american medical society for sports medicine recommended sports ultrasound curriculum for sports...

American Medical Society for Sports Medicinerecommended sports ultrasound curriculum forsports medicine fellowshipsJonathan T Finnoff,1,2 David Berkoff,3 Fred Brennan,4 John DiFiori,5 Mederic M Hall,6

Kimberly Harmon,7 Mark Lavallee,8,9,10 Sean Martin,11 Jay Smith,12,13 Mark Stovak14

Additional material ispublished online only. To viewplease visit the journal online(http://dx.doi.org/10.1136/bjsports-2014-094220).

For numbered affiliations seeend of article.

Correspondence toDr Jonathan T Finnoff, MayoClinic, 200 First Street SW,Rochester, MN 55905, USA;[email protected]

Accepted 2 October 2014

To cite: Finnoff JT,Berkoff D, Brennan F, et al.Br J Sports Med PublishedOnline First: [please includeDay Month Year]doi:10.1136/bjsports-2014-094220

ABSTRACTThe American Medical Society for Sports Medicine(AMSSM) developed a musculoskeletal ultrasoundcurriculum for sports medicine fellowships in 2010.As the use of diagnostic and interventional ultrasound insports medicine has evolved, it became clear that thecurriculum needed to be updated. Furthermore, thename musculoskeletal ultrasound was changed tosports ultrasound (SPORTS US) to reflect the broadrange of diagnostic and interventional applications ofultrasound in sports medicine.This document was created to outline the core

competencies of SPORTS US and to provide sportsmedicine fellowship directors and others interested inSPORTS US education with a guide to create a SPORTSUS curriculum. By completing this SPORTS UScurriculum, sports medicine fellows and physicians canattain proficiency in the core competencies of SPORTSUS required for the practice of sports medicine.

INTRODUCTIONThe following sports ultrasound (SPORTS US) cur-riculum is a revision of the curriculum developedby the American Medical Society for SportsMedicine (AMSSM) in 2010.1 Several changes havebeen made to the curriculum with the primary aimof providing a pathway by which a sports medicinefellow can obtain sufficient SPORTS US training tobecome proficient in the core competencies ofSPORTS US. The core competencies of SPORTSUS are outlined in the learning objectives section ofthis document.The term SPORTS US was purposefully chosen

rather than musculoskeletal ultrasound (MSK US)since it was recognised by the panel that the evolvingfield of SPORTS US encompasses non-MSK applica-tions of ultrasound such as the FAST examination(focused assessment with sonography for trauma).While the SPORTS US core competencies in this cur-riculum are all MSK in nature, they represent theminimum SPORTS US knowledge a sports medicinefellow should acquire during fellowship. However,additional training in more advanced MSK andnon-MSK applications of ultrasound can be providedat the fellowship directors discretion.Completion of this SPORTS US curriculum

fulfils the American Institute of Ultrasound inMedicines (AIUM) requirements to perform aMSK US examination, and the pre-requisites forthe American Registry for Diagnostic MedicalSonographys (ARDMS) MSK sonography certifica-tion examination.

OverviewThe educational process should include fourcomponents.

Didactic instructional sessionsDidactic instruction can occur via a dedicatedSPORTS US course or scheduled teaching sessionsduring the fellowship (see Didactic instructionalsessions). Didactics should include discussions ofultrasound physics, image acquisition and optimisa-tion, normal and pathological appearance oftissues, ultrasound artifacts, advantages and limita-tions of SPORTS US relative to other imagingmodalities, and diagnostic and interventional tech-niques pertaining to major body regions encoun-tered in a sports medicine practice.

Didactic practice sessionsHands-on didactic practice sessions should becompleted under the direct supervision of a qualifiedmentor. A qualified mentor is defined as an individualwho has met the qualifications outlined by theAIUM Training Guidelines for Physicians andChiropractors Who Evaluate and Interpret DiagnosticMusculoskeletal Ultrasound Examinations (http://www.aium.org). During these sessions, fellows shouldapply the knowledge and skills acquired during thedidactic instructional sessions in a controlled andsupervised environment (see Didactic practicesessions).

