University of Wisconsin Madison, WI, United States
Ann Chodara1, Sara McCoy1 and Jon Arnason2, 1University of Wisconsin, Madison, WI, 2University of Wisconsin Hospitals and Clinics, Madison, WI
Background/Purpose: Musculoskeletal ultrasound is an important training tool in rheumatology fellowship. The University of Wisconsin rheumatology fellowship has offered musculoskeletal ultrasound (MSUS) training as a structured part of its curriculum since 2013. The fellows learn ultrasound, primarily by doing US guided procedures with direct supervision by a MSUS certified rheumatologist.;
Methods: The MSUS curriculum takes place over two years. It is integrated into the fellows' schedule and consists of participation in ultrasound clinic one afternoon per week. Figure 1 shows the curriculum year plan. During ultrasound clinic, fellows receive individualized teaching on diagnostic and therapeutic ultrasound guided procedures. Fellows perform procedures from day one to enhance learning and applicability. Didactic training comprises i) an introductory lecture reviewing US fundamentals and standard joint views, ii) a "knobology" lecture focusing on technical aspects, and iii) pre-recorded monthly lectures with assignments to enhance asynchronous learning. Monthly assignments focus on selected joints, salivary gland ultrasound, and identifying pathology. Fellows have access to ultrasound machines at multiple clinical sites where they are encouraged to practice ultrasound on their own. Evaluations include direct, real-time feedback, monthly graded assignments, quarterly assessment of milestones and progression in skills, and biannual evaluation as a part of fellows' overall competency evaluation. Fellows are provided support and encouraged to apply to USSONAR or similar MSUS training course during their second year. In total, the fellows perform a minimum of 150 procedures and ultrasound examinations during the course of their fellowship which allows fellows to satisfy criteria to sit for the MSUS in Rheumatology (RhMSUS) examination through the American College of Rheumatology (ACR) upon completion of fellowship.
Results: Of the 11 fellows who have been offered US training since 2013, 9 fellows have completed training. 5/9 obtained USSONAR scholarship and 5 are RhMSUS certified, with one fellow preparing to take the exam. Of the graduated fellows, 7/8 fellows are currently using MSUS in their clinical practice.
Conclusion: The University of Wisconsin has established a successful MSUS curriculum comprising supervised procedures, individualized training, regular assignments, and scheduled feedback. We demonstrate our curriculum's success in training fellows competent in MSUS with high passing rates on the RhMSUS exam and incorporation of MSUS into clinical practice after graduation. Unique aspects of our curriculum include an emphasis on performing procedures from day one, and the integration into both fellow and attending schedules. Next steps include further refinement of the teaching curriculum and increasing exposure for those who desire additional specialized training. Figure 1. MSUS curriculum for University of Wisconsin rheumatology fellowship. Disclosures: A. Chodara, None; S. McCoy, Novartis, Bristol-Myers Squibb(BMS); J. Arnason, None.
Figure 1. MSUS curriculum for University of Wisconsin rheumatology fellowship.