Design and Implementation of a Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents

Abstract

Studies have shown that physical medicine and rehabilitation residents have poor surface anatomy palpation accuracy, suggesting that new methods of teaching musculoskeletal (MSK) examination need to be found. This study describes the design of a novel MSK ultrasound course that integrated ultrasonography skills with palpation skills. Ultrasound was used to teach, validate, and refine physical medicine and rehabilitation residents’ palpation of MSK structures. Surface anatomy palpation is intimately related to ultrasonography as clinicians should use palpation to guide their ultrasound examination rather than purely follow an algorithm. This study assessed whether the ultrasound course improved physical medicine and rehabilitation resident palpation accuracy at 12 upper limb structures. Palpation accuracy was tested at the beginning of their residency training and retested several weeks after completion of the ultrasound course’s upper limb component, to assess retention of skill. There was significant improvement (P < 0.05) in 9 of 12 sites from pretesting to posttesting. Mean postcourse palpation accuracy was within 1 cm for 8 of 12 structures. This study demonstrates that an integrated MSK ultrasound and palpation curriculum improves palpation accuracy at multiple MSK structures and this improvement is retained. Physical medicine and rehabilitation residencies should consider integrating palpation skills into their ultrasound curriculum to improve the caliber of their trainees.

Evaluation of an Ultrasound-Guided Palpation Intervention for Palpation Skill Training: A Single-Blind, Parallel Group, Randomised Controlled Trial

“…Accurate palpation of the anatomical location and accurate examination of the tenderness of soft tissue are very important clinically to identify the tissue causing pain. The importance of palpation skills using US images is expected to increase in the future, and it is desirable to construct a systematic curriculum that includes US imaging education of whole-body landmarks 10 . In contrast, it has been reported that the accuracy of palpation of the foot was still low even after training to improve palpation skills using ultrasonography 19 .…”

“…Many previous studies have supported the use of echo in improving palpation skills. Improved palpation skills have been reported by using echoes at the lumbar spine 11 , shoulder joint 5 , some body landmarks 15 , various upper extremity landmarks 10 , and knee joint landmarks 6 . However, these were only intervention studies without control groups, and the differences between the new method and the usual instructional method could not be assessed.…”

“…It is used to identify anatomical landmarks in many departments, including the physical medicine and rehabilitation areas 9 . Additionally, systematic learning courses for improving palpation skills using US images have been developed to take advantage of the US images recently 10 . There has also been an increasing number of interventional studies on the usefulness of US imaging as a tool to improve the palpation skills of medical students or residents [11][12][13][14][15] .…”

Randomised controlled trial for evaluation of an ultrasound-guided palpation intervention for palpation skill training

“…It is used to identify anatomical landmarks in many departments, including the physical medicine and rehabilitation areas 9 . Additionally, systematic learning courses for improving palpation skills using US images have been developed to exploit US images recently 10 . Additionally, there has been an increasing number of interventional studies on the usefulness of US imaging as a tool to improve the palpation skills of medical students or residents 11 , 12 .…”

“…Many preliminary studies have reported improvements in palpation skills using US imaging 5 , 6 , 10 – 12 , 16 – 18 . However, most of these were observational studies that did not examine confounders or interventional studies without a control group.…”