Brown A K, Roberts T E, Wakefield R J, Karim Z, Hensor E, O'connor P J, Emery P
Academic Unit of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK.
Rheumatology (Oxford). 2007 May;46(5):821-9. doi: 10.1093/rheumatology/kel412. Epub 2007 Jan 20.
The practice of musculoskeletal ultrasonography (MSKUS) by UK rheumatologists remains limited, despite their reported enthusiasm. This study aimed to investigate factors that may encourage or limit future dissemination of rheumatologist-performed MSKUS and provide insights into perceived clinical importance and learning motivation relating to published recommendations by MSKUS experts.
A written questionnaire study was conducted, involving 48 rheumatologists. Questions included the potential role of self-performed MSKUS, skills that they would be willing to learn and factors that may encourage or limit learning and practice. Competency recommendations proposed by imaging experts (142 skills in 7 anatomical areas) were reviewed, and quantitative and qualitative data collected regarding 'value to their practice' and 'learning motivation'.
Eighty-nine percent wished to learn MSKUS. Factors influencing learning and practice included time to achieve competency; relative-added clinical value of MSKUS examination; limited training infrastructure; access to existing imaging service; equipment funding. Skills offering greatest clinical utility were inflammatory arthritis assessment and guided procedures; least useful were evaluation of ligament/muscle lesions and soft tissue masses. There was a close correlation between clinical utility, learning motivation and competency standard.
A trade-off between added clinical value and time to achieve competency is the major factor influencing practice and training in MSKUS. Most rheumatologists report limited time to devote to training and therefore need to prioritize areas of importance for dedicated learning. Educational programmes need to be highly focused and relevant to clinical and job-plan requirements in order to encourage future dissemination of MSKUS practice by rheumatologists.
尽管英国风湿病学家对肌肉骨骼超声检查（MSKUS）表现出热情，但他们的实际操作仍然有限。本研究旨在调查可能促进或限制未来风湿病学家进行MSKUS检查传播的因素，并深入了解与MSKUS专家发表的建议相关的临床重要性和学习动机。
开展了一项书面问卷调查研究，涉及48名风湿病学家。问题包括自我进行MSKUS检查的潜在作用、他们愿意学习的技能以及可能促进或限制学习和实践的因素。对影像专家提出的能力建议（7个解剖区域的142项技能）进行了审查，并收集了关于“对他们实践的价值”和“学习动机”的定量和定性数据。
89%的人希望学习MSKUS。影响学习和实践的因素包括达到能力所需的时间；MSKUS检查的相对附加临床价值；培训基础设施有限；能否使用现有的影像服务；设备资金。临床效用最大的技能是炎症性关节炎评估和引导操作；最没用的是韧带/肌肉病变和软组织肿块的评估。临床效用、学习动机和能力标准之间存在密切相关性。
附加临床价值与达到能力所需时间之间的权衡是影响MSKUS实践和培训的主要因素。大多数风湿病学家表示用于培训的时间有限，因此需要对专门学习的重要领域进行优先排序。教育计划需要高度聚焦并与临床和工作计划要求相关，以鼓励未来风湿病学家传播MSKUS实践。
