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

Maria Antonietta D'Agostino, Eugene Y. Kissin, Jane Nishio, Mie Yang, Marina Backhaus, Peter V. Balint, George A. W. Bruyn, Jurgen Craig-Muller, Maria A. D'Agostino, Alexander Feoktistov, Janak Goyal, Annamaria Iagnocco, Robert W. Ike, Ingrid Moller, Esperanza Naredo, Carlos Pineda, Wolfgang A. Schmidt, Nanno Swen, Darren Tabechian, Richard J. WakefieldAlvin F. Wells, Gurjit S. Kaeley

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective. Because musculoskeletal ultrasound (MSUS) is highly user dependent, we aimed to establish whether non-mentored learning of MSUS is sufficient to achieve the same level of diagnostic accuracy and scanning reliability as has been achieved by rheumatologists recognized as international experts in MSUS. Methods. A group of 8 rheumatologists with more experience in MSUS and 8 rheumatologists with less experience in MSUS participated in an MSUS exercise to assess patients with musculoskeletal abnormalities commonly seen in a rheumatology practice. Patients' established diagnoses were obtained from chart review (gout, osteoarthritis, rotator cuff syndrome, rheumatoid arthritis, and seronegative arthritis). Two examining groups were formed, each composed of 4 less experienced and 4 more experienced examiners. Each group scanned 1 predefined body region (hand, wrist, elbow, shoulder, knee, or ankle) in each of 8 patients, blinded to medical history and physical examination. Structural abnormalities were noted with dichotomous answers, and an open-ended answer was used for the final diagnosis. Results. Less experienced and more experienced examiners achieved the same diagnostic accuracy (US-established diagnosis versus chart review diagnosis). The interrater reliability for tissue pathology was slightly higher for more experienced versus less experienced examiners (κ = 0.43 versus κ = 0.34; P = 0.001). Conclusion. Non-mentored training in MSUS can lead to the achievement of diagnostic accuracy in MSUS comparable to that achieved by highly experienced international experts. Reliability may increase slightly with additional experience. Further study is needed to determine the minimal training requirement to achieve proficiency in MSUS. © 2010, American College of Rheumatology.
Original languageEnglish
Pages (from-to)155-160
Number of pages6
JournalARTHRITIS CARE & RESEARCH
Volume62
DOIs
Publication statusPublished - 2010

Keywords

  • Adult
  • Clinical Competence
  • Education, Medical, Continuing
  • Humans
  • Musculoskeletal Diseases
  • Self Efficacy
  • Rheumatology
  • Ultrasonography
  • United States
  • Problem-Based Learning
  • Observer Variation

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