Saudi National Survey of Point of Care Ultrasound Training in Anesthesiology Residency Programs

Saudi National Survey of Point of Care Ultrasound Training in Anesthesiology Residency Programs | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Saudi National Survey of Point of Care Ultrasound Training in Anesthesiology Residency Programs Rothana Aljehani, Abdulrahman Alboog, Haneen Alnazzawi, Albaraa Alnazzawi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8448555/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Feb, 2026 Read the published version in BMC Anesthesiology → Version 1 posted 13 You are reading this latest preprint version Abstract Background Point-of-care ultrasonography (POCUS) has emerged as a valuable tool in anesthesiology, enhancing procedure accuracy, and real-time decision-making in the perioperative period. Although POCUS integration into Anesthesia practice has gained momentum in Saudi Arabia, yet its adoption, effectiveness, and challenges remain understudies. The purpose of this study is to evaluate the state of POCUS training and incorporation in Saudi Arabia Anesthesiology residency programs. Methods Program directors of Anesthesiology residency programs in Saudi Arabia, accredited by the Saudi Commission for Health Specialties, were invited access to an online survey. The survey evaluated the current state of POCUS training, the assessment methods employed by each institution, and the perceived challenges to its instruction. Directors were asked regarding their opinion on the anticipated development of POCUS training in Anesthesiology residency programs in Saudi Arabia, as well as their opinions on the significance of various POCUS applications. Results A total of 36 out of 42 program directors were able to complete our survey (85.7% response rate). All respondents state POCUS training for vascular access, nerve blocks, neuraxial blocks, and TTE is provided. However, 77.8% reported that their institutions lack organized training programs. The main teaching method was informal bedside instruction; only 38.9% of programs included formal evaluation plans. A significant barrier was low staff knowledge; 83.3% of respondents reported 25% or less of their faculty members are experts in TTE, lung US, and gastric US. Only 11 programs had a designated "local POCUS expert," and 66.7% of programs lacked funds for extracurricular POCUS training. These findings highlight the need of standardized POCUS curricula and faculty development training within anesthesiology residency programs in Saudi Arabia. Conclusions In Saudi Arabia Anesthesiology residency programs, POCUS training is markedly disparate; numerous programs are deficient in funding, structured instruction, or experienced personnel. Enhancing competency and optimizing patient care rely on structured training, formal assessments, and advanced faculty development. POCUS anesthesiology residency programs medical education Saudi Arabia Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Background Over the past decade, point-of-care ultrasound POCUS has become an important tool in many different areas of medicine, enhance patient safety, making procedures more accurate and making decisions faster ( 1 ). Numerous studies in Emergency Medicine and Primary Care illustrate the value of ultrasonography in patient management ( 2 , 3 ). Since the 1990s, emergency medicine departments in the United States have started the use of POCUS to aid in the assessment of trauma patients via the focused assessment with sonography for trauma (FAST) examination ( 4 ). Recently, the scope of clinical ultrasound (US) applications increased to incorporate nearly all medical specialties ( 5 ). POCUS has become increasingly important in the field of Anesthesia, as it enhances perioperative patient management, procedural guidance, and diagnostics. It is emerging as a critical and core skill that anesthesiologists should possess ( 6 , 7 ). Common application examples of POCUS in anesthesiology includes ultrasound-guided nerve block, vascular access, airway ultrasound, gastric ultrasound, lung ultrasound, neuraxial sonography, focused transthoracic (TTE) and transesophageal echocardiography (TEE). Thus, there are multiple potential areas where ultrasound can play a significant role in guiding and improving the safety and efficacy of many interventions ( 8 , 9 ). Currently, there is lack of published data describing how POCUS teaching and specific applications are incorporated into anesthesiology residency programs in Saudi Arabia. Therefore, this study aims to evaluate Saudi Arabian residency program directors’ level of POCUS integration, identify barriers to its adoption, and help identify gaps in core competencies to standardize training across different program. Methods Ethical approval was granted by the Institutional Review Board at University of Jeddah Institutional (no. HAP-02-J-094 on December 1, 2024). An electronic survey consisting of 20 questions was distributed via Google Forms among program directors of accredited Anesthesiology residency programs. The questionnaire was adapted from a previously published study by Mok et al. (2017) ( 3 ) with modification made to suite with our study objectives and the local educational context. Prior to finalization of the survey, a draft version was shared with 5 program directors for expert feedback to ensure adequate breadth and clarity of language. The survey data were collected over a two-month period between December 2024 and January 2025. An electronic signed written consent was required to proceed with the survey. We have identified 36 anesthesia residency programs in Saudi Arabia accredited by the Saudi Commission for Health Specialties. The participation link was sent through WhatsApp with following reminders every two weeks subsequently for a total of four reminders. Survey data were stored on the Google Forms server and downloaded for analysis following data collection. The data were analyzed using Microsoft® Excel [Version 16.103.2]. Descriptive statistics, including means, frequencies, and percentages were calculated as appropriate and no inferential statistical tests were performed. Results A total Thirty-six out of forty program directors of anesthesia residency programs completed the survey, resulting in an overall response rate of 90%. In response to a question about the number of residents currently enrolled in their respective residency programs, most of the programs reported having 11–20 residents (36.1%), and 25% had between one and five. Regarding professional experience, most program directors had 11 to 20 years’ experience in the field of anesthesiology, while only 22.2%, had more than 20 years of experience. In terms of professional rank, most directors were consultants (77.8%); more than half were trained locally via the Saudi Commission for Health Specialties (SCFHS), while 36.1% were trained abroad. Geographically, responses came predominantly from the Western region( 41.7%), which includes Jeddah, Medina, Makkah, and Taif, followed by 25% from the Eastern and 22.2% from the Central regions. Among the participating facilities, 38.9% were affiliated with the Ministry of Health, while 30.6% belonged to the private sector. Also, most institutions in our study reported having more than ten operation rooms (52.8%), while 38.9% had between six and ten operating rooms. Fig- 4 Operating Rooms in respected Centers Program directors were asked regarding the incorporation of POCUS applications in training; all programs reported that providing POCUS training is well established for vascular and arterial access, peripheral nerve blocks, neuraxial blocks, and transthoracic echocardiography (TTE). However, the other POCUS applications, such as Transesophageal Echocardiography (TEE), IVC Assessment, eFAST, Airway US for ETT placement, Gastric US, Optic Sheath Nerve Diameter, and Lung US, appear to be limited or underdeveloped. Interestingly, 77.8% had no structured, formalized training