Use of Musculoskeletal Ultrasound in Pediatric Rheumatology Fellowship Programs

Musculoskeletal ultrasound (MSUS) is a novel tool widely used in adult rheumatology to identify inflammation from synovitis to enthesitis in patients with possible inflammatory arthritis, and to assist in ultrasound-guided procedures. MSUS is better tolerated by patients, does not require radiation or sedation like more complex imaging modalities, and allows for multiple sites to be examined in one setting. Consequently, there is increasing interest in the use of MSUS in pediatric rheumatology. A 2017 survey of adult rheumatology fellowship program directors in the United States revealed 94% of programs provide some level of MSUS education. Responses to a 2014 survey sent to pediatric rheumatology program directors showed just 20% of their programs offer MSUS education. Thus, Perron et al created a survey to identify interest in, access to, and barriers to MSUS training in pediatric rheumatology fellowship programs.¹

The authors developed a cross-sectional website-based survey, which was adapted from a prior survey regarding MSUS education. Data were collected in a 4-week period in March and April 2022. The main outcome measures included fellows’ interest in and perceived benefit of MSUS training in fellowship, characterization of MSUS training received, barriers to learning, and reported use of MSUS in clinical practice by the individual respondent and the department overall. Background demographics were obtained. Participants were identified through the Childhood Arthritis and Rheumatology Research Alliance email registry.

A total of 113 eligible participants (93 current fellows and 20 recently graduated fellows) from 40 pediatric rheumatology programs in North America were identified. Of those who were eligible, 88 (78%) completed the survey. Of those who responded, 72% reported their pediatric rheumatology department had access to ultrasound, and 65% reported access to an ultrasound outside of clinic and teaching sessions for self-directed learning and practice. Three-fourths of respondents reported having some form of MSUS education in their pediatric rheumatology fellowship, and 67% wished they had more education in their training. Additionally, of the respondents with MSUS training, 23% reported having adult-only MSUS education. Only 36% noted their fellowship program had a formal MSUS curriculum. Of the respondents with MSUS training, 46% stated they are currently performing (or performed) MSUS as part of their clinical practice.

The majority of respondents felt MSUS training would be beneficial for their future career. However, 16% perceived no benefit, with the greatest barrier being lack of time (50%). Other barriers included lack of MSUS-trained faculty (48%) and lack of hands-on MSUS sessions (41%). Reported benefits were related to patient care, including the ability to avoid magnetic resonance imaging and sedation in children. Around one-third of respondents reported that their program offers to fund formal training in MSUS for fellows and that they plan to obtain MSUS certification. In bivariate analysis, those with access to MSUS training were significantly more interested in MSUS than those without.

To the authors’ knowledge, this study was the first published survey of pediatric rheumatology fellows in North America related to MSUS. They found an excellent response rate and a high percentage of respondents (86%) with interest in learning MSUS during fellowship. Benefits noted by respondents included improved clinical skills and confidence in diagnosis and improved accuracy with intra-articular joint injections. However, there were also several perceived barriers to adequate MSUS training.

These findings suggest a gap in the level of interest in MSUS education versus available training in pediatric rheumatology fellowships. Of note, the Ultrasound School of North American Rheumatologists has created a virtual MSUS curriculum for pediatric rheumatology fellows, and pediatric-specific MSUS courses are in development. Further work is needed to identify ways to increase pediatric MSUS exposure and training for pediatric rheumatology trainees.

Reference

1. 1. Perron MM, Ziniel SI, Curran M, et al. Needs assessment of musculoskeletal ultrasound training in North American pediatric rheumatology fellowship programs. Arthritis Care Res. 2024. doi:10.1002/acr.25337