Education & AdministrationIdentifying and Monitoring Deficiencies in Physical Examination of the Foot and Ankle With Diagnostic Ultrasound Experience From a Physical Medicine and Rehabilitation Residency Training ProgramBitterman, Jason MD; Oh-Park, Mooyeon MD; Lew, Henry L. MD, PhD, ABPMR; Ma, Rex T. MDAuthor Information From the Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey (JB); Burke Rehabilitation Hospital, White Plains, New York (MO-P); Arthur S. Abramson Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Health System, New York City, New York (MO-P); Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia (HLL); University of Hawaii School of Medicine, Honolulu, Hawaii (HLL); and Department of Physical Medicine & Rehabilitation, VA New Jersey Health Care System, East Orange, New Jersey (RTM). All correspondence should be addressed to: Jason Bitterman, MD, Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, 183 S. Orange Avenue, BHSB F-1556, Newark, NJ 07103. MO-P was affiliated with Kessler Institute for Rehabilitation at the onset of this study. She is now affiliated with Burke Rehabilitation Hospital. Jason Bitterman is in training. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. American Journal of Physical Medicine & Rehabilitation: October 2020 - Volume 99 - Issue 10 - p 961-967 doi: 10.1097/PHM.0000000000001425 Buy Metrics Abstract Despite the high incidence of foot and ankle injuries and their biomechanical importance to more proximal joints, the foot and ankle are some of the most daunting and underemphasized musculoskeletal structures in medical training. This study used musculoskeletal ultrasound to identify a knowledge gap in physical medicine and rehabilitation residents in foot and ankle surface anatomy palpation and to determine whether senior residents had higher examination performance compared with more junior residents. Physical medicine and rehabilitation residents at different levels of training were tested cross-sectionally, and palpation accuracy was compared by class year. There was a trend of improvement across class years, with significant class differences in accuracy for the talonavicular joint, calcaneocuboidal joint, and posterior tibialis and peroneal tendons (P < 0.05). Despite this trend, the accuracy was not consistently higher among the senior residents considering the training they received. For all 30 residents assessed, accuracy within 1 cm was highest for the tibiotalar joint (93.3%), peroneal tendons (83.3%), posterior tibialis tendon (63.3%), and talonavicular joint (50%). It was lower for the calcaneocuboidal joint (26.7%) and the second (13.3%) and fourth for the tarsometatarsal joints (20%). Anatomical knowledge and palpation skills of the foot and ankle, particularly at the midfoot and forefoot, may be an area of improvement for physical medicine and rehabilitation resident training. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.