJP Rep 2018; 8:e251-e260. [PMID: 30370179 PMCID: PMC6202070 DOI: 10.1055/s-0038-1675344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 09/05/2018] [Indexed: 11/18/2022] Open
Abstract
Objective The American Institute of Ultrasound in Medicine has described what constitutes a detailed fetal anatomic examination but what comprises an appropriate physician training program has not been described. The purpose of this paper is to describe a highly-structured program developed by our center to train maternal-fetal medicine fellows in a systematic approach to fetal diagnostic imaging. Study Design We describe this approach in three phases. Phase I: Development of Skills as a Perinatal Sonographer, Phase II: Mentored Evolution to a Perinatal Sonologist and Phase III: Supervised Independent Practice as Consultant-in-training. Results This curriculum was implemented in 2006. Of the eight maternal-fetal medicine fellows who completed this program, 100% were capable of following this curriculum and 100% felt comfortable performing and interpreting detailed sonograms including sonograms with significant and uncommon anomalies. Qualitative feedback was also positive. Finally, this structured approach resulted in an increase in the average total number of sonograms interpreted. Conclusion Our curriculum, by following the explicit guidelines and expectations set out by the American Institute of Ultrasound in Medicine and the American Board of Obstetrics and Gynecology for practicing maternal-fetal medicine fellowship graduates, provides an opportunity to explore national standardization for this component of training.
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Affiliation(s)
- Kathleen M Antony
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nauman Khurshid
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, ProMedica Toledo Hospital, University of Toledo, Toledo, Toledo, Ohio
| | - Barbara Trampe
- Meriter Center for Perinatal Care, Meriter-UnityPoint Health, Madison, Wisconsin
| | - Vivek K Gupta
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - J Igor Iruretagoyena
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Katharina S Stewart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Dinesh Shah
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Kanesa-thasan RM, Nazarian LN, Parker L, Rao VM, Levin DC. Comparative Trends in Utilization of MRI and Ultrasound to Evaluate Nonspine Joint Disease 2003 to 2015. J Am Coll Radiol 2018; 15:402-407. [DOI: 10.1016/j.jacr.2017.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
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Wortsman X, Alfageme F, Roustan G, Arias-Santiago S, Martorell A, Catalano O, di Santolo MS, Zarchi K, Bouer M, Gonzalez C, Bard R, Mandava A, Crisan M, Crisan D, Gaitini D. Proposal for an Assessment Training Program in Dermatologic Ultrasound by the DERMUS Group. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2305-2309. [PMID: 27629760 DOI: 10.7863/ultra.15.10068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ximena Wortsman
- Departments of Radiology and Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Fernando Alfageme
- Department of Dermatology, University Hospital Puerta del Hierro, EFSUMB Dermatologic Ultrasound Learning Center, Majahonda, Madrid, Spain
| | - Gaston Roustan
- Department of Dermatology, University Hospital Puerta del Hierro, EFSUMB Dermatologic Ultrasound Learning Center, Majahonda, Madrid, Spain
| | | | | | - Orlando Catalano
- Department of Radiology, National Cancer Institute Fondazione Pascale, Naples, Italy
| | | | - Kian Zarchi
- Department of Dermatology, Roskilde Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Marcio Bouer
- Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil
| | - Claudia Gonzalez
- Department of Radiology, Instituto Diagnóstico Médico, Instituto de Imágenes Diagnósticas, Bogota, Colombia
| | | | - Anitha Mandava
- Department of Radiodiagnosis, Central Hospital, Telangana, India
| | - Maria Crisan
- Departments of Dermatology and Histology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Crisan
- Department of Dermatology and Allergic Diseases, University Clinic Ulm, Ulm, Germany
| | - Diana Gaitini
- Department of Medical Imaging, Rambam Health Care Center, Haifa, Israel
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Berman JR, O'Rourke KS, Kolasinski SL, Aizer J, Wheatley MJ, Battistone MJ, Siaton BC, Criscione-Schreiber L, Pillinger MH, Lazaro DM. Rheumatology Research Foundation Clinician Scholar Educator Award: Fifteen Years Promoting Rheumatology Educators and Education. Arthritis Care Res (Hoboken) 2016; 68:1591-1597. [DOI: 10.1002/acr.22858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/10/2015] [Accepted: 02/02/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica R. Berman
- Hospital for Special Surgery and Weill Cornell Medical College, Cornell University; New York New York
| | | | - Sharon L. Kolasinski
- Perelman School of Medicine and Penn Musculoskeletal Center, University of Pennsylvania; Philadelphia