Mentored clinical experienceAs knowledge and skills are acquired, the fellowshould perform diagnostic scanning and interven-tional procedures on patients in a clinical settingunder the direct supervision of a qualified mentor. Asthe fellow gains proficiency in the clinical applicationof diagnostic and interventional SPORTS US techni-ques, the level of supervision may be modified asallowed by institutional policy governing teachingrules.

Supplementary and continuing educationThe fellows education should include supplemen-tary educational experiences to reinforce theknowledge and skills gained during the didactic ses-sions and mentored clinical experience.A. Required

1. Independent scanning practice sessionsB. Recommended

1. Reading reference texts and journal article2. Presenting SPORTS US related articles in

journal club

Finnoff JT, et al. Br J Sports Med 2014;0:16. doi:10.1136/bjsports-2014-094220 1

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3. Utilising online educational material and educationalDVDs

4. Attending SPORTS US conferences and presentationsThe integration of recommended supplementary educational

experiences may vary from fellowship to fellowship based onavailable resources and the overall curriculum structure.

This natural stepwise progression of diagnostic and interven-tional SPORTS US education will ensure the acquisition of suffi-cient SPORTS US skills to allow independent practice of thecore competencies of diagnostic and interventional SPORTS USon completion of fellowship.

Learning objectives for SPORTS US training duringfellowshipA. Identify and discuss the function of basic controls on an

ultrasound machine console, includingi. Transducer selectionii. Presetsiii. Depthiv. Focal zone/focal regionv. Gainvi. Time gain compensation/depth gain compensationvii. Zoom (including read zoom and write zoom)

B. Discuss the basic physics principles of ultrasound, includingi. How an US image is generatedii. Inter-relationship of machine controls (eg, frequency, reso-

lution and depth)iii. Doppler imaging (difference between power Doppler and

colour Doppler)C. Demonstrate how to optimise an ultrasound image

i. Superficial structuresii. Deep structures

D. Describe the normal ultrasonographic appearance ofadipose, muscle, tendon, ligament, bone, fascia, vessels,nerve, and cartilage

E. Describe the common pathological ultrasonographic appear-ance of adipose, muscle, tendon, ligament, bone, fascia,vessels, nerve, joint and cartilage

F. Discuss the benefits and limitations of SPORTS US relative toother imaging modalities

G. Identify and discuss the source and/or implications of basicultrasound artefacts, including

i. Anisotropyii. Reverberationiii. Refractioniv. Through transmissionv. Acoustic shadowing

Perform image acquisition of vascular structures includingneovessels using Color and Power Doppler.H. Perform a SPORTS US examination of the following

regions as recommended by the AIUM Practice Guidelinesfor the Performance of the MSK US Examination (seeonline supplementary appendix 1)

i. Shoulderii. Elbowiii. Wrist-Handiv. Hipv. Kneevi. Ankle-Foot

I. Obtain an acceptable set of SPORTS US images of the fol-lowing regions as recommended by the AIUM PracticeGuidelines for the Performance of the MSK US Examination(see online supplementary appendix 1)

i. Shoulderii. Elbowiii. Wrist-Handiv. Hipv. Kneevi. Ankle-Foot

J. Demonstrate appropriate labelling of SPORTS US imagesi. Use of text insertionii. Use of arrows and measurement calipers

K. Demonstrate how to capture, store and transfer SPORTS USimages

L. Generate an appropriate diagnostic SPORTS US reportM. Perform an appropriate SPORTS US evaluation to identify

and appropriately document (eg, capture, label, save andtransfer images; generate a report) of the followingconditions:

i. Shoulder1. Supraspinatus full thickness tear2. Supraspinatus tendinopathy3. Bicipital tendinopathy4. Subacromial-subdeltoid bursopathy5. Acromioclavicular joint osteoarthritis

ii. Elbow1. Common extensor tendinopathy2. Dynamic examination of the ulnar nerve at the elbow3. Common flexor tendinopathy

iii. Wrist-Hand1. DeQuervains tenosynovitis2. Carpal tunnel syndrome

iv. Hip1. Gluteus medius/minimus tendinopathy2. Hamstring tendinopathy

v. Knee1. Patellar tendinopathy2. Bakers cyst3. Knee joint effusion

vi. Ankle-Foot1. Peroneal tendinopathy (including dynamic evaluation

for instability)2. Achilles tendinopathy3. Plantar fasciopathy

N. Describe the advantages and disadvantages of needle track-ing using an in-plane versus out-of-plane approach, andprovide clinical examples of when each approach may bebeneficial.

