Ultraschall Med
DOI: 10.1055/a-2532-6860
Original Article

Expert learning in musculoskeletal ultrasound – an international observational study

Expertenlernen im muskuloskelettalen Ultraschall – eine internationale Beobachtungsstudie
1   Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen University Hospital – Rigshospitalet Glostrup, Copenhagen Center for Arthritis Research, Glostrup, Denmark (Ringgold ID: RIN568256)
2   Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Ringgold ID: RIN4321)
,
Lawrence Grierson
3   Department of Family Medicine, McMaster University Faculty of Health Sciences, Hamilton, Canada (Ringgold ID: RIN62703)
4   McMaster Education Research, Innovation, and Theory (MERIT), McMaster University Faculty of Health Sciences, Hamilton, Canada (Ringgold ID: RIN62703)
,
Lars Konge
2   Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Ringgold ID: RIN4321)
5   The Capital Region of Denmark, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark (Ringgold ID: RIN615551)
,
Søren Andreas Just
6   Section of Rheumatology, Department of Medicine, Svendborg Hospital, Odense Universitetshospital, Odense, Denmark (Ringgold ID: RIN11286)
,
Mogens Pfeiffer-Jensen
1   Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen University Hospital – Rigshospitalet Glostrup, Copenhagen Center for Arthritis Research, Glostrup, Denmark (Ringgold ID: RIN568256)
,
Mikkel Ostergaard
1   Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen University Hospital – Rigshospitalet Glostrup, Copenhagen Center for Arthritis Research, Glostrup, Denmark (Ringgold ID: RIN568256)
2   Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Ringgold ID: RIN4321)
,
Ingrid Möller
7   Poal Institute of Rheumatology, University of Barcelona, Barcelona, Spain (Ringgold ID: RIN16724)
8   Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain (Ringgold ID: RIN16724)
,
Maribel Miguel
8   Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain (Ringgold ID: RIN16724)
,
Luis Coronel
7   Poal Institute of Rheumatology, University of Barcelona, Barcelona, Spain (Ringgold ID: RIN16724)
9   Department of Rheumatology, Vall d'Hebron University Hospital, Barcelona, Spain (Ringgold ID: RIN16810)
,
David Bong
7   Poal Institute of Rheumatology, University of Barcelona, Barcelona, Spain (Ringgold ID: RIN16724)
,
Lene Terslev
1   Center for Rheumatology and Spine Diseases, Center for Head and Orthopaedics, Copenhagen University Hospital – Rigshospitalet Glostrup, Copenhagen Center for Arthritis Research, Glostrup, Denmark (Ringgold ID: RIN568256)
2   Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Ringgold ID: RIN4321)
› Institutsangaben
Gefördert durch: Danish Society of Diagnostic Ultrasound Travel grant

Clinical Trial: Registration number (trial ID): NCT05639296, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Observational study

Abstract

Purpose

To examine the effect of discovery learning on musculoskeletal ultrasound (MSUS) performance and to explore how expert learners engage in a collaborative learning environment.

Materials and Methods

Experts in MSUS participated in a discovery learning session where they were divided into groups. Each participant had one attempt to solve the same MSUS case and could seek assistance from other group members or learning resources. The video-recorded sessions were analyzed using both quantitative and qualitative methods. Performance was assessed using the validated Objective Structured Assessment of Ultrasound Skills (OSAUS) tool (1–5 points per item), and an outcome score was calculated based on the number of correct MSUS images (0–4). Participants’ comfort and perception of discovery learning were evaluated using a 5-point Likert scale questionnaire.

Results

28 MSUS experts from 13 different countries completed the study. The mean OSAUS score (standard deviation) was 3.96 (0.5), and the mean outcome score was 1.89 (0.9). Using Pearson’s correlation coefficient, we found a significant correlation between the OSAUS score and the outcome score (0.72, p < .001). The qualitative analysis revealed that the experts used actions associated with adaptive expertise and that social hierarchy persisted in the collaborative learning environment. Finally, we found high comfort with and acceptance of the discovery learning approach.

Conclusion

Discovery learning may be an effective teaching strategy for future advanced MSUS courses, including international Teach-the-Teachers courses. Since social hierarchy was present, a facilitator is necessary during collaborative training.

