Training

In 2002, the Department of Rheumatology at Tan Tock Seng Hospital decided to set up a rheumatology ultrasound service and started planning for training of rheumatologists to master the skills involved. Rheumatologists from our department were encouraged to take part in the short introductory ultrasound workshop at various international rheumatology annual scientific meetings, including the European League Against Rheumatism (EULAR) Annual Congress of Rheumatology and the American College of Rheumatology (ACR) Annual Scientific Meeting. I was selected to head and develop the service. Weekly contact with musculoskeletal radiologists who have a special interest in MSKUS was arranged. With the coaching of the radiologists and through reading of the recommended literature, theoretical knowledge of the physics of ultrasound and the features of ultrasound machines and probes was obtained.

A rheumatology ultrasound service was started at Tan Tock Seng Hospital in April 2004; this was the first dedicated MSKUS service run by a rheumatologist in Singapore and in all of Asia. After discussion with the radiologists, preliminary accreditation criteria for rheumatologists providing MSKUS as a service were set up to ensure a minimum level of quality. Rheumatologists interested in MSKUS attend the various MSKUS courses, workshops, and conferences that were held internationally. Radiologists who have a special interest in MSKUS meet with the rheumatologists at least weekly to assist in the training. The trainees are required to keep a log of the MSKUS scanning that they have performed under supervision. As a stakeholder, I represented the department as a member of the Hospital Ultrasound Working Group, which advises management regarding the optimal use of ultrasound technology in the hospital.

In 2004, the 11th Asia Pacific League of Associations for Rheumatology (APLAR) Scientific Meeting was held in Korea. An MSKUS workshop was included in the meeting for the first time. Many Korean musculoskeletal radiologists were involved in the teaching course and workshop. The response from rheumatologists throughout Asia was very encouraging.

In 2006, an MSKUS workshop remained a feature of the 12th APLAR Scientific Meeting in Kuala Lumpur, Malaysia, and was received with overwhelming response. Many rheumatologists in Asia were very keen to learn the skills. In the same year, the 16th Annual Conference of the Musculoskeletal Ultrasound Society was again held in Korea.

The development of rheumatology MSKUS in the region progressed steadily, with local and regional educational activities. To ensure minimal basic understanding of the physics of ultrasound and the features of the ultrasound machine and the various probes, a few of the departmental Continuing Medical Education (CME) sessions were dedicated to such topics. To increase awareness about the roles of MSKUS in the management of rheumatologic conditions among the local community of rheumatologists, a CME session on the topic was arranged by the Chapter of Rheumatologists, College of Physicians, Singapore.

During the past 5 years, rheumatology MSKUS in Singapore has developed slowly. Five rheumatologists actively use MSKUS in their daily clinical practice in Singapore. The number of patients who have undergone MSKUS examinations or ultrasound-guided procedures in our department has increased from fewer than 200 per year in 2004 to more than 400 annually in 2008. Other hospitals in Singapore with rheumatology departments are seriously considering setting up their own rheumatology MSKUS services.

In Malaysia, more and more rheumatologists are actively undergoing training in MSKUS. Rheumatology MSKUS services are being set up in major hospitals in the country.

The development of rheumatology MSKUS in other Asian countries is encouraging. Introduction of MSKUS to local rheumatologists in the Middle East started with an MSKUS workshop held during the Arab Health Rheumatology Exhibition and Conference in Dubai, United Arab Emirates, in 2009.