Undergraduate musculoskeletal ultrasound training based on current national guidelines-a prospective controlled study on transferability

Abstract

Introduction: Musculoskeletal ultrasound (MSUS) is integral to routine clinical diagnostics for musculoskeletal and joint disorders. This study aims to establish and validate a sonography course tailored to undergraduate medical students acquiring MSUS-specific skills at a German university.

Methods: A blended learning training concept, comprising 24 instruction sessions of 45 min each, was designed based on the current national guidelines of the German Society for Ultrasound in Medicine (DEGUM). This program was integrated into the clinical phase of the undergraduate students' medical education. The self-perceived improvement in competency and the effectiveness of the course design were evaluated using a a 7-point Likert scale questionnaire. Objective learning success was evaluated via a written test and a "Direct Observation of Practical Skills" practical exam. Control groups included medical students without MSUS training (control group 1) and doctors who had completed DEGUM-certified basic MSUS courses (control group 2). Both control groups completed the written test, while control group 2 also took the practical final exam. The study involved 146 participants: 56 were allocated to the study group, 44 to control group 1, and 46 to control group 2.

Results: The study group rated their skills significantly higher after the course (p < 0.01). Participants expressed high satisfaction with the course design, the teaching materials, and the teachers. The study group's performance on the final written test was comparable to those of control group 2 (p = 0.06) and significantly superior to control group 1 (p < 0.001). Additionally, the study group's performance on the practical final exam was not significantly different from control group 2 (p = 0.28), with both groups achieving scores exceeding 80%.

Conclusion: Both subjective and objective measures of learning suggest that an MSUS course designed for postgraduates can be effectively adapted for undergraduate medical students. Incorporating MSUS training into the clinical curriculum is recommended to enhance future medical professionals' educational experience and practical skills.

Keywords: Blended learning; Competency-based education; DOPS; Education; Medical; Musculoskeletal ultrasound; Ultrasonography; Undergraduate.

Fig. 1

Study planning, study process and training concept; DOPS = Direct Observation of Procedural Skills Test. a MSUS curriculum development process; b Timeline of participant recruitment; c Course design including assessments; d Module sequence; *These tests were performed by the control groups as well as the study group

Fig. 2

Results of the subjective competency assessment before (orange) and after (blue) completion of the curriculum regarding the “overall ultrasound competencies” (a), the “general ultrasound competencies” (b), and the “MSUS-specific competencies” (c), as well as the evaluation of the design (d). Likert answering formats with 1 = very good/completely and 7 = very bad/not at all. The visualisation was created using raincloud and violin plots

Fig. 3

Results of the theory test of the study group (blue), control group 1 (purple) and control group 2 (green). a represents the overall score while the score per subcategory is given in b–f

Fig. 4

Results of the practical test of the study group (blue) and control group 2 (green) overall (a) and per subcategory (b-i)