programs in their training centers. Informal bedside teaching identified as the most common method of instruction, making it the cornerstone of ultrasound education, but 90% used faculty-led lectures. Other commonly used modalities included online courses (77%) and simulation sessions (70%). In contrast, formal clinical rotations were uncommon, except for neuraxial block training (25%). The greatest rates among elective POCUS rotations were seen for TTE (36.1%) and TEE (33.3%). Although the SCFHS Anesthesiology Curriculum currently lacks specific requirements regarding minimum hours or expected number of scans by the end of residency training, several program directors indicated the necessity for structured training—especially peripheral nerve blocks. Eight programs specifically reported requiring at least 15 hours of formal training for peripheral nerve blocks, although no specific requirement was mentioned regarding the number of scans performed during residency rotations. In addition to training methods, program directors were inquired about the availability of funding for extracurricular POCUS training such as POCUS workshops offered during conferences or by other academic institutions;66.7% reported a lack of funding for such activities, and only 11.1% indicated that funding for POCUS is available, while the remaining are uncertain about the availability of financial support. Regarding the assessment of resident POCUS skills, only 50% had structured assessment processes in place to formally evaluate residents’ POCUS competency. These programs assess residents’ skills across a range of applications, including arterial access, venous access, peripheral nerve blocks, neuraxial blocks, TEE, lung US, and IVC assessment. These assessments were mostly using direct observation, procedure counts, image/video review, and written or practical exams. Program directors were asked to assess the importance of Anesthesiology residents being competent in various POCUS applications at the end of their training. In this context, competence was considered as the ability to independently obtain and interpret ultrasound imaging to answer a focused clinical question or to facilitate a procedure. The majority of directors (89%) considered competency in arterial and venous access, and peripheral nerve blocks either “important” or “very important”. Similarly, 81% viewed competency in neuraxial blocks as essential, whereas only 47% viewed TTE with high importance, and more than half the respondents viewed TEE, lung ultrasound ,and gastric ultrasound as at least moderately important .Notably, none of the program directors added any applications that were not listed on the survey that were considered essential for graduating residents. Program directors were also asked to estimate the percentage of faculty anesthesiologists within their training program who are competent in the POCUS applications listed in our survey. The proportion of faculty estimated to be competent in these applications varied widely among programs. Competency across programs was perceived to be relatively high in vascular access and in peripheral nerve blocks, and estimates for a given program usually ranged from 50% to over 75%. On the other hand, a remarkable 83.3% of program directors estimated that their faculty is 25% or less competent in the skills of TTE, lung ultrasound, and gastric ultrasound, reflecting a serious gap in expertise in advanced applications. At the end of the survey, only 30% of programs reported having a designated “local POCUS expert” responsible for POCUS education, while more than half had no such position. Of these, some programs reported developing the position, and others were unsure of future plans. These results emphasize critical gaps in faculty expertise and program leadership that may adversely impact comprehensive POCUS training within Anesthesiology residency programs. Discussion POCUS, or point-of-care ultrasound, is an advanced portable diagnostic tool with several applications readily accessible at the patient's bedside. The use of POCUS has surged in the last ten years across several medical fields, enabling improved patient diagnosis, evaluation, and management. ( 10 ). Over the past decade, POCUS has been extensively used across several medical specialties in Saudi Arabia, particularly in emergency medicine and critical care (11.12). However, its incorporation into residency training and clinical practice remains variable and underdeveloped, as prior survey studies in Saudi Arabia show that utilization of POCUS is hindered by training gaps, lack of standardized curriculum requirements, and limited resources ( 13 ).In anesthesiology, POCUS has emerged as a vital competency, enhancing perioperative safety, procedural precision, and clinical decision-making, especially in critical and time-sensitive scenarios. Although its recognized value is acknowledged worldwide ( 14 – 16 ), Anesthesiology has been slower to incorporate POCUS into routine training and practice, highlighting a significant educational gap ( 17 , 18 ). This national survey provides a comprehensive overview of the current status of point-of-care ultrasound (POCUS) training within Anesthesiology residency programs in Saudi Arabia. Our results reveal a significant opportunity for improved curriculum development, a perspective supported in an international context. Specifically, our data aligned with a study conducted in Canada in 2017, which also reported broader implementation of POCUS in emergency medicine and critical care compared to Anesthesiology ( 5 ). This persistent global trend reflects a common discipline- specific issue that extends beyond regional limitations, perhaps involving factors such as traditional training methods and uneven resource allocation. However, in comparison with the finding of Daniel mok( 5 ), important differences emerged that highlight unique characteristics of our national study. Initially, our study achieved a higher number of responses from Program directors, potentially providing a more comprehensive representation of the national training. Furthermore, while Canadian programs reported more consistent integration of transesophageal echocardiography (TEE), our data show that TEE is less routinely incorporated into Saudi Anesthesiology residency programs. This trend of variable and often restricted POCUS training is not unique to Canada. Our findings are further supported by a similar survey conducted in the United States ( 18 ), which also reported considerable variability in POCUS training among Anesthesiology residency programs. Surprisingly, the similarity in both the United states survey and our survey was that training was most comprehensive for basic competencies like vascular access and peripheral nerve block, while advanced applications such as transthoracic echocardiography, transesophageal echocardiography, gastric ultrasound, and lung ultrasound were less often included in teaching. The similarities extend to the recognized barriers, as US programs also identify the main barriers as lack of faculty expertise and standardized curricula. Also unsurprisingly, many programs rely on informal bedside teaching without structured competency-based assessments. The critical implication of these shared barriers is represented in our data, where 28 out of 36 program directors (77.8%) reported having no formal POCUS training themselves. Indeed, this represents a potential cyclical problem whereby a lack of formally trained faculty propagates into a lack of formal training for residents. We believe this likely deprives the residents of an opportunity to both attain and maintain procedural proficiency and may thus negatively impact patient care. Encouragingly, previous promising pilot studies, such as one performed by Lee et al. ( 19 ) in the U.S, have demonstrated a structured POCUS curriculum can heavily improve both resident confidence and measured competence. Such findings support our conclusion that