Background: Imaging diagnostics such as CT and MRI are practically inaccessible to many of this developing nation’s 42 million citizens. Ultrasound, however, is more readily available but primarily limited to use in obstetrics. With proper training, the diagnostic utility of ultrasonography may be expanded to non-obstetric point-of-care examinations. In this study, we aimed to evaluate the feasibility of training rural health providers, in a developing nation, relevant point-of-care ultrasound (POCUS) techniques.

Methods: Focused Assessment with Sonography in Trauma (FAST) and Focused Assessment with Sonography for HIV-Associated Tuberculosis (FASH) were taught to local providers by a group including a Hospitalist, two Emergency Medicine physicians and two third year medical students at four rural hospitals. Participants included physicians of various training levels, nurses and ultrasonographers. The curriculum included both didactic and hands on training over the course of one day at each site. Feasibility of this training was assessed by evaluating both participant confidence and knowledge which was conducted through anonymous surveys. Surveys were completed before and after each training session to assess participant confidence via Likert scale. Evaluation of ultrasound knowledge was assessed via a multiple-choice quiz.

Results: Baseline data demonstrated that 80.4% had no prior ultrasound experience (n=69). Pre-training mean confidence in the FAST and FASH were 1.81 and 1.65 respectively (corresponding to a value between not and slightly confident), compared to a post-training confidence level of 3.5 and 3.18 respectively (corresponding to a value between moderately and very confident). The increases in mean confidence for FAST and FASH were statistically significant (mean difference of 1.69 (p<0.01) and 1.53 (p<0.01) respectively). For the POCUS knowledge assessment, mean pre-training score was 48% compared to 78% post-training, with a statistically significant mean difference of 20% (p<0.01).

Conclusions: POCUS use is becoming more common in Hospital medicine, with many institutions developing internal training programs. Our study suggests that focused POCUS training significantly increased confidence and technical knowledge of ultrasound among trainees in the immediate post-training period suggesting feasibility of this intervention in this developing nation. It is possible that a similar strategy could be implemented in Hospital medicine domestically and demonstrates that Hospitalists trained in POCUS can utilize these skills to train providers in resource-limited areas thus expanding the reach of Hospital medicine in global health. Although immediate results of this study are promising, retention of knowledge will be evaluated in a twelve month follow up to ensure long-term benefit. These results suggest that Implementation of a formal, more robust POCUS program in a resource-limited setting poses an opportunity to positively impact lives via improved diagnostics and treatment.

IMAGE 1: Change in Confidence Pre and Post Intervention

IMAGE 2: Change in Knowledge Assessment Pre and Post FAST/FASH Training