Entrustable Professional Activities for Musculoskeletal Ultrasound Training in a Canadian Rheumatology Residency Program: A Pilot Study
Bibliographic record
Abstract
Objectives Point-of-care musculoskeletal ultrasound (MSUS) training is increasingly being implemented in the rheumatology training programs. However, a validated framework to reliably assess MSUS competency is needed. Recommendations for MSUS education in Canadian rheumatology residency programs were recently established by a national expert consensus panel.[1] Our study aimed to develop, evaluate, and implement MSUS Entrustable Professional Activities (EPAs) within the Adult Rheumatology residency program at the University of Toronto. Methods MSUS EPAs were developed by an expert MSUS panel of rheumatologists to define the progress in MSUS skill competency level on a 5-point entrustability scale indicating the resident’s level of independence. The EQual rubric was employed to appraise the quality of the EPAs through soliciting input from 5 clinical educators with substantial expertise in MSUS.[2] Data aggregation was performed to determine if the quality of the EPAs met satisfactory standards. Post-Graduate Year (PGY) 4 and 5 rheumatology residents enrolled in a two-year longitudinal MSUS curriculum at the University of Toronto participated in this study during 2023-2024. As part of the curriculum, they received fundamental MSUS teaching and participated in bimonthly hands-on MSUS clinic where they had EPAs completed. The residents self-reported their cognitive load level following completion of the EPA task using the NASA Task Load Index. Results Five EPAs were developed by a panel of 6 expert rheumatology ultrasonographers for 5 joint regions including the finger, wrist, knee, ankle and foot. Pooled data from EQual rubric ranged between 4.2-4.3 for all EPAs, passing the satisfaction cutoff (4.07). Eighteen EPAs were completed by 3 PGY4/5 rheumatology residents enrolled in the longitudinal MSUS curriculum. Of all EPAs, 83% were entrustable (score of > 3/5). The wrist joint was the most difficult to entrust (40% entrustable). All the MSUS tasks were rated by the residents to be associated with high level of cognitive load (55%, N = 5) or somewhat high (45%, N = 4). Conclusion The quality of the 5 EPAs developed was deemed satisfactory, indicating their educational effectiveness. The implementation of MSUS EPAs offers a viable approach for assessing MSUS competencies in rheumatology residents receiving MSUS training. Innovative educational strategies are needed to reduce the cognitive load associated with trainees performing the MSUS tasks. [1.] Powell M. Arthritis Rheumatol 2023;75 (suppl 9). [2.] Taylor D. Academic Medicine 2017;92:S110-7.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".