Integrated Point-of-Care Ultrasound Training in a Rwandan Medical School: Curriculum Development, Implementation, and Outcomes

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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. Point-of-care ultrasound Curriculum development Resource-limited Figures Figure 1 Background Point-of-care ultrasound (POCUS) is the use of ultrasound by the treating clinician at the bedside, with immediate interpretation and clinical integration of the imaging results. 1 Multiple studies demonstrate the clinical utility of POCUS in improving patient care outcomes. POCUS achieves diagnostic accuracy exceeding 96% compared to formal imaging, with faster diagnosis and higher odds of appropriate therapy. 2,3 POCUS also enhances procedural safety compared to landmark-based techniques. 4 The impact of POCUS is potentially greater in low- and middle-income countries (LMICs) where access to advanced imaging modalities remains limited. 5–7 In an emergency department in Ethiopia, 95% of POCUS scans provided clinically useful information and changed management plans in 45% of patients. 8 In an emergency department in Tanzania, POCUS changed the diagnostic impression or disposition plan in 29% of cases. 6 In Rwanda, POCUS routinely changed the medications administered (42%) and disposition (30%). 9 Access to ultrasound technology is increasing, with affordable and durable handheld devices able to operate without internet connections or reliable electricity while maintaining diagnostic accuracy. 10–12 This combination of utility and accessibility creates an ideal environment for increased training in resource-limited settings. A recent scoping review of POCUS training programs in LMICs demonstrated widespread interest in and feasibility of POCUS education, though 81% of studies described short courses and only five studies involved medical students. 13 Successful implementation requires longitudinal training programs rather than one-off sessions, with ongoing support and context-specific protocols adapted to the local needs. 13,14 One study from Rwanda of an intensive and longitudinal POCUS training program demonstrated sustained improvements in competency and universal increased job satisfaction and perceived quality of patient care. 15 Integration of POCUS training into undergraduate medical education represents a strategic approach to building sustainable diagnostic capacity in low-income settings. Early exposure to ultrasound during medical school improves anatomical understanding, physical exam skills, and performance on knowledge tests. 14 Students who complete a longitudinal POCUS training during medical school report improved skills compared to their peers during subsequent residency training. 16 This approach is particularly important in LMICs, where many graduates enter independent practice without post-graduate training, making undergraduate medical education the primary opportunity to develop POCUS competency. In a recent survey of 122 medical schools in the United States, 57% had an approved POCUS curriculum, but only 8% offered integrated, longitudinal curricula. 17 Reported barriers to implementation of POCUS training in undergraduate medical education include lack of trained faculty, lack of available time in the current curriculum, and lack of equipment. 16,17 Despite these barriers, there is evidence of successful integration of POCUS into early medical school education in the rural United States using a combination of online resources, remote collaborations, and local faculty development with improvements in student knowledge and confidence. 18 While there are descriptions of integrated, longitudinal POCUS curricula in medical schools, the published literature focuses on high-resource settings. 19 We describe the first published integrated POCUS curriculum in a medical school in a low-income country. Our description covers curriculum development, student experiences, and knowledge outcomes. We emphasize sustainable use of resources that may be applied in similar contexts, where graduates are expected to be competent general practitioners upon graduation. Methods Setting The University of Global Health Equity (UGHE) is a medical school in rural northern Rwanda. The university was founded in 2015 by Partners In Health in partnership with the government of Rwanda, with an emphasis on equity and community-based learning. The school offers a 6.5-year dual degree of a Bachelor of Medicine and Bachelor of Surgery (MBBS) and a Master of Science in Global Health Delivery (MGHD). The first class of 30 medical students enrolled in 2019 and graduated in January 2026. Class sizes have gradually increased to 60 students per year. The curriculum includes an organ-system-based preclinical phase (2 years), clinical clerkships (2.5 years), internship (1 year), and an integrated Masters curriculum (1 year). While the university has one main affiliated teaching hospital (Butaro Level 2 Teaching Hospital), students rotate at sites across the country during their clinical years. Clinical clerkships are intentionally delivered in resource-limited rural district teaching hospitals to expose students