well-designed, standardized training programs could address these educational deficiencies. Apart from curricular challenges, financial constraints regarding POCUS training were noted as a major obstacle in our data. About, 66.7% of program directors cited a lack of financial support for POCUS related- resources. Without adequate funding, programs may not be able to purchase the necessary ultrasound equipment, embed simulation-based sessions, or cover support to attend POCUS-related workshops. These further restrain residency programs from implementing comprehensive training. Overall, our results again underline the competence of POCUS, which residents in Anesthesiology should possess. However, generally poor curricula, lack of faculty training, and lack of funding present major obstacles to its implementation. Overcoming these deficiencies will require national standardization efforts-investing in faculty development and increasing resources that allow long-term implementation in residency training in Saudi Arabia. Barriers of integration Despite its numerous benefits, POCUS integration into Anesthesiology training continues to face several challenges in Saudi Arabia, such as lack of awareness and limited access to POCUS-specific funding, which discourages many residents from participating in POCUS-related courses. Also, there is a shortage of qualified expertise in POCUS, and in this way, in-house education by experienced instructors becomes quite difficult to performed within residency programs. Time constraints and heavy workloads also restrict residents’ ability to participate in supplementary training. Additionally, while one of the most important modes of learning is through experience, many institutions lack the necessary equipment, such as working ultrasound machines, sterile probe covers, or procedural equipment like spinal needles, to facilitate this kind of learning. Psychological factors also have their contributions to make. The fear of failure or rejection and the limited time available in some clinical rotations create an obstacle to residents' behavior of accepting POCUS training or putting their knowledge into practice. This landscape of multifactorial barriers creates a vicious cycle where, because of limited resources and faculty, there is reduced resident exposure, leading eventually to a problem with clinical competency. As POCUS is gaining more attention in anesthesiology, the solution to these barriers will require persistence on the part of education, faculty development, and institutional investment. Full implementation of a standardized, comprehensive training framework requires significant resources to realize the full clinical potential of POCUS. Limitation Several limitations are inherent to the online survey design of our study, including Predisposition to responder bias and possible misinterpretation of survey questions. Additionally, our survey focused on the perspective of residency program directors rather than residents, thus the results do not fully represent the resident point of view to POCUS training. Conclusions This survey represents the first comprehensive overview of the current status of point-of-care ultrasound (POCUS) training within Anesthesiology residency programs in Saudi Arabia. Our findings highlight that POCUS is a core competency for Anesthesiology residents, profoundly improving diagnostic accuracy and facilitating clinical procedures to improve patient outcomes in both the perioperative period and during critical care. This is, of course, not new but has been widely regarded as a standard of care for a long time, further underlining the need to be pursued in a structured fashion in Saudi residency training programs. For residents to learn the skills in ultrasound, residency programs should ensure access to appropriate equipment, allocate sufficient funds, establish proper checklists that are competency-based for specific learning objectives, and assign faculty with dedicated expertise in POCUS to provide leadership in education. Our study also underscores the importance of innovation and continued development in postgraduate medical education. This should particularly focus on assessing and developing the weaker areas of POCUS training, such as advanced applications including transthoracic and transesophageal echocardiography. Aligning with the Kingdom’s Vision 2030 goals for healthcare innovation and excellence, these improvements are vital to preparing Anesthesiology residents to meet international standards and deliver the highest level of patient care. Abbreviations POCUS-- Point-of-care ultrasonography TTE--Transthoracic echocardiogram US-- Ultrasound FAST--Focused assessment with sonography for trauma TEE--Transesophageal echocardiography IVC--Inferior vena cava Efast--Extended Focused Assessment with Sonography for Trauma ETT—Endotracheal tube SCFHS-- Saudi commission for Health Specialties Declarations Human Ethics and Consent to Participate: not applicable Clinical trial number: not applicable Ethics approval and consent to participate: Ethical approval was granted by the Institutional Review Board at University of Jeddah Institutional (no. HAP-02-J-094 on December 1, 2024). Consent for publication: Not applicable. Data availability: No datasets were generated or analysed during the current study Competing interests: The authors declare no competing interests Funding: No Authors Contributions: All authors contributed equally to the study design, survey preparation, data collection, interpretation of findings, and manuscript writing and revision. All authors approved the final version to be published. Acknowledgements: None References Lee SC, Yang EC, Navarro JC, Minard CG, Huang X, Deng Y. An introductory point-of-care ultrasound curriculum for an Anesthesiology residency program. MedEdPORTAL. 2022;18:11291. 10.15766/mep_2374-8265.11291 . Choi W, Cho YS, Ha YR, Oh JH, Lee H, Kang BS, Kim YW, Koh CY, Lee JH, Jung E, Sohn Y, Kim HB, Kim SJ, Kim H, Suh D, Lee DH, Hong JY, Lee WW, Society Emergency and Critical Care Imaging (SECCI). Role of point-of-care ultrasound in critical care and emergency medicine: update and future perspective. Clin Exp Emerg Med. 2023;10(4):363–81. 10.15441/ceem.23.101 . Blanco P, Volpicelli G. Common pitfalls in point-of-care ultrasound: a practical guide for emergency and critical care physicians. Crit Ultrasound J. 2016;8(1):15. 10.1186/s13089-016-0052-x . Wilcox J, Lawson B, Gauger A. Early point of care ultrasound training in medical education, making the case with a case report. Int J Med Students. 2023;11(3):229–32. 10.5195/ijms.2023.1719 . Mok D, Schwarz SKW, Rondi K. Point-of-care ultrasonography in Canadian Anesthesiology residency programs: a national survey of program directors. Can J Anaesth. 2017;64(10):1023–36. 10.1007/s12630-017-0935-8 . Sites BD, Brull R, Chan VW, Spence BC, Gallagher DW, Beach ML et al. Artifacts and pitfalls of ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2007;32(5):412 – 23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856172/ Alabama Board of Nursing. POC ultrasound in anesthesia care [Internet]. Montgomery (AL): Alabama Board of Nursing; 2020 Nov [cited 2025 Apr 18]. Available from: https://www.abn.alabama.gov/wp-content/uploads/2023/10/POC-Ultrasound-in-Anesthesia-Care_Nov-2020.pdf Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749–57. 10.1056/NEJMra0909487 . Meyer HL, Einloft J, Bedenbender S, et al. Impact and reception of point-of-care ultrasound training across medical education levels. BMC Med Educ. 2025;25:255. 10.1186/s12909-025-06825-4 . Nassar SM, Almubrik SA, Alyahya L, Alshalan M, Alhashem HM. Perception, knowledge, indications, and future prospects of point-of-care ultrasound among medical students in Saudi Arabia. Cureus. 2024;16(4):e57704. 10.7759/cureus.57704 . Almulhim KN, Alabdulqader RA, Alghamd MK, Alqarni AA, Althikrallah FM, Alarfaj AA. Assessing point-of-care ultrasound knowledge and utilization among emergency physicians in Saudi Arabia: a cross-sectional survey. Indian J Crit Care Med. 2024;28(8):769–76. 