Assessing the Efficacy of POCUS Training in The Republic of Somaliland: A Retrospective Analysis of 500 Scans Conducted by General Practitioners

Objective

Evaluate the effectiveness of a point-of-care ultrasound (POCUS) training programme for public sector general practitioners in The Republic of Somaliland.

Methods

This retrospective, observational study analysed 500 ultrasound scans of adult patients from four public hospitals. Twelve general practitioners with no prior non-obstetric ultrasound experience completed a 12-day, multi-organ training curriculum, then performed scans in the emergency department, ICU and outpatient clinics. Participants submitted their scans with a questionnaire providing their answer to one or more (out of 21 total) specific diagnostic questions, termed ‘studies’, answered by ultrasound. Blinded experts assessed image quality and accuracy. Concordance between learner and expert was calculated for each organ system alongside interrater reliability for each of the individual studies.

Results

Overall concordance between expert and learner was 90% (n = 500). Concordance was highest for renal (95%, n = 242), lung (91%, n = 365) and hepatobiliary (91%, n = 217) imaging, whereas cardiac (87%, n = 400) and DVT (83%, n = 42) concordance was lower. ICU studies had the highest concordance (91%), followed by those conducted in the clinic (89%) and emergency department (87%). Cohen's kappa coefficient between learner and expert interpretation was > 0.8 (p value < 0.05) for 18 out of 18 studies, indicating at least substantial agreement.

Conclusion

This POCUS training programme in The Republic of Somaliland resulted in high concordance between learner and expert interpretations, indicating effective training across multiple organ systems. Several areas for improvement were identified. These findings underscore POCUS's potential to enhance diagnostic capabilities in resource-limited settings.