A modular, flexible training strategy to achieve competence in diagnostic and interventional musculoskeletal ultrasound in patients with hip osteoarthritis

Abstract

This study sought to establish a model of training and an assessment of competency in musculoskeletal ultrasound (MSUS) diagnosis of hip synovitis and/or effusion and in MSUS-guided injection of the hip. The 'trainee' (no previous experience in MSUS) was trained by an 'expert' [a rheumatologist who is a trainer on the European League Against Rheumatism (EULAR) MSUS course] using a modular approach focused on hip ultrasound only. This consisted of (i) a 1.5 h initial tutorial and practical demonstration and (ii) indirectly supervised non-continuous scanning of 40 hips over 5 h. Competency was assessed in three ways: (i) ability to obtain standard EULAR reference MSUS images of the hip of sufficient image quality, (ii) accuracy in diagnosis of synovitis or hip effusion by measurement of the anterior femur-capsule distance, and (iii) accuracy in ultrasound-guided hip aspiration and injection. After a period of scanning of 75 min (10 hips), the images obtained by the trainee were consistently graded as acceptable for routine clinical use. Next, blinded triplicate measurements of the anterior femur-capsule distance performed by the trainee and expert showed agreement regarding diagnosis of hip effusion (>7 mm thickness) in 16/17 cases of hip arthritis (kappa 0.876). The trainee performed 40 MSUS-guided hip injections (seven directly supervised followed by 33 indirectly supervised). After 10 consecutive MSUS-guided hip injections, the novice achieved a subsequent accuracy rate of 25/26 (96%) confirmed by radiographic localization of radiopaque contrast. Using a modular approach, a learner-centred curriculum and a self-directed learning strategy with a minimum of direct supervision, a trainee achieved competence in MSUS diagnosis of hip effusion/synovitis and in MSUS-guided hip aspiration/injection.