Sofie M. Janette, BA
Medical Student
University of Miami Miller School of Medicine
Miami Beach, Florida, United States
Alwin David, MD
PGY-4 PM&R Resident
University of Miami
Miami, Florida, United States
Timothy Tiu, M.D., FAAPMR, CAQSM
Assistant Professor
University of Miami Miller School of Medicine
Miami, Florida, United States
Musculoskeletal ultrasound (MSKUS) skills are critical to Physical Medicine and Rehabilitation (PM&R) physicians, and high-level objectives for MSKUS training were added to the Accreditation Council for Graduate Medical Education guidelines in 2021. Despite this, standardized core competencies and assessment methods in MSKUS curricula are lacking. A 2019 study of 35 programs revealed considerable variability in the joints and nerves covered. This study evaluates the MSKUS curriculum of a large tertiary care center by analyzing resident performance on pre- and post-course assessments.
Design:
The curriculum is structured around monthly lectures and practical labs, with additional ultrasound machine access for independent learning. Resident performance was assessed using a 20-question written examination and an Objective Structured Clinical Examination (OSCE) before and after the course. The written exam evaluated theoretical principles of ultrasound including tissue appearance, probe selection, and anatomy. For the OSCE, residents obtained imaging of six pre-determined structures, one from each of the following: shoulder, elbow, hand/wrist, hip, knee, foot/ankle.
Results:
Twenty-four residents participated. A paired t-test for written examination scores showed a significant average improvement of 2.125 points (p = 0.000044). Advanced trainees performed best (PGY-4 > PGY-3 > PGY-2), yet PGY-2 residents reported the greatest increase in comfort with using ultrasound. Residents planning to pursue fellowships (n=12) had an average quiz score of 17.25, compared to 15.25 for those not pursuing fellowships (n=12). OSCE results are pending further statistical analysis.
Conclusions:
The curriculum significantly improved MSKUS technique and image interpretation. Proficiency was linked to experience level, and residents intending to pursue fellowships performed better, possibly due to higher motivation or prior experience. These findings contribute to the discussion of standardizing core competencies and developing robust assessment methods. Future research should focus on collaboration among programs to develop standardized curriculum and evaluation methods, aiming to enhance consistency and quality of MSKUS training.