O. Image a needle using an in-plane (longitudinal or long axis)and out-of-plane (short axis or transverse) approach usingultrasound guidance in a phantom, turkey breast, cadavericspecimen or other imaging medium, including demonstra-tion of the following transducer manipulations:

i. Translation (sliding/gliding)ii. Rotation

1. Describe cross-cut artefact when imaging/tracking aneedle during an interventional procedure

iii. Heel-toeiv. Tilting (toggling/wagging)v. Compression

P. Demonstrate the ability to efficiently relocate a lost needleduring an in-plane and out-of-plane needle trackingapproach.

Q. Demonstrate the ability to guide a needle into a targetregion or structure using an in-plane and out-of-planeapproach in a phantom, turkey breast, cadaveric specimenor other imaging medium.

2 Finnoff JT, et al. Br J Sports Med 2014;0:16. doi:10.1136/bjsports-2014-094220

Consensus statement


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R. Obtain an acceptable set of preprocedure, intraprocedure andpostprocedure images of an ultrasound-guided-procedure.

S. Demonstrate appropriate labelling of the ultrasound-guidedprocedure images.

T. Demonstrate how to store and transfer the ultrasound-guided procedure images.

U. Generate an appropriate ultrasound-guided procedurereport.

V. Perform and appropriately document (eg, capture, label,save, and transfer images; generate a report) the followingultrasound-guided procedures:i. Shoulder

1. Subacromial-subdeltoid bursa injection2. Intra-articular glenohumeral joint injection3. Intra-articular acromioclavicular joint injection4. Bicipital tendon sheath injection

ii. Elbow1. Intra-articular elbow joint injection2. Peritendinous or intratendinous injection of the

common extensor tendon origin3. Peritendinous or intratendinous injection of the

common flexor tendon originiii. Wrist-Hand

1. Carpal tunnel injection2. First dorsal compartment tendon sheath injection3. Intra-articular wrist injection

iv. Hip1. Intra-articular hip injection2. Greater trochanteric bursa injection3. Gluteus medius or minimus peritendinous or intraten-

dinous injectionv. Knee

1. Intra-articular knee injection2. Iliotibial band/bursa (distal) injection

vi. Ankle-Foot1. Intra-articular tibiotalar joint injection2. Peroneal tendon sheath injection3. Periplantar or intraplantar fascia injection

vii. Miscellaneous1. Aspiration or injection of a cyst

Resources/referencesBooksBianchi S, Martinoli C. Ultrasound of the musculoskeletalsystem. New York: Springer, 2007.Daniels JM, Dexter WW, eds. Basics of musculoskeletal ultra-sound. New York: Springer, 2013.Jacobson JA. Fundamentals of musculoskeletal ultrasound. 2ndedn. Philadelphia: Saunders Elsevier, 2013.Malanga G, Mautner K, eds. Atlas of ultrasound-guided muscu-loskeletal injections. New York: McGraw-Hill, 2014.ONeill J, ed. Musculoskeletal ultrasound: anatomy and tech-nique. New York: Springer, 2008.Sconfienza LM, Serafini G, Silvestri E, eds. Ultrasound guidedmusculoskeletal procedures: the upper limb. New York:Springer, 2012.Silvestri E, Muda A, Sconfienza LM, eds. Normal ultrasoundanatomy of the musculoskeletal system: a practical guide.New York: Springer, 2012.

Additional resourcesAmerican College of Radiology (ACR) Practice Guideline forCommunication of Diagnostic Imaging Findings. http://www.acr.org

