Concepts for point-of-care ultrasound training in low resource settings: a scoping review

Abstract

Background: Point-of-care ultrasound (POCUS) is a potent diagnostic tool especially in resource-limited settings. The implementation of POCUS diagnostics requires adequate training of POCUS operators. This scoping review aimed to identify and describe POCUS training concepts that have been applied in low-and middle-income countries (LMICs).

Methods and findings: All studies on diagnostic POCUS training in LMICs that could be found in the Cochrane, Embase, Google Scholar, and Medline databases up to July 6, 2023, were included and data was extracted for descriptive analysis. The review protocol was registered at OSF https://doi.org/10.17605/OSF.IO/8FQJW . A total of 53 publications were included with 59% of studies (n = 31) conducted in Africa and 23% (n = 12) in Asia. The majority of studies (n = 41, 81%) described short courses amongst which 40% were one-off sessions and 60% described longitudinal trainings. Curricula were mostly related to emergency medicine and obstetrics and organ-focused protocols (lung n = 29 (54%), cardiac n = 28 (53%), obstetric n = 23 (43%)). Trainees were largely medical doctors and clinical officers with minimal or absent ultrasound skills. Training challenges included resource constraints and lack of context adaptation. Best practice recommendations included focus on hands-on training, low trainer to trainee ratio, protected training time, online training options, use of local trainers, short and concise training manuals in print, continuous supervision and early and on-going evaluation, as well as tele-mentoring.

Conclusions: Context integration and focus on local needs, trainer availability and suitability, durable equipment and maintenance, as well as emphasis on hands on training including patients with relevant pathology, were key aspects for targeted and sustainable POCUS training in LMICs identified in this review.

Keywords: LMIC; POCUS; Point of care ultrasound; Training.

Fig. 1

PRISMA Flow diagram of literature search and review: This flow chart illustrates the study selection process for this scoping review, following PRISMA guidelines. The initial literature search was conducted on December 8, 2022, with a search update on July 6, 2023. The diagram outlines the number of records identified, screened, and excluded at each stage, along with reasons for exclusion. It details the numbers of records removed due to duplication, non-relevant titles/abstracts, and other exclusion criteria, as well as the final number of studies included in the analysis

Fig. 2

Geographical distribution of publications incl. POCUS modalities by region: Blue-shaded countries represent study locations, with darker shades indicating a higher number of studies conducted. Black numbers within each country denote the number of studies per country (note: asterisks* indicate countries with multinational studies included). Green boxes outline different WHO world regions, showing the total number of publications from each region (n) and the POCUS modalities reported as being taught within these regions (n = frequency, % = percentage of total publications from that region). One additional box ("Africa, Americas") represents a single intercontinental study conducted in both Tanzania (WHO African Region) and Mexico (WHO Region of the Americas), and is shown separately to reflect this cross-regional context

Fig. 3

Target clinical setting distribution: The pie chart shows the distribution of target clinical settings across studies. Each sector represents one of the following categories: primary, primary & secondary, secondary, secondary & tertiary, tertiary, and unclear settings. Percentages indicate the proportion of studies within each category

Fig. 4

Number of publications by length of training this bar diagram displays the distribution of publications based on the length of training. Categories include: up to 1 day, up to 1 week (> 1 day), up to 1 month (> 1 week), up to 1 year (> 1 month), more than 1 year, and unspecified duration. The length of each bar represents the number of publications in each category, with the exact number displayed at the end of each bar

Fig. 5

Distribution of training types: this pie-of-pie chart illustrates the distribution of different training types across studies. The left pie chart represents the main categories: short courses, longitudinal trainings, follow-up mentoring only, and unspecified training types. The right sub-pie chart further breaks down short course categories into: one-off short courses, short course with on-the-job mentoring and refresher training, short course with on-the-job mentoring, and short course with refresher training. Percentages in brackets represent the proportion of total publications, while segment sizes reflect sub-total percentages within each category