Self‐directed learning of basic musculoskeletal ultrasound among rheumatologists in the United States |
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| Authors: | Eugene Y Kissin Mei Yang Peter V Balint George A W Bruyn Jurgen Craig‐Muller Maria A D'Agostino Alexander Feoktistov Annamaria Iagnocco Robert W Ike Ingrid Moller Esperanza Naredo Carlos Pineda Wolfgang A Schmidt Nanno Swen Darren Tabechian Richard J Wakefield Gurjit S Kaeley |
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| Institution: | 1. Boston University Medical Center, Boston, MassachusettsDr. Kissin has received consultant fees, speaking fees, and/or honoraia (less than $10,000 each) from SonoSite and Amgen‐Wyeth.;2. Boston University Medical Center, Boston, Massachusetts;3. National Institute of Rheumatology and Physiotherapy, Budapest, Hungary;4. Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands;5. CentraCare Clinic, Saint Cloud, Minnesota;6. H?pital Ambroise Pare, Paris, France;7. Tufts University School of Medicine, Boston, Massachusetts;8. University de la Sapienza, Rome, Italy;9. University of Michigan, Ann Arbor;10. Instituto Poal de Reumatologia, Barcelona, Spain;11. Hospital Severo Ochoa, Madrid, Spain;12. National Institute of Rehabilitation, Mexico City, Mexico;13. Hospital Berlin‐Buch, Berlin, Germany;14. Medisch Centrum Alkmaar, Alkmaar, The Netherlands;15. University of Rochester, Rochester, New York;16. Chapel Allerton Hospital, Leeds, UK |
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| 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. |
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