Musculoskeletal Ultrasound in Canadian Rheumatology Training Programs: Towards a National Curriculum

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Introduction: In 2019 the Royal College of Physicians and Surgeons of Canada added educational experiences in MSUS to the core competencies in rheumatology as an optional training experience. Many Canadian rheumatology programs offer MSUS training for residents, but there is currently no national ultrasound curriculum in Canada outside of externally available courses. Objectives: This thesis had two objectives. Objective one was to explore how educators prioritize competencies while developing educational content for a rheumatology MSUS curriculum. Objective two was to define the expert consensus recommendations for MSUS in Canadian post-graduate rheumatology training programs. Methods: To address objective one, we invited educators with rheumatology MSUS expertise to participate in a modified nominal group technique (NGT) with a sequential mixed methods design. For objective two, we assembled a MSUS working group including educators with rheumatology MSUS expertise, rheumatology residents, and rheumatology program directors. We used a three-stage consensus design including a modified NGT, modified Delphi technique, and structured online focus group to establish consensus among the MSUS working group on MSUS competencies that should be included in a national rheumatology resident curriculum. Results: We identified seven themes that represent key elements educators consider when prioritizing competencies during the curriculum development process, which balance two key factors: clinical utility and learnability. We used these themes to develop a conceptual framework that can be used to help guide educators when curricular content must be prioritized. For the consensus recommendations, key rheumatology MSUS stakeholders agreed that it should be mandatory for all Canadian post-graduate rheumatology trainees to learn basic ultrasound skills; how to perform a focused MSUS exam of the hands, wrists, and feet for features of inflammatory arthritis; and perform a limited MSUS exam of the knee and ankle to identify a joint effusion. Conclusion: This thesis used a hybrid of consensus methods to advance MSUS education in Canadian post-graduate rheumatology training programs. We hope that this work can contribute to the goal of a national MSUS curriculum for all Canadian post-graduate rheumatology trainees.
Medical education, Curriculum development, Rheumatology, Musculoskeletal ultrasound, Consensus methods
Powell, M. (2023). Musculoskeletal ultrasound in Canadian rheumatology training programs: towards a national curriculum (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from