A preceptorship programme to learn ultrasonography for diagnosis of giant cell arteritis.

Abstract

Objective: Ultrasonography has been proposed as the initial diagnostic modality in suspected giant cell arteritis. Proposed quality standards advocate for a certified sonographer. Currently, there are no formal training programmes, and single educational events do not suffice as certification. We developed a preceptorship programme for diagnostic ultrasonography. Here, we describe its contents and test its efficacy.

Method: The programme comprises three stages. The preclinical stage includes machine setting and surface anatomy. Second stage includes supervised assessment, passed via a directly observed procedure form. In the final validation stage, the trainee and trainer perform an ultrasonography examination in succession, with a comparison of the results. For this programme, a scan included all three segments of the superficial temporal artery and all three parts of the axillary arteries. Comparison of the intima-media thickness (IMT) and categorical judgements for the halo sign and final diagnosis were made.

Results: Six trainees have been through this programme so far. A median of 16 ultrasonography examinations was required to reach the validation stage. The mean ± SD IMT in 360 segments, as measured by the trainee and trainer, was 0.45 ± 0.34 and 0.46 ± 0.35, respectively (p = 0.26). The agreement between trainee and trainer for the presence or absence of halo was excellent in 403 segments (κ = 0.91, 95% confidence interval 0.86, 0.96). There was 100% agreement on the final diagnosis.

Conclusion: The integration of technical knowledge with practical skills results in a robust training programme, validating trainees to continue scanning independently.