title: The challenges of integrating ultrasonography into routine rheumatology practice: addressing the needs of clinical rheumatologists.
abstract: OBJECTIVE
  The practice of musculoskeletal ultrasonography (MSKUS) by UK rheumatologists remains limited, despite their reported enthusiasm. This study aimed to investigate factors that may encourage or limit future dissemination of rheumatologist-performed MSKUS and provide insights into perceived clinical importance and learning motivation relating to published recommendations by MSKUS experts.
  
  
  METHODS
  A written questionnaire study was conducted, involving 48 rheumatologists. Questions included the potential role of self-performed MSKUS, skills that they would be willing to learn and factors that may encourage or limit learning and practice. Competency recommendations proposed by imaging experts (142 skills in 7 anatomical areas) were reviewed, and quantitative and qualitative data collected regarding 'value to their practice' and 'learning motivation'.
  
  
  RESULTS
  Eighty-nine percent wished to learn MSKUS. Factors influencing learning and practice included time to achieve competency; relative-added clinical value of MSKUS examination; limited training infrastructure; access to existing imaging service; equipment funding. Skills offering greatest clinical utility were inflammatory arthritis assessment and guided procedures; least useful were evaluation of ligament/muscle lesions and soft tissue masses. There was a close correlation between clinical utility, learning motivation and competency standard.
  
  
  CONCLUSIONS
  A trade-off between added clinical value and time to achieve competency is the major factor influencing practice and training in MSKUS. Most rheumatologists report limited time to devote to training and therefore need to prioritize areas of importance for dedicated learning. Educational programmes need to be highly focused and relevant to clinical and job-plan requirements in order to encourage future dissemination of MSKUS practice by rheumatologists.
authors.affiliation: Academic Unit of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK. andrewkbrown@ukonline.co.uk
authors.forename: A K
authors.initials: AK
authors.lastname: Brown
authors.forename: T E
authors.initials: TE
authors.lastname: Roberts
authors.forename: R J
authors.initials: RJ
authors.lastname: Wakefield
authors.forename: Z
authors.initials: Z
authors.lastname: Karim
authors.forename: E
authors.initials: E
authors.lastname: Hensor
authors.forename: P J
authors.initials: PJ
authors.lastname: O'connor
authors.forename: P
authors.initials: P
authors.lastname: Emery
mesh_terms: D001294:Attitude to Health; D002983:Clinical Competence / Q000592:standards*; D004059:Diffusion of Innovation; D004503:Education, Medical, Graduate / Q000379:methods; D004739:England; D006801:Humans; D007858:Learning; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology; D009042:Motivation; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging*; D020380:Needs Assessment; D011216:Practice Management, Medical; D011871:Radiology / Q000193:education* / Q000592:standards; D012219:Rheumatology / Q000193:education* / Q000592:standards; D013997:Time Factors; D014463:Ultrasonography