Nearly 70% of VA rheumatology chiefs want more point-of-care ultrasound training
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Key takeaways:
- Most rheumatology groups at VA medical centers use point-of-care ultrasound, but chiefs of staff report barriers to training.
- Groups currently using ultrasound desired training significantly more than those not using it.
Most rheumatology groups at VA medical centers reported having at least one provider using point-of-care ultrasound, while 69% of VA rheumatology chiefs of staff expressed interest in more training for their team, according to data.
“Nearly all medical specialties are now using point-of-care ultrasound (POCUS),” Nilam J. Soni, MD, MS, FHM, FACP, director of the VA Point-of-Care Ultrasound Patient Safety Center at University of Texas Health San Antonio, told Healio.
“POCUS in rheumatology can be utilized to differentiate inflammatory from noninflammatory conditions, discerning between various inflammatory arthropathies such as rheumatoid arthritis and spondyloarthritis, monitoring disease activity and allowing performance of image-guided procedures,” he added. “However, little is known on how rheumatologists are using POCUS in practice and what barriers exist to implementation.”
To examine the current use of POCUS, as well as training needs and barriers to use, Soni and colleagues conducted a prospective, observational study using a web-based survey at all medical centers run by the U.S. Department of Veterans Affairs. A 10-question survey was sent to all 130 VA chiefs of staff between August 2019 and October 2019, while a separate 18-question survey was issued to 95 rheumatology chiefs of staff between December 2019 and March 2020. Paired chi-squared tests were used to compare answers from groups using POCUS vs. groups not using POCUS.
Response rates were 100% for the larger chief-of-staff group and 84% for the rheumatology-specific group.
According to the researchers, 56% of rheumatology groups reported at least one provider using POCUS. The most common diagnostic applications for POCUS were for synovitis, joint effusion, tendinopathies, bursitis and rotator cuff, while the top procedural applications were arthrocentesis and injections in joints, bursa and tendons.
Meanwhile, 69% of rheumatology chiefs of staff reported a desire for additional training. Groups currently using POCUS desired training significantly more than groups not using it — 78% vs. 57% (P = .048) — the researchers wrote.
“This implies that some exposure gives one an appreciation of the utility of POCUS and subsequently greater training is desired,” Soni said.
The most commonly cited barriers to POCUS use were lack of training providers (68%), lack of training funding (54%), lack of training opportunities (38%), lack of funding for travel (38%) and lack of ultrasound equipment (31%).
According to the researchers, “few” centers had policies regarding the use of POCUS (20%), image archiving (25%) or quality assurance processes (6%).
“Although competency in POCUS is not mandated by [the Accreditation Council for Graduate Medical Education], the 2023 requirements state clinical sites must have access to ultrasound, and ‘fellows must demonstrate knowledge of the indications for and interpretation of ultrasonography,’” Soni said. “Future studies shall longitudinally follow the impact of incorporating POCUS training into rheumatology fellowship on use in clinical practice after fellowship graduation.”
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