ACR Practice Guidelines for the Performance of theMusculoskeletal Ultrasound Examination. http://www.acr.orgAmerican Institute of Ultrasound in Medicine (AIUM) PracticeGuidelines for the Performance of the MusculoskeletalUltrasound Examination, 2012. http://www.aium.org, or in theJ Ultrasound Med 2012;31:1480.AIUM Practice Guideline for the Performance of the ShoulderUltrasound Examination. http://www.aium.orgAIUM Practice Guideline for Documentation of the DiagnosticUltrasound Examination. http://www.aium.orgAIUM Practice Guideline for Performance of the DiagnosticUltrasound Examination. http://www.aium.orgAIUM Training Guidelines for Physicians and ChiropractorsWho Evaluate and Interpret Diagnostic MusculoskeletalUltrasound Examinations. http://www.aium.orgEuropean Society of Skeletal Radiology (ESSR) MusculoskeletalUltrasound Scanning Technique Demonstrations. http://www.ESSR.orgSmith J, Finnoff JT. Diagnostic and interventional musculoskel-etal ultrasound: part 1. Fundamentals. PMR 2009;1:6475.Smith J, Finnoff JT. Diagnostic and interventional musculoskel-etal ultrasound: part 2. PMR 2009;1:16277.

Didactic instructional sessionsThe SPORTS US didactic instructional sessions include six basicunits described in this section. Each fellowship should provideappropriate resources for fellows to preview and review theinformation relevant to each session (see Resource/referencelist). Whereas the number of teaching sessions can be modifiedas desired or necessary, all fellows should receive instruction inall listed topics. It is strongly recommended that teaching ses-sions for diagnostic scanning (Units 15) utilise established scan-ning protocols to guide learning and ensure compliance withaccepted standards (See SPORTS US Scanning Protocol inonline supplementary appendix 2). Finally, although the orderof Units 25 may be modified, fellows should master the diag-nostic skills for a specific region before initiating ultrasound-guided procedure training in that region (eg, mastery of theshoulder diagnostic scans should proceed formal training inultrasound-guided shoulder interventions).

The first unit introduces the fellow to basic SPORTS USphysics, image acquisition and optimisation, normal and patho-logical appearance of tissues, ultrasound artefacts and theadvantages and limitations of SPORTS US relative to otherimaging modalities. During Units 25, a qualified MSK sonogra-pher/sonologist should demonstrate the scanning protocol(s) forone or more body regions, followed by supervised practice.A qualified MSK sonographer is defined as an individual whohas met the AIUM Practice Guidelines for the Performance of aMSK US examination. The fellow should only consider thesesessions as an introduction to scanning and independent practicebetween didactic sessions is necessary to facilitate skill acquisi-tion (see Supplementary and continuing education above).

Unit 6 involves at least three individual sessions dedicated tointerventional SPORTS US procedures. Initial topics reviewedinclude pharmacological principles of commonly used medica-tions, patient selection, aseptic technique for ultrasound-guidedprocedures, procedural risks, and treatment of common adverseevents. Thereafter, the fellow should be introduced to methodsof ultrasound-guided needle image optimisation, needle reloca-tion and dynamic needle tracking using both in-plane andout-of-plane approaches. Once these skills are mastered, thefellow should be introduced to common upper and lowerextremity ultrasound-guided interventional procedures (with a


Consensus statement


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focus on the core interventional ultrasound competencies) viadiscussion, demonstration and supervised practice under theguidance of a qualified practitioner. Multiple mediums may besuitable for practising ultrasound-guided interventional proce-dures. The ideal mediums are unembalmed cadaveric specimens.However, if unembalmed cadaveric specimens are unavailable,the fellow can practice patient positioning and target acquisitionon live models followed by practice of needle visualisation andguidance on turkey breasts, pig feet, pig legs, firm tofu, phan-toms and/or other non-cadaveric specimens. The fellow shouldpractice needle visualisation and guidance techniques betweenmentored didactic sessions to enhance his/her skills (see supple-mentary and continuing education above).i

Unit 1 Principles of SPORTS US and an Introduction toScanning Techniques1. Instruction in Knobology and basic scanning techniques2. Instruction on basic US physics3. Demonstration of normal sonographic appearance of

adipose, muscle, tendon, ligament, bone, fascia, vessels,nerve, and cartilage

4. Discussion of the common abnormal sonographic appear-ances of adipose, muscle, tendon, ligament, bone, fascia,vessels, nerve, joint and cartilage

5. Muscle, tendon, ligament and nerve.6. Demonstration of the use of Color and Power Doppler for

imaging vascular and neovascular structures7. Demonstration of transducer movements to optimise image

(translation (sliding), rotation, heel-toe, tilt (toggle) and pres-sure/compression)

