Expert Consensus Recommendations for Musculoskeletal Ultrasound Education in Canadian Rheumatology Residency Programs

We aimed to develop expert consensus recommendations for musculoskeletal ultrasound (MSUS) education in Canadian rheumatology residency programs.

This three-stage consensus study used an international working group of 13 MSUS experts and 5 nonexpert stakeholders and incorporated cognitive load theory to ensure educational feasibility. In stage one, MSUS experts participated in a modified nominal group technique (NGT) to generate and prioritize items for stage two. In stage two, the working group completed three survey rounds using a modified Delphi technique, with consensus defined as agreement ≥70%. In stage three, experts reviewed items from stage two in a structured focus group, rating each for clinical utility, learnability, and feasibility of national implementation.

The NGT generated 30 prioritized anatomic areas and pathologies. The Delphi working group represented 7 of 12 (58%) Canadian rheumatology programs (English stream) and two US experts. The response rate across all Delphi rounds was 100%. Round one included 83 items, round two included 52, and round three included 9. Consensus was reached on all but 5 items, yielding 42 core and 38 optional items. In the structured focus group, consensus was reached that all core items are clinically valuable, learnable for rheumatology residents, and feasible for national implementation. Core items were then organized into 33 MSUS competencies, encompassing general ultrasound skills; features of inflammatory arthritis in the hands, wrists, and metatarsophalangeal (MTP) joints; double contour sign in the MTP joints; and effusion detection in the knee and ankle joints.

These recommendations provide a foundation for standardized MSUS curricula in rheumatology residency programs.