Musculoskeletal Ultrasonography 

Fellowship Program at McMaster

Welcome to the Rheumatology Musculoskeletal Ultrasonography Fellowship program at McMaster University.

Dr. Maggie Larché, Program Director
Dr. Maggie Larché, Program Director


The Rheumatology Musculoskeletal Ultrasonography Fellowship at St. Joseph's
Healthcare/McMaster Hamilton is a mentored training program of one year for physician
investigators who have a strong interest in rheumatological ultrasonography and wish to pursue
a period of specialized training.

With an emphasis on clinical utility of POCUS, the fellow will have access to approximately 50
patients per week.
During the fellowship the fellow will participate in all aspects of the Rheumatology POCUS
program including: running clinics alongside the supervising staff; learning the basic and more
advanced skills of ultrasonography; develop a research question to investigate aspects of
ultrasonography in inflammatory arthritis using prospective patient enrollment or prospective
reviews of data already collected; develop educational materials and programs to assist with
rheumatology and internal medicine trainees education.
The trainee will undertake the Fellowship between July 1, 2021 to June 30, 2022 at St. Joseph's
Healthcare/McMaster University, which has the availability of senior faculty mentors.

The goals and specific objectives of the R-POCUS Fellowship are to:

Acquire expertise in the basic skills of ultrasonography in healthy individuals with the
        goal of understanding normal MSK anatomy
Become familiar in recognizing ultrasonography features of inflammatory arthritis,
        tendonitis, bursitis, synovitis, erosions and enthesitis
Become proficient in reporting US images
Learn the technique of US-guided joint injections
Understand the utility of US in treating to target and in patient education and compliance
        to medications
Become more familiar with the major unmet research needs in rheumatology POCUS
The achievement of each will be assessed through ITERs

Certification Outcome

Successful completion of the fellowship will be recognized with a Fellowship McMaster Certification.

Entry Requirements

Applicants will have completed an MD (or equivalent), internal medicine training and should be nearing completion of postgraduate fellowship in rheumatology, with the expectation of full certification from the Royal College of Physicians and Surgeons (or equivalent).

The candidate must have a training license or full license to practice in Ontario where the Fellowship will take place from the START of the Fellowship.

The fellow must be a citizen of Canada or have a valid visa to work in Canada that is acceptable to St. Joseph's/McMaster from the START of the Fellowship/funding period.

Application Deadline

Six Months prior to start date

Goals of Training

The overall training objectives for the Hospitalist Fellowship Program are:

Medical Expert Role:
By the end of the fellowship program, learners should be able to
• Appreciate the role of musculoskeletal ultrasound to optimize clinical decision-making
and therapeutic management.
• Understand principles of US technology and knowledge of ultrasound equipment to
optimize image quality.
• Know joint anatomy. Perform a standard grey scale and power Doppler ultrasound
scan of the hands, wrists, elbows, knees, ankles, and feet (shoulders, hips). Employ
ultrasound guidance aspiration and injection techniques.
• Recognize typical ultrasound pathology of: Joint effusion; Synovial hypertrophy;
Bone erosion; Tenosynovitis; Enthesopathy; Bursitis; Osteoarthritis; Crystalline
arthritis; Focal Nerve entrapments-median nerve.
• Seek appropriate consultation from other health professionals, recognizing the limits
of their expertise.

Communicator Role:
The learner will have skills to establish rapport with the patients and manage an encounter
The learner will obtain and provide information and explanation in oral and written form to
the patient, families and colleagues.

Collaborator Role:
The learner will participate effectively and appropriately in the interprofessional health care
team and effectively work to prevent, negotiate and resolve interprofessional conflict

Leader Role:
The learner will manage their time to effectively integrate musculoskeletal point of care
ultrasound in their practice.
The learner will allocate finite health care resources appropriately and make decisions that
contribute to a sustainable practice and health care system.

Health Advocate Role:
Learners will develop expertise to advocate for patients to obtain MSK point-of-care
ultrasound to advance the health and wellbeing of patients

Scholar Role:
Learners will demonstrate lifelong commitment to maintain and enhance their
musculoskeletal ultrasound skills. This is done through ongoing practice, reflective learning,
courses/ workshops, critical evaluation of information and its sources.
The learner will facilitate learning of patients, families and other health professionals on
MSK point-of-care US. They may contribute to creation, dissemination, application and
translation of future MSK ultrasound teaching and practices.

Professional Role:
Learners will demonstrate a commitment to ethical practice of MSK ultrasound to their
patients, profession and society.

Additional skills:

• The implementation and completion of an academic research project that includes a literature
review related to a commonly encountered problem, and the implications and the application
of the findings to both the fellow’s current clinical setting and to the practice to which they
will be returning.

• Opportunities to become involved in teaching medical students and clinical clerks

Length of Training

The fellowship program is 12 months in duration, and includes experiential and structured educational components.

Curriculum Highlights

Experiential Components (70%) Through a log-book, the fellow will keep track of
their scans, and will be expected to complete 100 patients for the small joints of
hands and feet and 50 patients for the shoulder, elbow and knee. The fellow will be
expected to perform at least 10 of each joint region US guided injections during the
course of the fellowship

The weekly schedule will be as follows:

• 4 days ultrasound clinics of Dr Maggie Larche and Dr Abraham Chaiton.
• 1 day clinical research – consenting patients, capturing clinical data, analyzing data,
writing abstracts and papers
Structured educational components (30%)
• Participate in weekly rheumatology rounds (Wednesdays 4-5pm)
• Review ultrasound images daily
• Conduct a research project based on retrospective or prospective data collection, with a
publication related to this research project
• Submit a challenging case for the annual Canadian Rheumatology Association or
international meeting
• Present ultrasonography educational sessions for academic half days for rheumatology
• Attend national or international Ultrasonography courses such as the Canadian
Rheumatology Ultrasound Society (CRUS) Course
• Develop educational materials for the Division of Rheumatology website

Supervision & Feedback

The assessment will involve a combination of direct workplace based assessment for clinical
(WBA) and intraining assessment reports (ITAR) for other components of the fellowship. A
case-log will be submitted, reviewed and signed off by the program director for fellowship completion

Margaret Larche

Medicine, Rheumatology
Larche, Margaret
Scleroderma Fellowship Program Director

Accessibility for Ontarians With Disabilities Act (AODA)


The Faculty of Health Sciences is committed to providing a website that is accessible to the widest possible audience. If there is an accessibility issue with this website, please contact us at