Zusammenfassung

Ziel

Untersuchung der Auswirkungen des entdeckenden Lernens auf die Leistung im muskuloskelettalen Ultraschall (MSUS) und Erforschung der Art und Weise, wie Experten in einer kollaborativen Lernumgebung lernen.

Material und Methoden

MSUS-Experten nahmen an einer Lerneinheit zum entdeckenden Lernen teil, bei der sie in Gruppen eingeteilt wurden. Jeder Teilnehmer hatte einen Versuch, um denselben MSUS-Fall zu lösen, und konnte dabei die Hilfe anderer Gruppenmitglieder oder Lernressourcen in Anspruch nehmen. Die Videoaufzeichnungen der Sitzungen wurden sowohl mit quantitativen als auch mit qualitativen Methoden analysiert. Die Leistung wurde mithilfe des validierten Tools OSAUS („Objective Structured Assessment of Ultrasound Skills)“ bewertet (1–5 Punkte pro Aufgabe) und ein Ergebnis-Score wurde anhand der Anzahl der korrekten MSUS-Bilder (0–4) berechnet. Das Wohlbefinden der Teilnehmer und ihre Wahrnehmung des entdeckenden Lernens wurden mit einem Fragebogen auf einer 5-Punkte-Likert-Skala bewertet.

Ergebnisse

28 MSUS-Experten aus 13 verschiedenen Ländern nahmen an der Studie teil. Der mittlere OSAUS-Score (Standardabweichung) betrug 3,96 (0,5) und der mittlere Ergebnis-Score 1,89 (0,9). Mithilfe des Korrelationskoeffizienten nach Pearson stellten wir eine signifikante Korrelation zwischen dem OSAUS-Score und dem Ergebnis-Score fest (0,72, p <0,001). Die qualitative Analyse ergab, dass die Experten Maßnahmen im Zusammenhang mit adaptiver Expertise ergriffen und dass die soziale Hierarchie in der gemeinsamen Lernumgebung fortbestand. Schließlich stellten wir fest, dass der Ansatz des entdeckenden Lernens sehr gut angenommen wurde und auf hohe Akzeptanz stieß.

Schlussfolgerung

Das entdeckende Lernen könnte eine effektive Lehrstrategie für zukünftige fortgeschrittene MSUS-Kurse sein, einschließlich internationaler Teach-the-Teachers-Kurse. Da eine soziale Hierarchie vorhanden war, ist während des kollaborativen Trainings ein Moderator erforderlich.

Supplementary Material



Publikationsverlauf

Eingereicht: 17. Dezember 2024

Angenommen nach Revision: 29. Januar 2025

Artikel online veröffentlicht:
08. April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • References

