Education Research: Feasibility, Reliability and Educational Value of Neuromuscular Ultrasound Training in a Canadian Neurology Residency Program: A Pilot Study.

BACKGROUND AND

OBJECTIVES

Point-of-care neuromuscular ultrasound (NMUS) is increasingly used in the evaluation of peripheral nervous system disorders; however, there remains a gap in education and training for neurology residents. We evaluated whether neurology residents can feasibly be trained in basic NMUS skills and nerve cross-sectional area (CSA) measurement and whether they value incorporation of this training into their curriculum.

METHODS

Participants included neurology residents (postgraduate years 1-5) at the University of Alberta (Edmonton, Alberta, Canada). All completed pretraining and posttraining surveys using a Likert scale, rating their confidence in independently performing NMUS and their degree of agreement regarding the educational value of NMUS training. Residents underwent training (7 hours) comprising 1 didactic and 2 hands-on sessions, detailing NMUS of median, ulnar, and fibular nerves. Participants could then opt-in to a posttraining testing session where CSA measurements (mm2) of the median, ulnar, and fibular nerve at multiple sites were independently performed on 3 healthy volunteers and compared with measurements obtained by the trainer.

RESULTS

Eighteen residents participated in training and pretraining/posttraining surveys. Nine completed the testing component. Nerve CSA measurement reliability between the trainer and trainees across all nerve sites combined was very good (intraclass correlation coefficient [ICC] 0.93, 95% CI 0.83-0.96) but varied by nerve and site. ICC was good to very good (0.62-0.95) except for the ulnar nerve-distal forearm/wrist (0.39-0.58) and fibular nerve-fibular head (0.12) sites. The coefficient of variation (CoV) across all sites was 19.6% (95% CI 17.3-21.8) and best for the median nerve-wrist site at 15.5% (9.8-20.8). The mean absolute difference between trainer and trainee measurements was low (<0.5 mm2 across all sites). Comparing pretraining and posttraining survey responses, there was a significant increase in agreement that basic NMUS operational skills were obtained and in confidence in independently measuring each nerve. NMUS training was considered a valuable component of a neurology residency program curriculum (median rating: strongly agree).

DISCUSSION: Neurology residents across stages of training can acquire basic NMUS and CSA measurement skills of the median and ulnar nerves after 2 half-days of training and value incorporation of NMUS training in their educational curriculum.