Intensive point-of-care ultrasound training with long-term follow-up in a cohort of Rwandan physicians Patricia C. Henwood 1,2 , David C. Mackenzie 2,3 , Joshua S. Rempell 1,2 , Emily Douglass 2 , Damas Dukundane 2,4 , Andrew S. Liteplo 5 , Megan M. Leo 2,6 , Alice F. Murray 2,6 , Samuel Vaillancourt 2,7 , Anthony J. Dean 2,8 , Resa E. Lewiss 2,9 , Stephen Rulisa 4 , Elizabeth Krebs 10 , A. K. Raja Rao 2 , Emmanuel Rudakemwa 11 , Vincent Rusanganwa 12 , Patrick Kyanmanywa 13 and Vicki E. Noble 2,5 1 Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA 2 Point-of-Care Ultrasound in Resource Limited Environments, Boston, MA, USA 3 Department of Emergency Medicine, Maine Medical Center, Portland, OR, USA 4 University Teaching Hospital of Kigali, Kigali, Rwanda 5 Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA 6 Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA 7 Department of Emergency Medicine, St. Michael’s Hospital, Toronto, Canada 8 Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA 9 Department of Emergency Medicine, University of Colorado, Denver, CO, USA 10 Department of Emergency Medicine, Duke University Medical Center, Durham, NC, USA 11 King Faisal Specialist Hospital, Kigali, Rwanda 12 Ministry of Health, Kigali, Rwanda 13 University of Rwanda, Butare, Rwanda Abstract objective We delivered a point-of-care ultrasound training programme in a resource-limited setting in Rwanda, and sought to determine participants’ knowledge and skill retention. We also measured trainees’ assessment of the usefulness of ultrasound in clinical practice. methods This was a prospective cohort study of 17 Rwandan physicians participating in a point-of- care ultrasound training programme. The follow-up period was 1 year. Participants completed a 10- day ultrasound course, with follow-up training delivered over the subsequent 12 months. Trainee knowledge acquisition and skill retention were assessed via observed structured clinical examinations (OSCEs) administered at six points during the study, and an image-based assessment completed at three points. results Trainees reported minimal structured ultrasound education and little confidence using point-of-care ultrasound before the training. Mean scores on the image-based assessment increased from 36.9% (95% CI 32–41.8%) before the initial 10-day training to 74.3% afterwards (95% CI 69.4–79.2; P < 0.001). The mean score on the initial OSCE after the introductory course was 81.7% (95% CI 78–85.4%). The mean OSCE performance at each subsequent evaluation was at least 75%, and the mean OSCE score at the 58-week follow up was 84.9% (95% CI 80.9–88.9%). conclusions Physicians providing acute care in a resource-limited setting demonstrated sustained improvement in their ultrasound knowledge and skill 1 year after completing a clinical ultrasound training programme. They also reported improvements in their ability to provide patient care and in job satisfaction. keywords ultrasound, global health, Rwanda, curriculum, education Introduction Ultrasound performed by the treating clinician at the bed- side is increasingly integral to the practice of many medi- cal and surgical specialties, and is a core component of residency training in a range of disciplines [1]. In eco- nomically poor settings, diagnostic imaging is limited by equipment availability, equipment expense and patients’ ability to pay for imaging and transport to such services. As ultrasound has become increasingly portable and affordable, it has been proposed as a potentially transfor- mative technology for patient care in low-income coun- tries [2–5]. One of the major impediments to more widespread utilisation is the need for mastery of cognitive © 2016 John Wiley & Sons Ltd 1531 Tropical Medicine and International Health doi:10.1111/tmi.12780 volume 21 no 12 pp 1531–1538 december 2016