Musculoskeletal ultrasound objective structured clinical examination: an assessment of the test.
OBJECTIVE
To determine the reliability and validity of an objective structured clinical examination (OSCE) for musculoskeletal ultrasound (MSUS).


METHODS
A 9-station OSCE was administered to 35 rheumatology fellows trained in MSUS and to 3 expert faculty (controls). Participants were unaware of joint health (5 diseased/4 healthy). Faculty assessors (n = 9) graded image quality with predefined checklists and a 0-5 global rating, blinded to who performed the study. Interrater reliability, correlation between a written multiple choice question examination (MCQ) and OSCE performance, and comparison of fellow OSCE results with those of the faculty were measured to determine OSCE reliability, concurrent validity, and construct validity.


RESULTS
Assessors' interrater reliability was good (intraclass correlation coefficient [ICC] 0.7). Score reliability was good in the normal wrist and ankle stations (ICC 0.7) and moderate in the abnormal wrist and ankle stations (ICC 0.4). MCQ grades significantly correlated with OSCE grades (r = 0.52, P < 0.01). The fellows in the bottom quartile of the MCQ scored 3.07 on the OSCE, significantly worse than the top quartile fellows (3.32) and the faculty (3.29; P < 0.01). Scores also significantly discriminated bottom quartile fellows from faculty in the normal wrist and ankle stations (3.38 versus 3.78; P < 0.01), but not in the abnormal stations (3.37 versus 3.49; P = 0.08).


CONCLUSIONS
MSUS OSCE is a reliable and valid method for evaluation of MSUS skill. Normal joint assessment stations are more reliable than abnormal joint assessment stations and better discriminate poorly performing fellows from faculty. Therefore, MSUS OSCE with normal joints can be used for the assessment of MSUS skill competency.
Boston University School of Medicine, Boston, Massachusetts.
Eugene Y
EY
Kissin
Peter C
PC
Grayson
Amy C
AC
Cannella
Paul J
PJ
Demarco
Amy
A
Evangelisto
Janak
J
Goyal
Rany
R
Al Haj
Jay
J
Higgs
Daniel G
DG
Malone
Midori J
MJ
Nishio
Darren
D
Tabechian
Gurjit S
GS
Kaeley
D000843:Ankle Joint / Q000000981:diagnostic imaging; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000379:methods; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D009141:Musculoskeletal System / Q000000981:diagnostic imaging*; D015588:Observer Variation; D015203:Reproducibility of Results; D012219:Rheumatology / Q000193:education*; D014463:Ultrasonography / Q000379:methods*; D014955:Wrist Joint / Q000000981:diagnostic imaging