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Musculoskeletal ultrasound: postgraduate certificate in medical imaging (medical ultrasound)

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1988 (Published 12 April 2011) Cite this as: BMJ 2011;342:d1988
  1. Manoj Sivan, specialist trainee in rehabilitation medicine,
  2. James Brown, locum consultant in sports and exercise medicine
  1. 1Leeds, UK
  1. m.sivan{at}leeds.ac.uk

Who is it for?

Professionals who work in the field of musculoskeletal (MSK) medicine—musculoskeletal physicians, sports physicians, rehabilitation physicians, rheumatologists, radiographers, physiotherapists, podiatrists, and general practitioners with a special interest in MSK medicine.

When did you do it?

We did the course while training in musculoskeletal and sports medicine. We use portable ultrasound regularly in outpatient clinics for diagnosis and guiding interventions.

Why did you do it?

The use of portable ultrasound in outpatient clinics is gaining popularity among clinicians in this area. As ultrasound is highly dependent on the operator, a formal qualification is necessary to set standards comparable to those of radiologists and radiographers providing a similar service.

The use of portable equipment in clinics enables on the spot diagnosis and helps explain findings to the patient. Using ultrasound to guide the injection during procedures increases the confidence of the clinician and the patient. Having seen the images on the screen, patients understand their condition better and are more likely to comply with the treatment plan. The images can also be saved for follow-up consultations to assess response to treatment and to change treatment if needed. Such a one stop approach of assessment, diagnosis, and treatment in one single consultation avoids referrals to the radiology department and is a cost effective use of NHS resources.

How is the course structured?

The postgraduate certificate is awarded on successfully completing three modules: (1) clinical MSK ultrasound; (2) human sciences; and (3) ultrasound physics. Each module requires compulsory attendance at a five day taught session at the University of Cumbria and assignments to submit before the start of the next module. The modules are spaced four months apart and can be done in any order. This means you can start the course any time in the year, and it will take a minimum of a year to complete all three modules.

How much effort does it entail?

You have to arrange hands on training from a local MSK radiologist or clinician with considerable experience in MSK ultrasound. The Royal College of Radiologists recommends 300 hours of supervised scanning in an accredited training department to gain experience in MSK ultrasound.

The clinical module requires adequate practical experience to be demonstrated; passing the written exam and practical exam; and submitting a case project. The human sciences module has two 2500 word essays to complete. The physics module has one written exam and an experiment file to submit.

Is there an exam?

The clinical exam is conducted by your local trainer. Three assessments are to be carried out on different days. Each assessment involves doing three scans, which are rated in terms of knowledge of equipment controls, communication with patient, scanning technique, and providing the ultrasound report at the end. A tutor from the university will be present for the first assessment to ensure the standards of the exam are being met.

The clinical and physics modules each have a written exam. They are two hours long and have short-answer-type questions (the physics exam has a multiple choice section as well). The exams can be taken either in the university or locally in the presence of a local invigilator, which has to be arranged with the university beforehand.

How much does it cost?

£1100 for the three modules.

How does this course help junior doctors?

The course improves your understanding of the basic principles of ultrasound, your scanning technique, your ability to optimise image quality, and your recognition of artefacts. It also gives you the confidence to deal with unexpected findings in the musculoskeletal system and manage them appropriately. Holding a postgraduate qualification increases the chances of securing a consultant job in the field.

Was it worth it?

Having a postgraduate certificate gave us the confidence to use the scanner independently in clinics for diagnosis and intervention. The local radiologists appreciate our work, and because we have the formal qualification they are satisfied that standards are being met. Orthopaedic surgeons who get involved in the management of some of our cases use our ultrasound reports to decide on the management of patients. The referral rate to our clinics has gone up considerably because of the service we provide.

Top tips

  • Before you start, arrange local training and mentorship from a radiologist or clinician with considerable experience in musculoskeletal ultrasound, and ensure the trainer understands what he or she is taking on.

  • Be prepared to invest time and effort on attending the week-long taught sessions, writing essays, preparing for exams, and conducting your own experiments in physics.

  • Maintain a logbook of cases and arrange frequent appraisals from your trainer.

  • As the qualification entitles you to provide a clinical service, it does involve hard work, but it is worthwhile and rewarding if you will be using your own scanner in clinics on a regular basis.

Further information

  • Janice Grimwood, Postgraduate Administration, School of Medical Imaging Sciences, University of Cumbria, Bowerham Road, Lancaster LA1 3JD. Tel: 01524 384566; janice.grimwood{at}cumbria.co.uk; www.cumbria.ac.uk