Feasibility of point-of-care ultrasound training and remote quality assurance for community physicians in conflict-affected Syria.

Abstract

Background: Point-of-care ultrasound (PoCUS) can extend diagnostic capabilities where conventional imaging is unavailable, yet evidence on its implementation in active conflict zones remains scarce. We describe the operational feasibility of a PoCUS training, device deployment, and remote quality assurance program for community physicians working in village clinics in Syria.

Methods: Nine physicians from five community clinics, none of whom had prior PoCUS training and whose ultrasound experience was limited to specialty-specific applications, participated in a two-day in-person PoCUS training course adapted to a conflict-affected, resource-constrained setting. The curriculum focused on cardiac, lung, FAST, and soft-tissue applications. At course completion, each clinic received a handheld ultrasound device (iQ, Butterfly Network, Inc, Guilford, CT, USA). The participants subsequently uploaded examinations to a cloud-based platform for remote expert review and feedback. Outcomes included immediate post-course satisfaction, perceived confidence, and early post-course PoCUS use over 6 months of follow-up. PoCUS competency was not objectively assessed.

Results: Overall satisfaction was high (mean, 9.2/10; SD, 0.8), and eight participants (89%; 95% CI, 57-98%) would recommend the course to colleagues. All participants reported that hands-on practice increased their confidence. The duration of hands-on practice received the lowest rating (mean, 2.9/5), and six of seven participants who offered suggestions recommended more training time. During follow-up, four physicians from four clinics uploaded 12 examinations; 11 of 12 examinations (92%; 95% CI, 65-99%) were classified as adequate quality on initial review by a single, non-blinded expert reviewer.

Conclusion: A brief, context-adapted PoCUS training program with device deployment and remote expert feedback was operationally feasible and well received by community physicians in conflict-affected Syria. Early post-course use was observed but limited, and competency was not assessed. These findings demonstrate the feasibility of implementation rather than educational effectiveness or clinical impact, and provide a framework for larger prospective studies incorporating extended hands-on training, structured competency assessment, standardized blinded image-quality review, and longer follow-up.