10.5005/jp-journals-10071-24763 . Epub 2024 Jul 31. Abdelshafey EE, Abdalkreem NS, Altayar AS. Use of critical care ultrasound in Saudi Arabia: questionnaire analysis. Saudi Crit Care J 2023 Apr-Jun;7(2):29–36. 10.4103/sccj.sccj_7_23 Abuguyan F, Almasry NW, Alzahrani AA. Barriers to point-of-care ultrasound utilization among emergency medicine residents in Riyadh, Saudi Arabia. Cureus. 2024;16(7):e65765. 10.7759/cureus.65765 . Gohad R, Jain S. The use of point-of-care ultrasound (POCUS) in anesthesiology: a narrative review. Cureus. 2024;16(9):e70039. 10.7759/cureus.70039 . Mahmood F, Matyal R, Skubas N, et al. Perioperative ultrasound training in anesthesiology: a call to action. Anesth Analg. 2016;122(6):1794–804. 10.1213/ANE.0000000000001134 . Johnson DW, Oren-Grinberg A. Perioperative point-of-care ultrasonography: the past and the future are in anesthesiologists' hands. Anesthesiology. 2011;115(3):460–2. 10.1097/ALN.0b013e31822a62a1 . Remskar MH, Theophanous R, Bowman A, Simonson LE, Koehler J, Basrai Z, Manohar CM, Mader MJ, Nathanson R, Soni NJ. Current use, training, and barriers of point-of-care ultrasound in anesthesiology: a national survey of Veterans Affairs hospitals. J Cardiothorac Vasc Anesth. 2023;37(8):1390–6. 10.1053/j.jvca.2023.03.042 . Epub 2023 Apr 5. Edwards J, Ahn D, Alcaraz D, Chiles C, Khuu T, Soni NJ, Goyal V, Manohar C. Point-of-care ultrasound training among Anesthesiology residency programs in the United States. BMC Anesthesiol. 2025;25(1):105. 10.1186/s12871-025-02929-y . Chu SC, Goh V, Kawaguchi T, Lee HF, Hsu HC. Advancing point-of-care ultrasound (POCUS) utilization and education: a comprehensive analysis among postgraduate physicians in a tertiary teaching hospital. J Acute Med. 2025;15(3):98–107. 10.6705/j.jacme.202509_15(3).0003 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Feb, 2026 Read the published version in BMC Anesthesiology → Version 1 posted Editorial decision: Revision requested 20 Jan, 2026 Reviews received at journal 19 Jan, 2026 Reviews received at journal 19 Jan, 2026 Reviewers agreed at journal 18 Jan, 2026 Reviewers agreed at journal 18 Jan, 2026 Reviewers agreed at journal 15 Jan, 2026 Reviewers agreed at journal 13 Jan, 2026 Reviewers agreed at journal 13 Jan, 2026 Reviewers invited by journal 13 Jan, 2026 Editor invited by journal 30 Dec, 2025 Editor assigned by journal 29 Dec, 2025 Submission checks completed at journal 29 Dec, 2025 First submitted to journal 25 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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2","display":"","copyAsset":false,"role":"figure","size":79308,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003enumber of years of experience\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/5b5eb7e8bbe0313d1f7a0fa9.png"},{"id":100276642,"identity":"25c9829e-ac87-475c-b8bc-15a355fa4a9f","added_by":"auto","created_at":"2026-01-14 23:48:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":154981,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResident’s training centers\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/ec40d40010b5e42b1bd40e05.png"},{"id":100372499,"identity":"86378ccc-e21a-43ae-ab02-69213885c5c9","added_by":"auto","created_at":"2026-01-16 08:12:30","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":67178,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOperating Rooms in respected Centers\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/c4bdd664aa0975463f53c56a.png"},{"id":100276654,"identity":"843deaae-c812-4b9e-bb66-411af42d341f","added_by":"auto","created_at":"2026-01-14 23:48:08","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":33937,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFormal training in POCUS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/a28e4af4089c738d749837f2.png"},{"id":100276655,"identity":"36f27601-d3a4-4855-adda-d5cb99922436","added_by":"auto","created_at":"2026-01-14 23:48:08","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":63496,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTraining modalities used to teach residents\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/80f238cfbce2e7d134b3aadb.png"},{"id":100276644,"identity":"eab4414b-5caf-4a7c-9137-3fe857423aaa","added_by":"auto","created_at":"2026-01-14 23:48:08","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":39528,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ethe amount of formal training (\u003c/strong\u003e\u003cu\u003ein hours\u003c/u\u003e\u003cstrong\u003e) that residents may receive by the end of residency\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/8700e7aa7254467aa4e109be.png"},{"id":100373447,"identity":"72b6a2f5-c63d-4a05-8622-15608eed2ee6","added_by":"auto","created_at":"2026-01-16 08:14:28","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":89964,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunding availability for POCUS.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/3da76098c47e4d2b4241fd26.png"},{"id":100373073,"identity":"f125673d-7f4e-4a24-91a7-2158d689aa3e","added_by":"auto","created_at":"2026-01-16 08:13:35","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":91587,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eModalities of formal training\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/8cdc201e2700d666b08f9f9a.png"},{"id":100276660,"identity":"8e4e1754-21ac-47fa-ada5-b0ae46f73edd","added_by":"auto","created_at":"2026-01-14 23:48:08","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":52229,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRate the importance of trainees achieving competence\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/587f0458d64ac97d9abad032.png"},{"id":100276651,"identity":"e69044d7-9e7b-4988-ab7d-b1c44430495f","added_by":"auto","created_at":"2026-01-14 23:48:08","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":47297,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ecompetency of anesthesiologists in different pocus modalities in their respected centers.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/14f446eb876fdd3f10898868.png"},{"id":100276661,"identity":"6cfdd205-ad54-4063-aefb-a7eeb9184f0d","added_by":"auto","created_at":"2026-01-14 23:48:08","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":49142,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAnesthesiologist in your program who acts as the local POCUS expert\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"12.png","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/decbbc02a5db47a6b4c21871.png"},{"id":102785490,"identity":"321d1d03-235a-4f1f-a083-ea99cf5335a6","added_by":"auto","created_at":"2026-02-16 16:07:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1372685,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8448555/v1/bbae9dd4-a4dd-4110-9769-0a4b3ca3a4f8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Saudi National Survey of Point of Care Ultrasound Training in Anesthesiology Residency Programs","fulltext":[{"header":"Background","content":"\u003cp\u003eOver the past decade, point-of-care ultrasound POCUS has become an important tool in many different areas of medicine, enhance patient safety, making procedures more accurate and making decisions faster (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Numerous studies in Emergency Medicine and Primary Care illustrate the value of ultrasonography in patient management (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Since the 1990s, emergency medicine departments in the United States have started the use of POCUS to aid in the assessment of trauma patients via the focused assessment with sonography for trauma (FAST) examination (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Recently, the scope of clinical ultrasound (US) applications increased to incorporate nearly all medical specialties (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). POCUS has become increasingly important in the field of Anesthesia, as it enhances perioperative patient management, procedural guidance, and diagnostics. It is emerging as a critical and core skill that anesthesiologists should possess (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Common application examples of POCUS in anesthesiology includes ultrasound-guided nerve block, vascular access, airway ultrasound, gastric ultrasound, lung ultrasound, neuraxial sonography, focused transthoracic (TTE) and transesophageal echocardiography (TEE). Thus, there are multiple potential areas where ultrasound can play a significant role in guiding and improving the safety and efficacy of many interventions (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Currently, there is lack of published data describing how POCUS teaching and specific applications are incorporated into anesthesiology residency programs in Saudi Arabia. Therefore, this study aims to evaluate Saudi Arabian residency program directors\u0026rsquo; level of POCUS integration, identify barriers to its adoption, and help identify gaps in core competencies to standardize training across different program.