8. Supervised practiceUnit 2 SPORTS US Examination of the Knee-Hip

1. Knee US Scanning ProtocolA. Instruction and supervised practiceB. Resources

i. SPORTS US Scanning Protocol ChecklistsKneeii. AIUM and ACR Guidelines for Performance of the

MSK US Examination2. Hip and Thigh US Scanning Protocol

A. Instruction and supervised practiceB. Resources

i. SPORTS US Scanning Protocol ChecklistsHip-Thigh

ii. AIUM and ACR Guidelines for Performance of theMSK US Examination

3. Independent scanningUnit 3 SPORTS US Examination of the Elbow andWrist-Hand

1. Elbow US Scanning ProtocolA. Instruction and supervised practiceB. Resources

i. SPORTS US Scanning Protocol ChecklistsElbowii. AIUM and ACR Guidelines for Performance of the

MSK US Examination2. Wrist-Hand US Scanning Protocol

A. Instruction and supervised practiceB. Resources

i. SPORTS US Scanning Protocol ChecklistsWrist-Hand

ii. AIUM Guidelines for Performance of the MSK USExamination

3. Independent scanningUnit 4 SPORTS US Examination of the Ankle-Foot

1. Ankle-Foot US Scanning ProtocolA. Instruction and supervised practiceB. Resources

i. SPORTS US Scanning Protocol ChecklistsAnkle-Foot

ii. AIUM and ACR Guidelines for Performance of theMSK US Examination

2. Independent scanningUnit 5 SPORTS US Examination of the Shoulder

1. Shoulder US Scanning ProtocolA. Instruction and supervised practiceB. Resources

i. SPORTS US Scanning Protocol ChecklistsShoulder

ii. AIUM Guidelines for Performance of the ShoulderUltrasound Examination

iii. AIUM and ACR Guidelines for Performance of theMSK US Examination

2. Independent scanningUnit 6 US Guided Interventional Procedures

1. Didactic instruction and discussionA. Rationale for US-guided proceduresB. Principles of US-guided procedures

i. Patient selectionii. Ergonomicsiii. Aseptic techniqueiv. In-plane and out-of-plane needle trackingv. Image optimisation for needle location, relocation

and dynamic tracking, including transducer manipu-lation: translation (sliding), rotation, heel toe, tilting(toggling) and compression

vi. Recognising and correcting cross-cut artefact whenneedle tracking

C. Specific applications and techniquesi. Joint, tendon sheath, nerve, ligament, bursa/cystii. Use of stand-off /oblique stand-off, hydrodissection,

lavage and aspiration2. Demonstration, discussion and practice using unembalmed

cadaveric specimens, phantoms, turkey breasts, pig feet, pigslegs, firm tofu or other appropriate mediumA. In-plane and out-of-plane needle location and trackingB. Needle relocationC. Cross-cut artefactD. Commonly performed US-guided procedures. It is

strongly recommended that these procedures be prac-ticed on an unembalmed cadaveric specimen. However,if this is not feasible, then fellows should practice allaspects of needle visualisation and tracking using otherappropriate medium, and the principles of the proce-dures listed below reviewed in a formal didactic setting.i. Shoulder

1. Subacromial-subdeltoid bursa injection2. Intra-articular glenohumeral joint injection3. Intra-articular acromioclavicular joint injection4. Bicipital tendon sheath/groove injection

ii. Elbow1. Intra-articular elbow joint injection

iPlease note that the educational material has been divided into units tofacilitate teaching of related concepts and skills. The number ofeducational sessions required to teach the knowledge and skillscontained in a specific unit may vary depending on scheduling andavailable resources.


Consensus statement



2. Peritendinous or intratendinous injection ofthe common extensor tendon origin

3. Peritendinous or intratendinous injection ofthe common flexor tendon origin

iii. Wrist-Hand1. Carpal tunnel injection2. First dorsal compartment tendon sheath

injection3. Intra-articular wrist injection

iv. Hip1. Intra-articular hip injection2. Greater trochanteric bursa injection3. Gluteus medius or minimus peritendinous or

intratendinous injectionv. Knee

1. Intra-articular knee injection2. Iliotibial band/bursa (distal) injection

vi. Ankle-Foot1. Intra-articular tibiotalar joint injection2. Peroneal tendon sheath injection3. Periplantar or intraplantar fascia injection

