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never used the ultrasound prior to the course and this did not change after the course. Three residents had never used it and started using after the course, one of whom recalled using ultrasound approximately 48 times in the 6 months following the session. Two residents described previous use of ultrasound, one of whom increased his use after the course while the other did not use ultrasound after the session. Testing for differences in practical or written scores between residents who increased their use and those who did not following the intervention did not reach statistical significance. Discussion An MSK POCUS curriculum for orthopaedic residents was successfully developed and implemented into the orthopaedic training program. The development drew inspiration from the curriculum developed by Finnoff et al. [21] for PM&R residents. However, our ultrasound curriculum is significantly shorter and less extensive than that of Finnoff et al. [21]. The decision was made during the development of teaching the basics and concepts, and leaving the residents own interest guide their self-learning if they wanted to develop their knowledge further. This decision was rewarded by the residents’ good overall rating of the quality of the course, which was similar to the ratings seen in Finnoff et al. [21]‘s study. The residents also mostly described the course length as adequate but requested that more time be spent describing abnormal pathologies and covering ultrasound guided nerve blocks and hip aspirations. It was also hypothesized that orthopaedic residents already had more extensive knowledge of musculoskeletal anatomy and a better sense of the tridimensional spatial orientation of body, requiring less additional training in these areas. Our positive outcome results seem to support this assertion. Interest towards learning ultrasound was lower in our study than that of Finnoff et al. [21], where average interest in learning MSK POCUS was 9.0/10. This discrepancy could be explained by the orthopaedic residents limited prior exposure to MSK POCUS, or by them not being aware of the different practical uses for orthopaedic surgeons. In contrast, the interest of physiatrist in using MSK POCUS as a means of evaluating pathologic soft tissue structures and guiding therapeutic procedures is well documented [21]. The orthopaedic residents’ 65% improvement in written test scores parallels the 67% increase seen in Finnoff et al. [21]‘s study. Despite a different written exam in the two studies, this demonstrates that both programs were able to improve significantly their participants’ knowledge of MSK POCUS. There was no significant drop in our residents’ written test score at 6 months, meaning the knowledge was maintained despite no further training in MSK POCUS. It is however unclear if residents reviewed their ultrasound knowledge prior to the sixmonth assessment. To our knowledge, no other study has assessed MSK POCUS knowledge retention at 6 months. Finnoff, Smith [21] also documented a 237% increase in practical scores following the course. We consciously elected against pre-testing ultrasound practical ability as it was felt to be a futile endeavour before the learners knew how the ultrasound machine functioned. Fig. 4 Residents’ comfort level in the 6 months before and after the course. Subjective comfort level (NAS) of the residents while performing ultrasound tasks in the 6 months preceding (blue) and the 6 months following (orange) the course. Abbreviations: inj = injection, asp = aspiration, # = fracture Larrivée et al. BMC Medical Education (2019) 19:474 Page 7 of 9 However, our average score of 78.7% on the practical post-course shoulder examination was similar to the 73.3% score obtained by the participants in Finnoff et al. [21]‘s study. Despite using a different practical test, these results show residents were able to acquire substantial practical skills following our short curriculum. Unfortunately, these skills were not maintained at 6 months. This is likely related to a low number of opportunities to use ultrasound clinically in a busy orthopaedic surgery residency. Few rotations are amenable to ultrasound use, and only one consultant in our centre routinely uses ultrasound for clinical diagnosis of rotator cuff tears. Busy calls and minimal practice might also have discouraged residents from using it in the emergency department for diagnosis of soft-tissue injury, guidance of aspirations, and reduction of fractures. These assumptions are strengthened by the fact that no significant increase in use was reported at the six-month mark. Residents’ subjective comfort level following the course improve significantly at 6 months for all aspects of ultrasound use. While no study reported on a similar outcome at 6 months, Piposar et al. [19] reported improved subjective comfort level of 15 orthopaedic residents after an online tutorial on ankle ultrasonography. Their comfort level improved from 2.3 to 6.8 on a 10 points visual analog scale, similar to our improvement from 3.8 to 5.9 out of 10. Their residents also had an accuracy of about 90% to identify and measures ankle tendons on a cadaver. Seventy-one percent of their orthopaedic residents answered that they were likely to use ultrasound in their future practice, while 90% of our residents were “likely” or “very likely” to consider using ultrasound in their career. This shows that the
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