Web-Based Deliberate Practice of Pediatric Point of Care Ultrasound Cases in Resource-Limited Settings: A Multicenter Implementation and Effectiveness Study.

Abstract

Objectives: The main objective of this study was to implement an online pediatric case-based POCUS course in low-resource medical settings and examine learning outcomes and feasibility.

Methods: This was a multicenter prospective cohort study conducted in a convenience sample of clinicians affiliated with Médecins Sans Frontières (MSF) training sites. MSF POCUS trainers provided the standard hands-on, on-site POCUS training and supplemented this with access to a web-based course. Participants provided diagnoses for 400 image-based POCUS cases from four common pediatric POCUS applications until they achieved the mastery learning standard of 90% accuracy, sensitivity (cases with pathology), and specificity (cases without pathology). Each participant also completed a course evaluation.

Results: From 10 MSF sites, 110 clinicians completed 82,206 cases. There were significant learning gains across the POCUS applications with respect to accuracy (delta 14.2%; 95% CI 13.1, 15.2), sensitivity (delta 13.2%; 95% CI 12.1, 14.2), and specificity (delta 13.8%; 95% CI 12.7, 15.0). Furthermore, 90 (81.8%) achieved the mastery learning standard in at least one application, and 69 (62.7%) completed a course evaluation on at least one application for a total of 231 evaluations. Of these, 206 (89.2%) agreed/strongly agreed that the experience had relevance to their practice, met expectations, and had a positive user design. However, 59/110 (53.6%) clinicians reported a lack of protected time, and 54/110 (49.0%) identified challenges with accessing internet/hardware.

Conclusions: In resource-limited MSF settings, implementing web-based POCUS case practice demonstrated successful learning outcomes despite approximately half of the participants encountering significant technical challenges.