Development of a Foundational Neuromuscular Ultrasound Competency Assessment for Trainees

Neuromuscular ultrasound (NMUS) is becoming increasingly incorporated as a complementary tool in electrodiagnostic (EDX) medicine. Competency assessment is critical to ensure adequate quality, appropriate application, and accurate interpretation. The primary objective was to develop a competency-based assessment tool of foundational NMUS skills among postgraduate medical trainees in a single center.

The assessment included written (28 multiple-choice, short answer, or yes/no) questions and practical skills (15 prompts) sections recommended by a published consensus-based survey to include the knowledge and skills necessary to achieve minimal competency for unsupervised practice of NMUS for common conditions. The written portion included interpretation of basic pathology. Core practical content focused on the most evaluated structures in the Mayo EDX laboratory: the median and ulnar nerves and diaphragm muscle. The practical portion was administered by a single examiner and scored with a five-point competency-based rating. Four experienced educators used the Angoff standard setting method to set passing scores for each section.

Subjects included three EMG-track clinical neurophysiology fellows who completed a NMUS lecture series with supervised hands-on scanning and a 2-week intra-lab NMUS elective during fellowship. Composite scores ranged from 89% to 97%. All subjects met minimum passing scores for each section (77% and 88% for the knowledge and skills sections, respectively).

This NMUS competency assessment was successfully implemented and may be incorporated into postgraduate medical trainee evaluation to ensure minimal competency in evaluation of carpal tunnel syndrome, ulnar neuropathy at the elbow, and diaphragm function. This effort integrates quality NMUS evaluations into clinical practice.