| | - Juliet Aizer
- Hospital for Special Surgery and Weill Cornell Medical College, Cornell University; New York New York
| | - Mary J. Wheatley
- Rheumatology Research Foundation, American College of Rheumatology; Atlanta Georgia
| | | | | | | | - Michael H. Pillinger
- New York University School of Medicine and Hospital for Joint Diseases; New York New York
| | - Deana M. Lazaro
- State University of New York Downstate College of Medicine and VA New York Harbor Healthcare System; Brooklyn New York
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Goldenberg MG, Garbens A, Szasz P, Hauer T, Grantcharov TP. Systematic review to establish absolute standards for technical performance in surgery. Br J Surg 2016; 104:13-21. [PMID: 27686465 DOI: 10.1002/bjs.10313] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/12/2016] [Accepted: 08/10/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Standard setting allows educators to create benchmarks that distinguish between those who pass and those who fail an assessment. It can also be used to create standards in clinical and simulated procedural skill. The objective of this review was to perform a systematic review of the literature using absolute standard-setting methodology to create benchmarks in technical performance. METHODS A systematic review was conducted by searching MEDLINE, Embase, PsycINFO and the Cochrane Database of Systematic Reviews. Abstracts of retrieved studies were reviewed and those meeting the inclusion criteria were selected for full-text review. The quality of evidence presented in the included studies was assessed using the Medical Education Research Study Quality Instrument (MERSQI), where a score of 14 or more of 18 indicates high-quality evidence. RESULTS Of 1809 studies identified, 37 used standard-setting methodology for assessment of procedural skill. Of these, 24 used participant-centred and 13 employed item-centred methods. Thirty studies took place in a simulated environment, and seven in a clinical setting. The included studies assessed residents (26 of 37), fellows (6 of 37) and staff physicians (17 of 37). Seventeen articles achieved a MERSQI score of 14 or more of 18, whereas 20 did not meet this mark. CONCLUSION Absolute standard-setting methodologies can be used to establish cut-offs for procedural skill assessments.
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Affiliation(s)
- M G Goldenberg
- Department of Surgery, University of Toronto, Toronto, Canada
| | - A Garbens
- Department of Surgery, University of Toronto, Toronto, Canada
| | - P Szasz
- Department of Surgery, University of Toronto, Toronto, Canada
| | - T Hauer
- Department of Surgery, University of Toronto, Toronto, Canada
| | - T P Grantcharov
- Department of Surgery, University of Toronto, Toronto, Canada
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Maloney E, Hippe DS, Paladin A, Chew FS, Ha AS. Musculoskeletal Ultrasound Training for Radiology Residents: Lecture Versus Interactive Learning Module. Acad Radiol 2016; 23:789-96. [PMID: 27067604 DOI: 10.1016/j.acra.2015.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/20/2015] [Accepted: 11/22/2015] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES A prospective randomized study was conducted to assess whether an electronic learning module was as effective as a didactic lecture to teach musculoskeletal ultrasound to radiology residents. MATERIALS AND METHODS Thirty-three residents were randomized into a module group versus a didactic group. All residents took a written "pretest" to assess baseline knowledge. Subsequently, the 17 residents in the didactic group attended a live didactic session delivered by a subspecialist musculoskeletal radiology faculty member. The 16 residents in the module group completed an electronic learning module that contained similar content to the live didactic session. Finally, all residents completed a written "posttest," which served as the outcome measure. RESULTS Mean score significantly improved between pre- and posttest by 10.6 ± 11.2% in the didactic group (DG; P = 0.002) and 14.0 ± 8.2% in the module group (MG; P < 0.001), with a nonsignificant difference between groups (P = 0.4). Mean pretest scores (75.6 ± 9.4% DG and 73.7 ± 9.2% MG, P = 0.6) and posttest scores (86.2 ± 9.7% DG and 87.7 ± 5.2% MG, P = 0.5) were not significantly different. The adjusted mean difference in posttest scores between groups was -1.9% (95% confidence interval: -7.2 to 3.5%). CONCLUSION If didactic training was better than electonic module training, the difference was relatively small (<5%). A similar web-based, interactive module could be employed to teach American Board of Radiology Core Examination and Accreditation Council for Graduate Medical Education (ACGME) Diagnostic Radiology Milestone musculoskeletal ultrasound learning objectives to radiology residents. An electronic module could reduce demands on faculty staff time invested in musculoskeletal ultrasound training and be more widely available to residents.