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eEthical approval was granted by the Institutional Review Board at University of Jeddah Institutional (no. HAP-02-J-094 on December 1, 2024). An electronic survey consisting of 20 questions was distributed via Google Forms among program directors of accredited Anesthesiology residency programs. The questionnaire was adapted from a previously published study by Mok et al. (2017) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) with modification made to suite with our study objectives and the local educational context. Prior to finalization of the survey, a draft version was shared with 5 program directors for expert feedback to ensure adequate breadth and clarity of language. The survey data were collected over a two-month period between December 2024 and January 2025. An electronic signed written consent was required to proceed with the survey. We have identified 36 anesthesia residency programs in Saudi Arabia accredited by the Saudi Commission for Health Specialties. The participation link was sent through WhatsApp with following reminders every two weeks subsequently for a total of four reminders. Survey data were stored on the Google Forms server and downloaded for analysis following data collection. The data were analyzed using Microsoft\u0026reg; Excel [Version 16.103.2]. Descriptive statistics, including means, frequencies, and percentages were calculated as appropriate and no inferential statistical tests were performed.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total Thirty-six out of forty program directors of anesthesia residency programs completed the survey, resulting in an overall response rate of 90%. In response to a question about the number of residents currently enrolled in their respective residency programs, most of the programs reported having 11\u0026ndash;20 residents (36.1%), and 25% had between one and five.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding professional experience, most program directors had 11 to 20 years\u0026rsquo; experience in the field of anesthesiology, while only 22.2%, had more than 20 years of experience. In terms of professional rank, most directors were consultants (77.8%); more than half were trained locally via the Saudi Commission for Health Specialties (SCFHS), while 36.1% were trained abroad.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGeographically, responses came predominantly from the Western region( 41.7%), which includes Jeddah, Medina, Makkah, and Taif, followed by 25% from the Eastern and 22.2% from the Central regions. Among the participating facilities, 38.9% were affiliated with the Ministry of Health, while 30.6% belonged to the private sector.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAlso, most institutions in our study reported having more than ten operation rooms (52.8%), while 38.9% had between six and ten operating rooms.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFig- 4 Operating Rooms in respected Centers\u003c/b\u003e \u003c/p\u003e \u003cp\u003eProgram directors were asked regarding the incorporation of POCUS applications in training; all programs reported that providing POCUS training is well established for vascular and arterial access, peripheral nerve blocks, neuraxial blocks, and transthoracic echocardiography (TTE). However, the other POCUS applications, such as Transesophageal Echocardiography (TEE), IVC Assessment, eFAST, Airway US for ETT placement, Gastric US, Optic Sheath Nerve Diameter, and Lung US, appear to be limited or underdeveloped. Interestingly, 77.8% had no structured, formalized training programs in their training centers.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eInformal bedside teaching identified as the most common method of instruction, making it the cornerstone of ultrasound education, but 90% used faculty-led lectures. Other commonly used modalities included online courses (77%) and simulation sessions (70%). In contrast, formal clinical rotations were uncommon, except for neuraxial block training (25%). The greatest rates among elective POCUS rotations were seen for TTE (36.1%) and TEE (33.3%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAlthough the SCFHS Anesthesiology Curriculum currently lacks specific requirements regarding minimum hours or expected number of scans by the end of residency training, several program directors indicated the necessity for structured training\u0026mdash;especially peripheral nerve blocks. Eight programs specifically reported requiring at least 15 hours of formal training for peripheral nerve blocks, although no specific requirement was mentioned regarding the number of scans performed during residency rotations.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn addition to training methods, program directors were inquired about the availability of funding for extracurricular POCUS training such as POCUS workshops offered during conferences or by other academic institutions;66.7% reported a lack of funding for such activities, and only 11.1% indicated that funding for POCUS is available, while the remaining are uncertain about the availability of financial support.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRegarding the assessment of resident POCUS skills, only 50% had structured assessment processes in place to formally evaluate residents\u0026rsquo; POCUS competency. These programs assess residents\u0026rsquo; skills across a range of applications, including arterial access, venous access, peripheral nerve blocks, neuraxial blocks, TEE, lung US, and IVC assessment. These assessments were mostly using direct observation, procedure counts, image/video review, and written or practical exams.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eProgram directors were asked to assess the importance of Anesthesiology residents being competent in various POCUS applications at the end of their training. In this context, competence was considered as the ability to independently obtain and interpret ultrasound imaging to answer a focused clinical question or to facilitate a procedure.\u003c/p\u003e \u003cp\u003eThe majority of directors (89%) considered competency in arterial and venous access, and peripheral nerve blocks either \u0026ldquo;important\u0026rdquo; or \u0026ldquo;very important\u0026rdquo;. Similarly, 81% viewed competency in neuraxial blocks as essential, whereas only 47% viewed TTE with high importance, and more than half the respondents viewed TEE, lung ultrasound ,and gastric ultrasound as at least moderately important .Notably, none of the program directors added any applications that were not listed on the survey that were considered essential for graduating residents.