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Musculoskeletal Ultrasound training in the UK

– the current situation

 

With an ever increasing number of physiotherapists using ultrasound in clinical practice inevitably questions arise about training. The issues surrounding ultrasound training are complex, and are dependent upon how the clinician wishes to use ultrasound, for instances; as a tool for assessing muscle function and biofeedback, as an adjunct to their clinical assessment and for guiding injections, or as a diagnostic test in its own right

In the UK, a number of sonographic courses are available, and broadly they fall into two categories informal CPD courses, and formal courses.  These are not mutually exclusive and physiotherapists trained in ultrasound have normally progressed from informal to formal courses.

 

CPD courses

 Introductory Courses

Short introductory CPD courses, suitable for clinicians with little or no experience, make up the majority of MSK ultrasound courses advertised in the UK. They typically offer a basic theoretical and practical introduction, but not leading to any form of competency based qualification. 

These are run by independent providers or by Universities as a stand alone module or part of an MSc programme.

 
 
Independent courses

  • Introductory courses typically 1-2 days, organised by clinical groups such as ourselves (DUG), and Shoulderscan.
  • Taster days – run by manufacturers including Sonosite and suppliers SKF, Mobilis, Physiomed, and EMS

University based

Currently three universities offer ‘M’ level modules in MSK ultrasound for physiotherapists: 

  • Coventry University (3rd intake October 2009)
  • Keele University ( 2nd intake September 2009)
  • Essex University (commences Jan 2010)

  

Further Training

There are at present very few courses available that provide training beyond the introductory level. These include 

  • Skills courses – Oxford (and Aston) skills course (3 days)
  • (DUG) London musculoskeletal ultrasound programme
  • MSK seminars – Oxford and Leeds MSK ultrasound course (3 days)

 

Formal Courses and Qualifications

CASE

The ‘gold’ standard for practicing sonography (as an AHP) in the UK is overseen by a group known as CASE (consortium for the accreditation of sonographic eductation). CASE recognised courses are taught to PgC, PgD and MSc level.  Enrolling as a postgraduate student leads to a recognised competency based sonographic qualification. The three MSK ultrasound courses we are aware of are at the Universities of Canterbury, Cumbria (Lancaster campus) and Bournemouth (AECC site).

 
 These courses are modular courses requiring submission of course work, logged examinations, formal clinical placement, and competency examinations.  A PgC qualification would involve studying a physics and instrumentation module, a health science/professional issue module, an MSK module. Enrollment on a CASE accredited course is generally dependent on obtaining suitable clinical placement, and this represents a significant hurdle to most students who are not sponsored by a Radiology department.


Royal College of Radiology Guidelines

 
The Royal College of Radiology also established a competency framework specifically for clinicians, with a less formal structure. This can be followed using informal training schemes such as CPD courses and in house teaching, but with similar clinical requirements, including supervised scanning and competency assessment.

 

Starting to use ultrasound

  
Typically, a 2 day course should provide students with sufficient knowledge to begin using ultrasound in their practice. Basic muscle assessment and biofeedback can normally be covered adequately, and these courses act as a starting point for developing the more advanced skills required for the structural assessment of soft tissues, such as the rotator cuff and Achilles tendon.  However, considerably more experience, and further study is normally required before ultrasound can contribute significantly to clinical assessment, and clinicians should have attained a recognised level of competence before clinical decisions can be made based primarily on ultrasound findings.

 
Ultrasound guided injections require not only good injection technique, but also well developed probe skills, and considerable scanning experience. Ideally to use ultrasound to guide injections, clinicians should have attained a recognised level of diagnostic competency, though this is not essential.

John Leddy
Mark Maybury