vii. Miscellaneous1. Aspiration or injection of a cyst

Didactic practice sessionsDidactic practice sessions should be scheduled with a qualifiedmentor on regular basis throughout the fellowship. A qualifiedmentor is one who has met the requirements outlined in theAIUM Training Guidelines for Physicians and ChiropractorsWho Evaluate and Interpret Diagnostic MusculoskeletalUltrasound Examinations (http://www.aium.org). During thesesessions the fellow should apply the knowledge and skillsacquired during the didactic instructional sessions in a con-trolled and supervised educational environment. The didacticpractice sessions should include the following:1. Practice and demonstration of performing a complete ultra-

sound evaluation of each major region listed in the scanningprotocols including proper image optimisation and acquisi-tion (see online supplementary appendix 1).

2. Practice and demonstration of proper image labelling andstorage. Transference of images should follow the guidelinesoutlined by the Health Insurance Portability andAccountability Act (HIPAA).

3. Review of saved images from the fellows self-directed prac-tice scanning sessions and provision of constructive feedbackregarding study completeness, and proper image optimisa-tion, labeling, storage and transfer. Deficiencies should bereconciled during subsequent scanning sessions.

4. Practice and demonstration of interventional skills, prefer-ably using unembalmed cadaveric specimens. If cadavericspecimens are not available, the fellow should practiceappropriate imaging of target structures on live models, andshould practice needle imaging and guidance techniquesusing turkey breasts, pig feet, pig legs, firm tofu, phantomsor other appropriate medium. As the fellows skills improve,more advanced SPORTS US examination techniques andinterventional procedures should be introduced into thedidactic practice sessions (eg, hydrodissection, percutaneoustreatment of calcific tendinosis, etc).

Mentored clinical experienceThe fellow should have regularly scheduled clinical time inwhich they receive supervised hands-on experience performingdiagnostic and interventional SPORTS US on patients. During

this experience, fellows should practice and eventually demon-strate competency in all aspects of SPORTS US outlined in thelearning objectives. Special attention should be paid to obtainingproficiency in performing the core competency diagnostic ultra-sound examinations of the pathological conditions andultrasound-guided procedures listed in the learning objectives.Determining competence will be discussed further in Recordkeeping and competency.

This component of the fellows SPORTS US training processis required to ensure that the fellow can proficiently performthe core diagnostic and interventional SPORTS US competen-cies in clinical practice.

Supplementary and continuing SPORTS US educationThe fellows SPORTS US education should not be restricted tothe formal educational activities outlined in Didactic instruc-tional sessions through Mentored clinical experience. Thefellow should be required to participate in independent practicescanning, during which time they can practice diagnostic scan-ning techniques, positioning for procedures, and scanning pro-tocols using volunteers. During this time, the fellow should alsoacquire studies for review with their mentor, as previously dis-cussed. The fellow should also be required to independentlypractice ultrasound-guided needle tracking using the appropriatemedium (eg, cadaver, phantom, etc).

In addition to the above required supplementary and continu-ing SPORTS US education experiences, as time and resourcesallow, the fellow should be encouraged to participate in one ormore of the following:1. Reading SPORTS US journals and texts on a regular basis2. Reviewing SPORTS US-related articles on regular basis. It is

recommended that the fellow present a SPORTS US-relatedjournal article during journal club at least on a quarterlybasis

3. Participating in online SPORTS US related courses or DVDs4. Reading online SPORTS US related educational material5. Attending SPORTS US related conferences

Record keeping and competencyThe fellow should maintain detailed records of all SPORTS USeducational activities in which they participate throughout thefellowship. The fellow should also maintain a procedure log ofall diagnostic and interventional SPORTS US procedures,including their role in the procedure (eg, observation, perform-ance, interpretation or reporting). Detailed recording keepingserves multiple purposes1. Assists with credentialing2. Assists in practice accreditation3. Supports application for certification examinations

Although maintaining records of the type and number ofdiagnostic and interventional ultrasound procedures is import-ant, performing a specific number of ultrasound proceduresdoes not necessarily determine competence. A milestone systemis a more appropriate way of determining competence and is inagreement with graduate medical education competency assess-ment recommendations by the Accreditation Council forGraduate Medical Education. Milestones use a five-pointordinal scale of escalating skill level, with competence deter-mined when a level three or higher has been achieved.Milestones for each learning objective in the SPORTS USshould be developed, and the fellow should achieve competencein all of the milestones on completion of their fellowship.Sample diagnostic and interventional ultrasound milestones areprovided in online supplementary appendix 2.