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eProgram directors were also asked to estimate the percentage of faculty anesthesiologists within their training program who are competent in the POCUS applications listed in our survey. The proportion of faculty estimated to be competent in these applications varied widely among programs. Competency across programs was perceived to be relatively high in vascular access and in peripheral nerve blocks, and estimates for a given program usually ranged from 50% to over 75%. On the other hand, a remarkable 83.3% of program directors estimated that their faculty is 25% or less competent in the skills of TTE, lung ultrasound, and gastric ultrasound, reflecting a serious gap in expertise in advanced applications.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAt the end of the survey, only 30% of programs reported having a designated \u0026ldquo;local POCUS expert\u0026rdquo; responsible for POCUS education, while more than half had no such position. Of these, some programs reported developing the position, and others were unsure of future plans. These results emphasize critical gaps in faculty expertise and program leadership that may adversely impact comprehensive POCUS training within Anesthesiology residency programs.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePOCUS, or point-of-care ultrasound, is an advanced portable diagnostic tool with several applications readily accessible at the patient's bedside. The use of POCUS has surged in the last ten years across several medical fields, enabling improved patient diagnosis, evaluation, and management. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Over the past decade, POCUS has been extensively used across several medical specialties in Saudi Arabia, particularly in emergency medicine and critical care (11.12). However, its incorporation into residency training and clinical practice remains variable and underdeveloped, as prior survey studies in Saudi Arabia show that utilization of POCUS is hindered by training gaps, lack of standardized curriculum requirements, and limited resources (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).In anesthesiology, POCUS has emerged as a vital competency, enhancing perioperative safety, procedural precision, and clinical decision-making, especially in critical and time-sensitive scenarios. Although its recognized value is acknowledged worldwide (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), Anesthesiology has been slower to incorporate POCUS into routine training and practice, highlighting a significant educational gap (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This national survey provides a comprehensive overview of the current status of point-of-care ultrasound (POCUS) training within Anesthesiology residency programs in Saudi Arabia. Our results reveal a significant opportunity for improved curriculum development, a perspective supported in an international context. Specifically, our data aligned with a study conducted in Canada in 2017, which also reported broader implementation of POCUS in emergency medicine and critical care compared to Anesthesiology (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This persistent global trend reflects a common discipline- specific issue that extends beyond regional limitations, perhaps involving factors such as traditional training methods and uneven resource allocation. However, in comparison with the finding of Daniel mok(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), important differences emerged that highlight unique characteristics of our national study.\u003c/p\u003e \u003cp\u003eInitially, our study achieved a higher number of responses from Program directors, potentially providing a more comprehensive representation of the national training. Furthermore, while Canadian programs reported more consistent integration of transesophageal echocardiography (TEE), our data show that TEE is less routinely incorporated into Saudi Anesthesiology residency programs. This trend of variable and often restricted POCUS training is not unique to Canada. Our findings are further supported by a similar survey conducted in the United States (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), which also reported considerable variability in POCUS training among Anesthesiology residency programs. Surprisingly, the similarity in both the United states survey and our survey was that training was most comprehensive for basic competencies like vascular access and peripheral nerve block, while advanced applications such as transthoracic echocardiography, transesophageal echocardiography, gastric ultrasound, and lung ultrasound were less often included in teaching. The similarities extend to the recognized barriers, as US programs also identify the main barriers as lack of faculty expertise and standardized curricula. Also unsurprisingly, many programs rely on informal bedside teaching without structured competency-based assessments.\u003c/p\u003e \u003cp\u003eThe critical implication of these shared barriers is represented in our data, where 28 out of 36 program directors (77.8%) reported having no formal POCUS training themselves. Indeed, this represents a potential cyclical problem whereby a lack of formally trained faculty propagates into a lack of formal training for residents. We believe this likely deprives the residents of an opportunity to both attain and maintain procedural proficiency and may thus negatively impact patient care. Encouragingly, previous promising pilot studies, such as one performed by Lee et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) in the U.S, have demonstrated a structured POCUS curriculum can heavily improve both resident confidence and measured competence. Such findings support our conclusion that well-designed, standardized training programs could address these educational deficiencies.\u003c/p\u003e \u003cp\u003eApart from curricular challenges, financial constraints regarding POCUS training were noted as a major obstacle in our data. About, 66.7% of program directors cited a lack of financial support for POCUS related- resources. Without adequate funding, programs may not be able to purchase the necessary ultrasound equipment, embed simulation-based sessions, or cover support to attend POCUS-related workshops. These further restrain residency programs from implementing comprehensive training. Overall, our results again underline the competence of POCUS, which residents in Anesthesiology should possess. However, generally poor curricula, lack of faculty training, and lack of funding present major obstacles to its implementation. Overcoming these deficiencies will require national standardization efforts-investing in faculty development and increasing resources that allow long-term implementation in residency training in Saudi Arabia.\u003c/p\u003e\n\u003ch3\u003eBarriers of integration\u003c/h3\u003e\n\u003cp\u003eDespite its numerous benefits, POCUS integration into Anesthesiology training continues to face several challenges in Saudi Arabia, such as lack of awareness and limited access to POCUS-specific funding, which discourages many residents from participating in POCUS-related courses. Also, there is a shortage of qualified expertise in POCUS, and in this way, in-house education by experienced instructors becomes quite difficult to performed within residency programs.\u003c/p\u003e \u003cp\u003eTime constraints and heavy workloads also restrict residents\u0026rsquo; ability to participate in supplementary training. Additionally, while one of the most important modes of learning is through experience, many institutions lack the necessary equipment, such as working ultrasound machines, sterile probe covers, or procedural equipment like spinal needles, to facilitate this kind of learning.\u003c/p\u003e \u003cp\u003ePsychological factors also have their contributions to make. The fear of failure or rejection and the limited time available in some clinical rotations create an obstacle to residents' behavior of accepting POCUS training or putting their knowledge into practice. This landscape of multifactorial barriers creates a vicious cycle where, because of limited resources and faculty, there is reduced resident exposure, leading eventually to a problem with clinical competency.