Background: Practical skills are a central part of a healthcare professional’s role and for patients a successful clinical outcome often depends on the competent execution of a technical procedure. Procedural skill training in medicine are based on the “Learn, See, Practice, Prove, Do, Maintain” framework [1]. In our university, we built a training program for teaching practical skills to perform ultrasound (US)-guided injections of the upper and lower limbs. This program combined theoretical e-learning, 5 days of practice on cadaveric subjects (simulation-based learning) and independent practice with provision of feedback on US images acquired during the procedures.

Objectives: The objective of the study was to evaluate the short and mid-term impact of this program on rheumatologists’ practices.

Methods: A survey was sent by e-mail to practitioners who had completed the training between 2016 and 2022 (N=211). We collected their type of activity (private practice, hospital or both), and US-guided procedures performed before and after the training. Statistics were carried out using SPSS. p<0.05 was considered as significant.

Results: From May to July 2023, 111 practitioners (52%) responded to the survey (7 undelivered e-mails, 2 retired MD, 91 no reply): 75% of them were rheumatologists while 14% were sport physicians and 8% general practitioners. At the time of the survey, 51 (46.4%) were in private practice, 40 (36.4%) worked at the hospital and 19 (17.3%) had both private and hospital practices. About 2/3 of the participants (N=73, 65.8%) did perform US-guided injections before attending the program et 110 (99%) were still doing so at the time of the study. Participants were performing more US-guided injections per week (p<0.0001) with greater diversity compared with before training (on average, 12 different procedures before versus 29 after the training (p<0.0001)). Analysis of post-training procedures identified 2 clusters of practitioners: those performing a large number of procedures (profile A) and those performing a smaller number (profile B). There was no difference between these two groups in terms of specialization or type of practice. Profile A was significantly associated with the practice of US-guided injections prior to the training (p=0.015) and with a greater number of procedures per week (p=0.001). Interestingly, half of those not performing US-guided procedures prior to the training were profile A practitioners at the time of the survey. After the training, some injections remained rarely performed: distal insertion of long biceps, hamstrings, piriformis and temporomandibular joint, mainly due to lack of recruitment (72.2%).

Conclusion: The study showed that practitioners had diversified their practice and continued to perform ultrasound-guided procedures after the training, regardless of their type of activity (level 3 of Kirkpatrick’ four-level training evaluation model). Of the doctors who did not perform any procedures before training, half of them performed a wide variety of procedures afterwards. This study demonstrated the value of a multimodal approach to teach ultrasound-guided procedures.

REFERENCES: [1] Sawyer T, White M, Zaveri P, Chang T, Ades A, French H, Anderson J, Auerbach M, Johnston L, Kessler D. Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine. Acad Med. 2015 Aug;90(8):1025-33.

Acknowledgements: NIL.

Disclosure of Interests: None declared.