TABLE 5.

Sample extracorporeal shockwave therapy (ESWT) milestones for trainee education with associated target competencies

Procedural skills: Extracorporeal shockwave therapy
Level 0	Level 1	Level 2	Level 3	Level 4 (Graduation target)	Level 5 (Aspirational)
Foundational understanding of ESWT principles: ‐Physics ‐Knobology ‐Ergonomics ‐Safety protocols	Clinical knowledge of ESWT application: ‐Indications for use (radial vs. focused) ‐Risks ‐Benefits ‐Side effects ‐Contraindications	Demonstration or verbal description of appropriate protocols in a simulated setting: Preprocedural: ‐Setup ‐Positioning & ergonomics ‐Informed consent Procedural: ‐Device placement & settings ‐Titration goal ‐Anatomic landmarks, etc. Postprocedural: ‐Patient counseling ‐Device cleaning Performance of informed consent and time‐out in a clinical setting Performance of beginner level ESWT procedures with supervision + signficant hands‐on assistance	Performance of beginner/intermediate level ESWT procedures with supervision + little to no hands‐on assistance (may require verbal assistance) Ability to titrate dose based on clinical response Generates appropriate documentation	Performance of advanced level ESWT procedures with supervision + little to no assistance Experience across an expanding spectrum of diagnoses and patient‐specific factors, requiring individualization of care Ability to suggest protocol modifications based on clinical response Teaching of peers Publication of peer‐reviewed work related to ESWT with significant faculty mentorship	Performance of wide range of advanced level ESWT procedures adeptly and efficiently Independent modification of treatment protocols to achieve targeted and measurable patient outcomes with integration of current literature and evidence‐based treatment plans Teaching of peers and faculty Independent publication of peer‐reviewed work related to ESWT
□     □    □     □          □         □        □        □        □        □      □ Selection of a box between levels indicates that some, but not all, milestones in the higher level have been achieved.
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