\u003c/p\u003e \u003cp\u003eAs POCUS is gaining more attention in anesthesiology, the solution to these barriers will require persistence on the part of education, faculty development, and institutional investment. Full implementation of a standardized, comprehensive training framework requires significant resources to realize the full clinical potential of POCUS.\u003c/p\u003e"},{"header":"Limitation","content":"\u003cp\u003eSeveral limitations are inherent to the online survey design of our study, including Predisposition to responder bias and possible misinterpretation of survey questions. Additionally, our survey focused on the perspective of residency program directors rather than residents, thus the results do not fully represent the resident point of view to POCUS training.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis survey represents the first comprehensive overview of the current status of point-of-care ultrasound (POCUS) training within Anesthesiology residency programs in Saudi Arabia. Our findings highlight that POCUS is a core competency for Anesthesiology residents, profoundly improving diagnostic accuracy and facilitating clinical procedures to improve patient outcomes in both the perioperative period and during critical care. This is, of course, not new but has been widely regarded as a standard of care for a long time, further underlining the need to be pursued in a structured fashion in Saudi residency training programs.\u003c/p\u003e \u003cp\u003eFor residents to learn the skills in ultrasound, residency programs should ensure access to appropriate equipment, allocate sufficient funds, establish proper checklists that are competency-based for specific learning objectives, and assign faculty with dedicated expertise in POCUS to provide leadership in education. Our study also underscores the importance of innovation and continued development in postgraduate medical education.\u003c/p\u003e \u003cp\u003eThis should particularly focus on assessing and developing the weaker areas of POCUS training, such as advanced applications including transthoracic and transesophageal echocardiography. Aligning with the Kingdom\u0026rsquo;s Vision 2030 goals for healthcare innovation and excellence, these improvements are vital to preparing Anesthesiology residents to meet international standards and deliver the highest level of patient care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u0026nbsp;POCUS-- Point-of-care ultrasonography\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;TTE--Transthoracic echocardiogram\u003c/p\u003e\n\u003cp\u003eUS-- Ultrasound\u003c/p\u003e\n\u003cp\u003eFAST--Focused assessment with sonography for trauma\u003c/p\u003e\n\u003cp\u003eTEE--Transesophageal echocardiography\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIVC--Inferior vena cava\u003c/p\u003e\n\u003cp\u003eEfast--Extended Focused Assessment with Sonography for Trauma\u003c/p\u003e\n\u003cp\u003eETT\u0026mdash;Endotracheal tube\u003c/p\u003e\n\u003cp\u003eSCFHS-- Saudi commission for Health Specialties\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eHuman Ethics and Consent to Participate: not applicable\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the Institutional Review Board at University of Jeddah Institutional (no. HAP-02-J-094 on December 1, 2024).\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eData availability:\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare no competing interests\u003c/p\u003e\n\u003cp\u003eFunding: No\u003c/p\u003e\n\u003cp\u003eAuthors Contributions:\u003c/p\u003e\n\u003cp\u003eAll authors contributed equally to the study design, survey preparation, data collection, interpretation of findings, and manuscript writing and revision. All authors approved the final version to be published.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLee SC, Yang EC, Navarro JC, Minard CG, Huang X, Deng Y. An introductory point-of-care ultrasound curriculum for an Anesthesiology residency program. MedEdPORTAL. 2022;18:11291. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15766/mep_2374-8265.11291\u003c/span\u003e\u003cspan address=\"10.15766/mep_2374-8265.11291\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi W, Cho YS, Ha YR, Oh JH, Lee H, Kang BS, Kim YW, Koh CY, Lee JH, Jung E, Sohn Y, Kim HB, Kim SJ, Kim H, Suh D, Lee DH, Hong JY, Lee WW, Society Emergency and Critical Care Imaging (SECCI). Role of point-of-care ultrasound in critical care and emergency medicine: update and future perspective. Clin Exp Emerg Med. 2023;10(4):363\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15441/ceem.23.101\u003c/span\u003e\u003cspan address=\"10.15441/ceem.23.101\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlanco P, Volpicelli G. Common pitfalls in point-of-care ultrasound: a practical guide for emergency and critical care physicians. Crit Ultrasound J. 2016;8(1):15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13089-016-0052-x\u003c/span\u003e\u003cspan address=\"10.1186/s13089-016-0052-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilcox J, Lawson B, Gauger A. Early point of care ultrasound training in medical education, making the case with a case report. Int J Med Students. 2023;11(3):229\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5195/ijms.2023.1719\u003c/span\u003e\u003cspan address=\"10.5195/ijms.2023.1719\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMok D, Schwarz SKW, Rondi K. Point-of-care ultrasonography in Canadian Anesthesiology residency programs: a national survey of program directors. Can J Anaesth. 2017;64(10):1023\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12630-017-0935-8\u003c/span\u003e\u003cspan address=\"10.1007/s12630-017-0935-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSites BD, Brull R, Chan VW, Spence BC, Gallagher DW, Beach ML et al. Artifacts and pitfalls of ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2007;32(5):412\u0026thinsp;\u0026ndash;\u0026thinsp;23. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856172/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856172/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlabama Board of Nursing. POC ultrasound in anesthesia care [Internet]. Montgomery (AL): Alabama Board of Nursing; 2020 Nov [cited 2025 Apr 18]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.abn.alabama.gov/wp-content/uploads/2023/10/POC-Ultrasound-in-Anesthesia-Care_Nov-2020.pdf\u003c/span\u003e\u003cspan address=\"https://www.abn.alabama.gov/wp-content/uploads/2023/10/POC-Ultrasound-in-Anesthesia-Care_Nov-2020.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMra0909487\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra0909487\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer HL, Einloft J, Bedenbender S, et al. Impact and reception of point-of-care ultrasound training across medical education levels. BMC Med Educ. 2025;25:255. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12909-025-06825-4\u003c/span\u003e\u003cspan address=\"10.1186/s12909-025-06825-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNassar SM, Almubrik SA, Alyahya L, Alshalan M, Alhashem HM. Perception, knowledge, indications, and future prospects of point-of-care ultrasound among medical students in Saudi Arabia. Cureus. 2024;16(4):e57704. