Integrated point-of-care ultrasound training in a Rwandan medical school

BACKGROUND: Point-of-care ultrasound (POCUS) training has been adopted in some undergraduate medical education programs globally, though it remains uncommon in low-income settings. In 2022, the University of Global Health Equity in Rwanda established an integrated, longitudinal POCUS curriculum spanning preclinical through clinical training, designed to produce general practitioners competent in POCUS examinations most needed in district hospital settings. We describe this curriculum and report educational outcomes from multiple student cohorts. METHODS: We developed competency-based learning objectives mapped onto the existing 6.5-year curriculum, incorporating didactic sessions, hands-on training with standardized patients, clinical application during clerkships, and online learning resources. Students used handheld ultrasound devices across clinical sites. We assessed the curriculum through student evaluations, self-reported confidence measures, knowledge assessments, and a final certification examination consisting of a 30-item multiple choice test and 3-station objective structured clinical examination. RESULTS: Knowledge scores improved significantly following educational sessions, from 68.8% to 90.0% after the introductory session (p < 0.001) and from 69.3% to 93.1% after intensive training (p < 0.001), with very large effect sizes on confidence measures (Cohen's d 1.39-2.38). Longitudinal assessment of one cohort demonstrated significant improvements in overall performing confidence (d = 1.11, p < 0.001) and interpreting confidence (d = 0.93, p < 0.001) across clinical training, with largest gains in obstetric (d = 1.70) and renal/bladder (d = 1.03) examinations. A subsequent cohort receiving the complete preclinical curriculum demonstrated significantly higher confidence than students who received clinical-only training at a similar training point (performing: d = 0.55, p = 0.022; interpreting: d = 0.47, p = 0.048), with 89% agreeing preclinical training facilitated clinical learning. During internship, 68% used POCUS clinically, with all finding it helpful for patient care. Twenty-seven of 30 graduating students took the final examination and 96% passed. Primary barriers were limited supervision, time constraints, and equipment access at district hospitals. CONCLUSIONS: An integrated, longitudinal POCUS curriculum is feasible in a low-income setting and produces graduates with strong foundational knowledge and clinical confidence. Earlier curriculum initiation may enhance preparation for clinical practice. Future efforts will focus on faculty development and improving POCUS infrastructure at clinical sites.

Certification · Cohort · Confidence interval · Curriculum · Educational measurement · Objective structured clinical examination · Problem-based learning · Cardiac Arrest and Resuscitation · Radiology practices and education · Ultrasound in Clinical Applications