Consensus statement


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Finally, it is recommended that an objective written and prac-tical test be developed to assist with assessing the sports medi-cine fellows SPORTS US knowledge and skill.

What are the new findings?

This document provides sports medicine fellowship directors andthose interested in sports ultrasound education with a guidelinefor creating a SPORTS US curriculum.

How might it impact on clinical practice in the nearfuture?

Completing this curriculum will prepare sports medicinephysicians to proficiently practice the core competencies ofSPORTS US.

Author affiliations1Department of Physical Medicine and Rehabilitation, University of California DavisSchool of Medicine, Sacramento, California, USA2Department of Physical Medicine and Rehabilitation, Mayo Clinic Sports MedicineCenter, Mayo Clinic School of Medicine, Rochester, Minnesota, USA3Department of Orthopedics, University of North Carolina, Chapel Hill, NorthCarolina, USA4University of New Hampshire, Durham, New Hampshire, USASeacoast Orthopedics and Sports Medicine, Somersworth, New Hampshire, USA

5Division of Sports Medicine and Non-Operative Orthopaedics, Department of FamilyMedicine and Orthopaedics, David Geffen School of Medicine, University ofCalifornia, Los Angeles, California, USA6Department of Orthopaedics and Rehabilitation, Department of Family Medicine,University of Iowa Sports Medicine, Iowa City, Iowa, USA7Departments of Family Medicine and Orthopaedics and Sports Medicine, Universityof Washington, Seattle, Washington, USA8York Hospital Sports Medicine Fellowship Program, York, Pennsylvania, USA9Department of Family and Community Medicine, Pennsylvania State UniversityCollege of Medicine, Hershey, Pennsylvania, USA10Department of Family, Community, and Preventive Medicine, Drexel UniversityCollege of Medicine, Philadelphia, Pennsylvania, USA11HQ Air Armament Center, Eglin Air Force Base Family Medicine Residency, Florida,USA12Department of Physical Medicine and Rehabilitation, Mayo Clinic College ofMedicine, Mayo Clinic Sports Medicine Center, Rochester, Minnesota, USA13Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic,Rochester, Minnesota, USA14University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA

Contributors All authors were involved in the initial planning of the curriculum.The structure and content of the entire curriculum was discussed. The initial draft ofthe document was then created by JTF. The document was subsequently distributedto all of the other authors (DB, FB, JD, MMH, KH, ML, SM, JS, MS) for review. Afterall of the authors reviewed the document, the authors again collectively discussedfurther revisions. The suggested revisions were then performed by JTF. The documentwas reviewed by all of the other authors (DB, FB, JD, MMH, KH, ML, SM, JS, MS)one final time before submission.

Competing interests None.

Provenance and peer review Not commissioned; externally peer reviewed.

REFERENCE1 Finnoff J, Lavallee ME, Smith J. Musculoskeletal ultrasound education for sports

medicine fellows: a suggested/potential curriculum by the American Medical Societyfor Sports Medicine. Br J Sports Med 2010;44:11448.


Consensus statement



curriculum for sports medicine fellowshipsMedicine recommended sports ultrasound American Medical Society for Sports

StovakHall, Kimberly Harmon, Mark Lavallee, Sean Martin, Jay Smith and Mark Jonathan T Finnoff, David Berkoff, Fred Brennan, John DiFiori, Mederic M

published online October 31, 2014Br J Sports Med

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American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowshipsAbstractIntroductionOverviewDidactic instructional sessionsDidactic practice sessionsMentored clinical experienceSupplementary and continuing education

Learning objectives for SPORTS US training during fellowshipPerform image acquisition of vascular structures including neovessels using Color and Power Doppler.Resources/referencesBooksAdditional resources

Didactic instructional sessionsDidactic practice sessionsMentored clinical experienceSupplementary and continuing SPORTS US educationRecord keeping and competency

References

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