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25
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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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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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Torralba KD, Villaseñor-Ovies P, Evelyn CM, Koolaee RM, Kalish RA. Teaching of clinical anatomy in rheumatology: a review of methodologies. Clin Rheumatol 2015; 34:1157-63. [PMID: 26037454 DOI: 10.1007/s10067-015-2984-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/23/2015] [Indexed: 11/29/2022]
Abstract
Clinical anatomy may be defined as anatomy that is applied to the care of the patient. It is the foundation of a well-informed physical examination that is so important in rheumatologic practice. Unfortunately, there is both documented and observed evidence of a significant deficiency in the teaching and performance of a competent musculoskeletal examination at multiple levels of medical education including in rheumatology trainees. At the Annual Meeting of the American College of Rheumatology in Boston, MA, that took place in November 2014, a Clinical Anatomy Study Group met to share techniques of teaching clinical anatomy to rheumatology fellows, residents, and students. Techniques that were reviewed included traditional anatomic diagrams, hands-on cross-examination, cadaver study, and musculoskeletal ultrasound. The proceedings of the Study Group section are described in this review.
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Affiliation(s)
- Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University, Loma Linda, USA
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Evangelisto AM, Nishio MJ, Higgs JB, Kissin EY, Kaeley GS. Musculoskeletal Ultrasound and Anatomy: Comment on the Article by Navarro-Zarza et al. Arthritis Care Res (Hoboken) 2014; 66:1432-3. [DOI: 10.1002/acr.22344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Jay B. Higgs
- San Antonio Military Medical Center and Joint Base San Antonio; San Antonio TX
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Kissin EY, Grayson PC, Cannella AC, Demarco PJ, Evangelisto A, Goyal J, Al Haj R, Higgs J, Malone DG, Nishio MJ, Tabechian D, Kaeley GS. Musculoskeletal ultrasound objective structured clinical examination: an assessment of the test. Arthritis Care Res (Hoboken) 2014; 66:2-6. [PMID: 23925978 DOI: 10.1002/acr.22105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/31/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the reliability and validity of an objective structured clinical examination (OSCE) for musculoskeletal ultrasound (MSUS). METHODS A 9-station OSCE was administered to 35 rheumatology fellows trained in MSUS and to 3 expert faculty (controls). Participants were unaware of joint health (5 diseased/4 healthy). Faculty assessors (n = 9) graded image quality with predefined checklists and a 0-5 global rating, blinded to who performed the study. Interrater reliability, correlation between a written multiple choice question examination (MCQ) and OSCE performance, and comparison of fellow OSCE results with those of the faculty were measured to determine OSCE reliability, concurrent validity, and construct validity. RESULTS Assessors' interrater reliability was good (intraclass correlation coefficient [ICC] 0.7). Score reliability was good in the normal wrist and ankle stations (ICC 0.7) and moderate in the abnormal wrist and ankle stations (ICC 0.4). MCQ grades significantly correlated with OSCE grades (r = 0.52, P < 0.01). The fellows in the bottom quartile of the MCQ scored 3.07 on the OSCE, significantly worse than the top quartile fellows (3.32) and the faculty (3.29; P < 0.01). Scores also significantly discriminated bottom quartile fellows from faculty in the normal wrist and ankle stations (3.38 versus 3.78; P < 0.01), but not in the abnormal stations (3.37 versus 3.49; P = 0.08). CONCLUSION MSUS OSCE is a reliable and valid method for evaluation of MSUS skill. Normal joint assessment stations are more reliable than abnormal joint assessment stations and better discriminate poorly performing fellows from faculty. Therefore, MSUS OSCE with normal joints can be used for the assessment of MSUS skill competency.
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Ultrasound in systemic sclerosis. A multi-target approach from joint to lung. Clin Rheumatol 2014; 33:1039-47. [PMID: 24535408 DOI: 10.1007/s10067-014-2518-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
Abstract
Ultrasound (US) is a cost-effective, noninvasive, accessible imaging modality that clinicians use at the point of care to assess disease activity and therapeutic efficacy in different rheumatic conditions. However, its utility has been prevalently demonstrated in the field of chronic arthritides. Only in the last few years there was an interest to explore the potential of US beyond the musculoskeletal area. In this way, preliminary US data about the assessment of the different targets involved in systemic sclerosis such as joints, tendons, skin, vessels, and lung have been provided. The main purpose of this US review is to provide an overview of the potential role of US in the multi-target assessment of SSc and to discuss the current evidence supporting its relevance and applications in daily clinical practice.
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