Stepwise Development of a Simulation-Based Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents.

Objectives: Musculoskeletal ultrasound (MSKUS) is a required part of Physical Medicine and Rehabilitation (PM&R) residency training, yet there remains a lack of standardized educational framework guiding its implementation across residency programs. While structured MSKUS curricula exist, variability in institutional resources limits generalizability. Moreover, there has been comparatively less focus on the advantages of incorporating longitudinal, simulation-based learning, which has been proven to enhance skill acquisition, clinical confidence, and patient safety. This study aims to address gaps in MSKUS curriculum by presenting the development and evaluation of a longitudinal, simulation-based MSKUS curriculum tailored to an academic PM&R residency program.

Methods: A longitudinal, simulation-based MSKUS curriculum was developed and implemented for PM&R residents at an academic institution from 2021 to 2025. The curriculum underwent iterative refinement each year in response to resident feedback, institutional needs, and evolving best practices. Core components included simulation-based scanning, near-peer instruction, standardized patients (SPs), and structured assessments aligned with progressive learning milestones. The curriculum designed was informed by Kern's six-step model and guided by Miller's Pyramid to support skill development from knowledge acquisition to clinical application.

Results: Feedback from curriculum implementation demonstrated increased clinical confidence and competence in MSKUS skill. Residents highlighted the value of active learning, clinical relevance, and peer collaboration. Iterative refinements addressed logistical barriers and aligned content with learner progression across PGY levels.

Conclusion: This simulation-based MSKUS curriculum provides an adaptable framework for PM&R residency programs. By emphasizing hands-on practice with SPs, team-based learning, and iterative feedback, it fosters skill development, mentorship, and sustainable ultrasound education applicable across diverse training environments.