  • 1 Ponte C, Grayson PC, Robson JC. et al. 2022 American College of Rheumatology/EULAR classification criteria for giant cell arteritis. Ann Rheum Dis 2022; 81 (12) 1647-1653
  • 2 Combe B, Landewe R, Daien CI. et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2017; 76 (06) 948-959
  • 3 Naredo E, Rodriguez-Garcia SC, Terslev L. et al. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. Ultraschall in Med 2022; 43 (03) 252-273
  • 4 Carstensen SMD, Velander MJ, Konge L. et al. Training and assessment of musculoskeletal ultrasound and injection skills – a systematic review. Rheumatology 2022; 6 (61) 3889-3901
  • 5 Brown AK, O’Connor PJ, Roberts TE. et al. Ultrasonography for rheumatologists: The development of specific competency based educational outcomes. Ann Rheum Dis 2006; 65 (05) 629-636
  • 6 Terslev L, Hammer HB, Torp-Pedersen S. et al. EFSUMB minimum training requirements for rheumatologists performing musculoskeletal ultrasound. Ultraschall in Med 2013; 34 (05) 475-477
  • 7 Naredo E, Bijlsma JWJ, Conaghan PG. et al. Recommendations for the content and conduct of European League Against Rheumatism (EULAR) musculoskeletal ultrasound courses. Ann Rheum Dis 2008; 67 (07) 1017-1022
  • 8 Carstensen SMD, Just SA, Pfeiffer-Jensen M. et al. Solid validity evidence for two tools assessing competences in musculoskeletal ultrasound: a validity study. Rheumatology 2024; 63 (03) 765-771
  • 9 Carstensen SMD, Just SA, Pfeiffer-Jensen M. et al. Development and validation of a new tool for assessment of trainees’ interventional musculoskeletal ultrasound skills. Rheumatology 2024;
  • 10 Bransford JD, Schwartz DL. Rethinking Transfer: A Simple Proposal With Multiple Implications. In Review of reseach in Education 1999; 24 (01) 61-100
  • 11 Brydges R, Fiume A, Grierson L. Mastery versus invention learning: impacts on future learning of simulated procedural skills. Adv Heal Sci Educ 2022; 27 (02) 441-456
  • 12 Mylopoulos M, Brydges R, Woods NN. et al. Preparation for future learning: A missing competency in health professions education?. Med Educ 2016; 50 (01) 115-123
  • 13 Iagnocco A, Terslev L, Backhaus M. et al. Educational recommendations for the conduct, content and format of EULAR musculoskeletal ultrasound Teaching the Teachers Courses. RMD Open 2015; 1 (01) e000139
  • 14 Arslan S. Traditional instruction of differential equations and conceptual learning. Teach Math its Appl An Int J IMA 2010; 29 (02) 94-107
  • 15 Steenhof N, Woods NN, Van Gerven PWM. et al. Productive failure as an instructional approach to promote future learning. Adv Health Sci Educ Theory Pract 2019; 24 (04) 739-749
  • 16 Kalyuga S, Rikers R, Pass F. Educational implications of expertise reversal effect in learning and performance of complex cognitive and sensorimotor skills. Educ Psychol Rev 2012; 24: 313-337
  • 17 Van der Linden J, Erkens G, Schmidt H. et al. Collaborative learning. In New learning. In: . Springer; 2000: 37-54
  • 18 Arifani Y. The Implementation of Team-Based Discovery Learning to Improve Students’ Ability in Writing Research Proposal. Int Educ Stud 2016; 9 (02)
  • 19 Saab N, Van Joolingen WR, Van Hout-Wolters BHAM. Supporting communication in a collaborative discovery learning environment: the effect of Instruction. Instr Sci 2007; 35: 73-98
  • 20 Wall S. Focused ethnography: a methodological adaptation for social research in emerging contexts. Forum Qual Soc Res 2014; 16 (01) 1-10
  • 21 Miller TT, Reinus WR. Nerve entrapment syndromes of the elbow, forearm, and wrist. Am J Roentgenol 2010: 585-594
  • 22 Tolsgaard MG, Todsen T, Sorensen JL. et al. International Multispecialty Consensus on How to Evaluate Ultrasound Competence: A Delphi Consensus Survey. PLoS One 2013; 8 (02) e57687
  • 23 Higginbottom G, Pillay J, Boadu N. Guidance on performing focused ethnographies with an emphasis on healthcare research. Qual Rep 2013; 18 (09) 1-6
  • 24 Elo S, Kyngas H. The qualitative content analysis process. J Adv Nurs 2008; 62 (01) 107-115
  • 25 Sandelowski M. What’s in a name? Qualitative description revisited. Res Nurs Health 2010; 33 (01) 77-84
  • 26 Vanstone M, Grierson L. Thinking about social power and hierarchy in medical education. Med Educ 2022; 56 (01) 91-97
  • 27 Todsen T, Melchiors J, Charabi B. et al. Competency-based assessment in surgeon-performed head and neck ultrasonography: A validity study. Laryngoscope 2018; 128 (06) 1346-1352
  • 28 Aagesen AH, Jensen RD, Cheung JJH. et al. The Benefits of Tying Yourself in Knots: Unraveling the Learning Mechanisms of Guided Discovery Learning in an Open Surgical Skills Course. Acad Med 2020; 95 (11) S37-S43
  • 29 Kiener M, Green P, Ahuna K. Using the Comfortability-in-Learning Scale to Enhance Positive Classroom Learning Environments. InSight A J Sch Teach 2014; 9: 36-43
  • 30 Tolsgaard MG, Madsen ME, Ringsted C. et al. The effect of dyad versus individual simulation-based ultrasound training on skills transfer. Med Educ 2015; 49 (03) 286-295