How a Unique Ultrasound Course Trains Medical Residents (2024)

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Science — one of the world’s top academic journals, with a 144-year legacy of publishing breakthrough research — recently published a study whose authors included Shirley Ryan AbilityLab's Colin Franz, MD, PhD, physician-scientist.

The study — from the lab of John Rogers, PhD, Dr. Franz’s frequent collaborator from Northwestern — demonstrated the novel use of an implanted device and ultrasound to quickly identify healing issues in patients who have undergone gastric bypass surgery.

Dr. Franz explained how this study built on similar previous research he had been involved with from Dr. Rogers’ lab.

“In the past, we had used ultrasound to monitor the reabsorption of devices. So, we had the idea that we could use our same setup to measure the swelling of an implant that is flexible and changes shape in response to the acidity of the environment,” he said. “We were able to demonstrate that this approach could detect complications from this gastric surgery model much quicker than anything currently available.”

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The ultrasound techniques that Dr. Franz utilized in this study were the same ones that he learned a decade ago during his residency at Shirley Ryan AbilityLab in the Musculoskeletal (MSK) Ultrasound Course.

“Learning how to do ultrasound has been a really valuable skill that I've taken from a clinical role and brought into my research,” he said.

Officially called the Dr. Scott Primack Physiatric Applications of Ultrasound Course, this two-day, hands-on course is named for a resident alumnus from the class of 1992. Dr. Primack not only is an Shirley Ryan AbilityLab alum and one of the pioneers of the field of musculoskeletal ultrasound, he even provided one of the first ultrasound machines devoted to resident education to our facility!

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The 2023-24 academic year marked the 16th year that our third- and fourth-year PM&R residents (PGY3s and PGY4s) and fellows have taken part in this course. They learned how ultrasound can be used to visualize joints, muscles, tendons and nerves, how to accurately interpret those images, and how to complete procedures like targeted joint and soft tissue injections that require ultrasound expertise. According to Samuel Chu, MD, program director of the Sports Medicine Fellowship who co-directs the course with Monica Rho, MD, program director of the PM&R Residency Program, the course represents the culmination of the resident MSK Foundations curriculum, a weekly lecture series that includes anatomy and ultrasound educational sessions.

“After they have done all the preparation during the year, practicing ultrasound scanning and learning about anatomy, then they come and participate in this course,” said Dr. Chu. “They will then do hands-on injections and procedure on cadavers and apply what they've learned from the year.”

Today’s residents and fellows enjoy expanded access to resources far exceeding those available to those taking the first MSK Ultrasound course in 2008. This includes access to six ultrasound machines and, thanks to a grant, use of cadavers through Northwestern Simulation — the Northwestern University Feinberg School of Medicine’s center for specialized training of healthcare professionals on technology like virtual reality simulators, hybrid models and mannequins. Dr. Chu explained that, when he was a resident (class of 2015) they had to practice using molds, chicken and other objects.

How important is it to get this hands-on training, and to put into practice all that they’ve learned from books and lectures during residency? Dr. Chu said it is “invaluable.”

“For example, if you’re doing an injection, how do you visualize the needle into the intended target? And, if you can't find it right away, what are some strategies to localize it and visualize it in a better way?” he said. “This is a unique part of ultrasound: you not only have to create the image yourself, but you also need to interpret it and be able to understand where you are in the body. You need the technical skill of doing the actual injection. For instance, how do you position your hand? How do you ergonomically set yourself up to make sure that procedure is successful?”

During the two-day course, PGY3s, PGY4s and fellows break up into small groups of four to five and rotate through different stations. They learn to perform procedures including injections in knee, shoulder and hip joints and bursae; and complete nerve injections for carpal tunnel syndrome. Additional stations were focused on using ultrasound to target muscle that could be used for spasticity management or for help with electromyography (EMG) studies.

“At each station, we have a faculty member teaching,” said Dr. Chu. “We even have had alumni who have gone through this program come back and volunteer their time to teach.”

Among those alumni is Dr. Franz, who has taught the course for the past six years. His focus on research applications of ultrasound has led to several recent publications, including:

• Use of guided joint injections for shoulder pain in patients with ALS (Dr. Franz and Dr. Chu are co-authors on this paper).
• Demonstration that neuromuscular ultrasound can improve accuracy of needle electrode placement compared to anatomic landmarks alone.
• Identification of diaphragm dysfunction as a symptom in survivors of COVID-19.

What draws Dr. Franz to give his time to teaching the next generation of clinicians? The chance to give back to the program that has meant so much to his career.

“MSK Ultrasound is a real jewel of our residency program,” he said.