Musculoskeletal ultrasound training for the internal medicine resident: Development and assessment of a teaching curriculum for elective rotation.

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Conference Proceeding

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J Gen Intern Med


NEEDS AND OBJECTIVES: Ultrasound has become increasingly utilized throughout internal medicine and its subspecialties. Musculoskeletal ultrasound is a vital tool for assessing patients with tendon and joint abnormalities, and is employed for diagnostic as well as therapeutic purposes. Internal medicine residents would benefit from using musculoskeletal ultrasound as musculoskeletal problems are among the most frequently encountered complaints in ambulatory clinic. Formal training in musculoskeletal ultrasound is largely absent from internal medicine residency programs. We sought to establish an elective rotation in musculoskeletal ultrasound for the internal medicine resident, and develop an effective teaching curriculum that could be easily implemented at other internal medicine residencies. SETTING AND PARTICIPANTS: The course took place as part of a month-long elective rotation at an outpatient rheumatology musculoskeletal ultrasound clinic. A senior staff rheumatologist who was board certified in musculoskeletal ultrasound by the American College of Rheumatology assisted with curriculum development and led the course. Internal medicine residents from a large academic teaching hospital and from all training levels took part, including some interested in pursuing rheumatology fellowship training. DESCRIPTION: Goals and objectives were created to reflect the six core competencies for residents in graduate medical education. A structured curriculum was developed using units with modules that incorporated book chapters, online videos, and hands-on workshops with the ultrasound, which were broken down by joint system. Residents spent time reading, observing, and practicing with the ultrasound before performing supervised examinations and interventions on their own. EVALUATION: A pre- and post-test was administered to the residents. It consisted of multiple choice questions and ultrasound-captured images covering principles of ultrasound as well as basic musculoskeletal anatomy and pathology. An opportunity to provide course feedback was given on the posttest evaluation. DISCUSSION/REFLECTION/LESSONS LEARNED: Feedback was very positive from the six internal medicine residents who took part in the course, and pre- to post-test scores improved by over fifty percent. Residents felt the course was a good learning experience and that its strengths were a clear curriculum, the amount of teaching and the opportunity to become comfortable using ultrasound to both understand musculoskeletal anatomy and pathology as well as perform joint aspirations and injections. Overall, everyone indicated that the course had very good utility for the internal medicine resident. Based on our positive results and feedback, we felt the course and its curriculum were an effective means to teach musculoskeletal ultrasound to internal medicine residents.





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