title: Self-directed learning of basic musculoskeletal ultrasound among rheumatologists in the United States.
abstract: OBJECTIVE
  Because musculoskeletal ultrasound (MSUS) is highly user dependent, we aimed to establish whether non-mentored learning of MSUS is sufficient to achieve the same level of diagnostic accuracy and scanning reliability as has been achieved by rheumatologists recognized as international experts in MSUS.
  
  
  METHODS
  A group of 8 rheumatologists with more experience in MSUS and 8 rheumatologists with less experience in MSUS participated in an MSUS exercise to assess patients with musculoskeletal abnormalities commonly seen in a rheumatology practice. Patients' established diagnoses were obtained from chart review (gout, osteoarthritis, rotator cuff syndrome, rheumatoid arthritis, and seronegative arthritis). Two examining groups were formed, each composed of 4 less experienced and 4 more experienced examiners. Each group scanned 1 predefined body region (hand, wrist, elbow, shoulder, knee, or ankle) in each of 8 patients, blinded to medical history and physical examination. Structural abnormalities were noted with dichotomous answers, and an open-ended answer was used for the final diagnosis.
  
  
  RESULTS
  Less experienced and more experienced examiners achieved the same diagnostic accuracy (US-established diagnosis versus chart review diagnosis). The interrater reliability for tissue pathology was slightly higher for more experienced versus less experienced examiners (kappa = 0.43 versus kappa = 0.34; P = 0.001).
  
  
  CONCLUSIONS
  Non-mentored training in MSUS can lead to the achievement of diagnostic accuracy in MSUS comparable to that achieved by highly experienced international experts. Reliability may increase slightly with additional experience. Further study is needed to determine the minimal training requirement to achieve proficiency in MSUS.
authors.affiliation: Boston University Medical Center, Boston, Massachusetts, USA. eugene.kissin@bmc.org
authors.forename: Eugene Y
authors.initials: EY
authors.lastname: Kissin
authors.forename: Jane
authors.initials: J
authors.lastname: Nishio
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
authors.forename: Marina
authors.initials: M
authors.lastname: Backhaus
authors.forename: Peter V
authors.initials: PV
authors.lastname: Balint
authors.forename: George A W
authors.initials: GA
authors.lastname: Bruyn
authors.forename: Jurgen
authors.initials: J
authors.lastname: Craig-Muller
authors.forename: Maria A
authors.initials: MA
authors.lastname: D'Agostino
authors.forename: Alexander
authors.initials: A
authors.lastname: Feoktistov
authors.forename: Janak
authors.initials: J
authors.lastname: Goyal
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.forename: Robert W
authors.initials: RW
authors.lastname: Ike
authors.forename: Ingrid
authors.initials: I
authors.lastname: Moller
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.forename: Carlos
authors.initials: C
authors.lastname: Pineda
authors.forename: Wolfgang A
authors.initials: WA
authors.lastname: Schmidt
authors.forename: Nanno
authors.initials: N
authors.lastname: Swen
authors.forename: Darren
authors.initials: D
authors.lastname: Tabechian
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wakefield
authors.forename: Alvin F
authors.initials: AF
authors.lastname: Wells
authors.forename: Gurjit S
authors.initials: GS
authors.lastname: Kaeley
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D009140:Musculoskeletal Diseases / Q000000981:diagnostic imaging*; D015588:Observer Variation; D018794:Problem-Based Learning; D012219:Rheumatology / Q000193:education* / Q000379:methods*; D020377:Self Efficacy; D014463:Ultrasonography; D014481:United States