Establishment and efficacy of a novel point-of-care ultrasound curriculum for Emergency Medicine residents in an East African program

Abstract

Introduction: As Emergency Medicine (EM) training expands in Africa, integration of comprehensive and sustainable point-of-care ultrasound (POCUS) curricula and building expertise are important considerations. The objectives were to describe and assess the efficacy of a novel ultrasound curriculum for EM residents in Tanzania and POCUS quality assurance training for local faculty. Novel aspects included digital didactics and testing, the incorporation of ultrasound image storage and longitudinal image review using a cloud-based platform, and faculty training. Methods: This was a pre/post intervention study involving first-year EM residents at Muhimbili University of Health and Allied Sciences and local faculty. A new POCUS curriculum was developed and implemented, including digital didactics, testing, hands-on instruction, and independent scanning with longitudinal review of participants' ultrasound studies. Local faculty experienced in POCUS completed quality assurance training. We analysed participants' pre- and post-knowledge assessments, observed structured clinical exam performance, and evaluated ultrasound study quality and accuracy. Agreement between local faculty and fellowship-trained external faculty was analysed for ultrasound study quality scores and accuracy. Results: A total of 17 first-year EM residents participated, along with five local faculty members. Altogether, 4557 ultrasound studies were performed and reviewed. The knowledge assessment scores for the residents increased by 38.9% (95% CI: 32.9-54.0). while OSCE scores increased by 40.7% (95% CI: 35.6-45.8). Using the ACEP 5-point scale, a comparison between the participants' first 25% of independent ultrasound scans and their final 25% showed an improvement in overall study quality by 0.12 (95% CI: 0.06-0.18), and accuracy increased by 3.3% (95% CI: 1.3-5.3). The agreement between local faculty and fellowship-trained external faculty was excellent for study accuracy (Kappa 0.83, 95% CI: 0.80-0.86) and fair for overall image score (Kappa 0.30, 95% CI: 0.25-0.35). Discussion: EM trainees in Africa should be equipped with POCUS expertise through participation in structured, quality curricula. We implemented an effective curriculum that includes new technologies that facilitate key aspects of training such as independent scanning and longitudinal image review. Development of local faculty quality assurance skills through didactics and joint image review is feasible and important to program sustainability.