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.57704\u003c/span\u003e\u003cspan address=\"10.7759/cureus.57704\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmulhim KN, Alabdulqader RA, Alghamd MK, Alqarni AA, Althikrallah FM, Alarfaj AA. Assessing point-of-care ultrasound knowledge and utilization among emergency physicians in Saudi Arabia: a cross-sectional survey. Indian J Crit Care Med. 2024;28(8):769\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5005/jp-journals-10071-24763\u003c/span\u003e\u003cspan address=\"10.5005/jp-journals-10071-24763\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2024 Jul 31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdelshafey EE, Abdalkreem NS, Altayar AS. Use of critical care ultrasound in Saudi Arabia: questionnaire analysis. Saudi Crit Care J 2023 Apr-Jun;7(2):29\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/sccj.sccj_7_23\u003c/span\u003e\u003cspan address=\"10.4103/sccj.sccj_7_23\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbuguyan F, Almasry NW, Alzahrani AA. Barriers to point-of-care ultrasound utilization among emergency medicine residents in Riyadh, Saudi Arabia. Cureus. 2024;16(7):e65765. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.65765\u003c/span\u003e\u003cspan address=\"10.7759/cureus.65765\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGohad R, Jain S. The use of point-of-care ultrasound (POCUS) in anesthesiology: a narrative review. Cureus. 2024;16(9):e70039. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.70039\u003c/span\u003e\u003cspan address=\"10.7759/cureus.70039\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahmood F, Matyal R, Skubas N, et al. Perioperative ultrasound training in anesthesiology: a call to action. Anesth Analg. 2016;122(6):1794\u0026ndash;804. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1213/ANE.0000000000001134\u003c/span\u003e\u003cspan address=\"10.1213/ANE.0000000000001134\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson DW, Oren-Grinberg A. Perioperative point-of-care ultrasonography: the past and the future are in anesthesiologists' hands. Anesthesiology. 2011;115(3):460\u0026ndash;2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/ALN.0b013e31822a62a1\u003c/span\u003e\u003cspan address=\"10.1097/ALN.0b013e31822a62a1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRemskar MH, Theophanous R, Bowman A, Simonson LE, Koehler J, Basrai Z, Manohar CM, Mader MJ, Nathanson R, Soni NJ. Current use, training, and barriers of point-of-care ultrasound in anesthesiology: a national survey of Veterans Affairs hospitals. J Cardiothorac Vasc Anesth. 2023;37(8):1390\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1053/j.jvca.2023.03.042\u003c/span\u003e\u003cspan address=\"10.1053/j.jvca.2023.03.042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2023 Apr 5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdwards J, Ahn D, Alcaraz D, Chiles C, Khuu T, Soni NJ, Goyal V, Manohar C. Point-of-care ultrasound training among Anesthesiology residency programs in the United States. BMC Anesthesiol. 2025;25(1):105. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12871-025-02929-y\u003c/span\u003e\u003cspan address=\"10.1186/s12871-025-02929-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChu SC, Goh V, Kawaguchi T, Lee HF, Hsu HC. Advancing point-of-care ultrasound (POCUS) utilization and education: a comprehensive analysis among postgraduate physicians in a tertiary teaching hospital. J Acute Med. 2025;15(3):98\u0026ndash;107. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.6705/j.jacme.202509_15(3).0003\u003c/span\u003e\u003cspan address=\"10.6705/j.jacme.202509_15(3).0003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"POCUS, anesthesiology, residency programs, medical education, Saudi Arabia","lastPublishedDoi":"10.21203/rs.3.rs-8448555/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8448555/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePoint-of-care ultrasonography (POCUS) has emerged as a valuable tool in anesthesiology, enhancing procedure accuracy, and real-time decision-making in the perioperative period. Although POCUS integration into Anesthesia practice has gained momentum in Saudi Arabia, yet its adoption, effectiveness, and challenges remain understudies. The purpose of this study is to evaluate the state of POCUS training and incorporation in Saudi Arabia Anesthesiology residency programs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eProgram directors of Anesthesiology residency programs in Saudi Arabia, accredited by the Saudi Commission for Health Specialties, were invited access to an online survey. The survey evaluated the current state of POCUS training, the assessment methods employed by each institution, and the perceived challenges to its instruction. Directors were asked regarding their opinion on the anticipated development of POCUS training in Anesthesiology residency programs in Saudi Arabia, as well as their opinions on the significance of various POCUS applications.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 36 out of 42 program directors were able to complete our survey (85.7% response rate). All respondents state POCUS training for vascular access, nerve blocks, neuraxial blocks, and TTE is provided. However, 77.8% reported that their institutions lack organized training programs. The main teaching method was informal bedside instruction; only 38.9% of programs included formal evaluation plans. A significant barrier was low staff knowledge; 83.3% of respondents reported 25% or less of their faculty members are experts in TTE, lung US, and gastric US. Only 11 programs had a designated \"local POCUS expert,\" and 66.7% of programs lacked funds for extracurricular POCUS training. These findings highlight the need of standardized POCUS curricula and faculty development training within anesthesiology residency programs in Saudi Arabia.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn Saudi Arabia Anesthesiology residency programs, POCUS training is markedly disparate; numerous programs are deficient in funding, structured instruction, or experienced personnel. Enhancing competency and optimizing patient care rely on structured training, formal assessments, and advanced faculty development.\u003c/p\u003e","manuscriptTitle":"Saudi National Survey of Point of Care Ultrasound Training in Anesthesiology Residency Programs","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-14 23:48:03","doi":"10.21203/rs.3.rs-8448555/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-20T08:34:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-19T09:59:07+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-19T05:16:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205574896283183760097106268653520850372","date":"2026-01-18T16:57:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88926252818897936062898452340252021910","date":"2026-01-18T11:20:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296334305957471265280858879735412401015","date":"2026-01-15T10:30:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251895768286204769602777277363622476853","date":"2026-01-13T13:05:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"233066162067889127025562879636040680368","date":"2026-01-13T11:44:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-13T06:09:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-30T06:32:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-29T05:12:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T05:10:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2025-12-25T10:49:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e8bc4357-7a03-4daa-b416-f75704c59125","owner":[],"postedDate":"January 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:04:07+00:00","versionOfRecord":{"articleIdentity":"rs-8448555","link":"https://doi.org/10.1186/s12871-026-03684-4","journal":{"identity":"bmc-anesthesiology","isVorOnly":false,"title":"BMC Anesthesiology"},"publishedOn":"2026-02-13 15:58:26","publishedOnDateReadable":"February 13th, 2026"},"versionCreatedAt":"2026-01-14 23:48:03","video":"","vorDoi":"10.1186/s12871-026-03684-4","vorDoiUrl":"https://doi.org/10.1186/s12871-026-03684-4","workflowStages":[]},"version":"v1","identity":"rs-8448555","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8448555","identity":"rs-8448555","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}