Musculoskeletal ultrasound in internal medicine residency - a feasibility study

Ultrasound has become indispensable in medicine for diagnosis and therapeutics. In Internal Medicine Residency Training Program (IMRTP), there is a deficiency of a structured, competency-based musculoskeletal ultrasound (MSKUS) training despite its growing popularity.

We conducted a feasibility study for incorporating MSKUS in IMRTP and competency assessment. We recruited internal medicine residents from all training levels. Rheumatology attending with expertise in MSKUS supervised curriculum-design and patient-based assessment. A structured curriculum was developed for knee MSKUS, including training material and a pre- and post-test. An Observed Structured Clinical Exam (OSCE) was used for competency assessment. Attending evaluations and participant feedbacks were collected.

Fifteen residents participated and 12 completed the OSCE. The pre-post tests showed a statistically significant increase (p<0.001) for all subcomponents (anatomy, pathology, and biophysics). The residents scored high on the OSCE [8.8±1.1 (range 7-10)]. Attending evaluations for cognitive and technical skills were rated 'Excellent' (66%) and 'Good' (87%), respectively. The training program was perceived very valuable with regard to time and resources spent by residents and faculty, although some felt a need for more patient assessments.

The competency assessed with our OSCE and highly positive feedback reflects this preliminary study's importance and sets the platform for future studies of formal ultrasound training in internal medicine.