to the settings where they will practice upon graduation. During internship, students are assigned to work in hospitals across the country and are not supervised by UGHE clinical faculty. Upon graduation, students are assigned to work as independent general practitioners in hospitals across the country. Resources available As the first class of students began their clinical rotations, the school only had three full time clinical faculty. The university relies on global partnerships with foreign institutions for educational support. There are now over 17 full-time clinical faculty, including general practitioners and specialty-trained physicians. The school had an established Simulation and Skills Centre with one cart-based ultrasound prior to introduction of the POCUS curriculum. Development of curriculum To develop our POCUS curriculum, we began by reviewing published international consensus recommendations for undergraduate medical education. 20 After discussing the proposed competencies with our clinical faculty working in district hospitals in each core specialty, we refined the list to what should be expected of a general practitioner in our local context. The final competency list was then agreed upon and approved by academic leadership (Table 1). Using published curricula of integrated POCUS training programs to guide timing and pacing of education, we mapped our competencies onto the existing medical school curriculum, matching each learning objective to a preclinical organ-system-based module or clinical clerkship, ensuring regular exposure to POCUS educational sessions (Table 2). 19 Implementation The curriculum was first implemented in 2022, at the time the school had three cohorts at different stages of training. The inaugural cohort, who graduated in January 2026, and the second cohort were already in their clinical clerkships, while the third cohort was still in the preclinical phase of training (Figure 1). Approval was obtained from preclinical faculty to integrate 30- to 90-minute didactic and practical sessions into relevant preclinical modules. An intensive 8-hour training was incorporated into the Introduction to the Practice of Medicine module delivered immediately prior to the start of clinical clerkships. Integration of POCUS into clinical clerkships included both dedicated didactic and hands-on teaching sessions as well as routine use of POCUS during clinical rotations. Students submitted ultrasound examinations for faculty review during designated clerkships. During internship, students were given shared access to handheld ultrasounds at their internship sites and could submit scans for review by faculty. To further increase exposure and interest in POCUS, annual ultrasound competitions were held with teams comprised of students from multiple different years of training. Resources required To actualize the curriculum, we needed to address three common barriers: lack of trained faculty, lack of available time, and lack of equipment. 16,17 We initially relied on two core clinical faculty trained in POCUS to coordinate and deliver teaching sessions. We also recruited visiting faculty from partner institutions outside of Rwanda to volunteer time to teach ultrasound, with over 15 visiting faculty contributing to POCUS education since the curriculum was implemented. This includes three visiting faculty from the United States who were involved in the inception and development of the curriculum and remained involved in its ongoing implementation and assessment. Some visiting faculty returned annually to provide continued support. In addition to scheduled teaching sessions, they spent time supervising student ultrasound exams in the wards and helped run the annual ultrasound competition. To optimize the time of available faculty, UGHE partnered with the Global Ultrasound Institute to obtain access to high quality educational POCUS content with libraries of normal and abnormal images for learners to review. This allowed faculty to spend less time teaching basic concepts and more time teaching hands-on sessions. The platform also enabled students to upload scans for faculty to review, allowing visiting faculty to provide feedback remotely. To reduce the dependence on visiting faculty, we hosted training-of-trainer educational sessions for interested core faculty, with an institutional commitment to train all full-time clinical faculty in POCUS by the end of 2026. For hands-on sessions, we predominantly relied on standardized patients recruited from the local community. For obstetrics sessions, we recruit pregnant women from the community to serve as scanning models. Standardized patients consented and were compensated. During the clinical years, hands-on sessions were held on the wards using consenting patients to demonstrate pathology. Equipment was the most expensive part of POCUS integration. We purchased a total of 16 handheld Butterfly iQ+ ultrasounds and associated tablets (Butterfly Inc., Burlington, MA). Butterfly waived annual subscription fees to allow use for global medical education. These ultrasounds were distributed to different clinical sites to ensure each clinical rotation has access to a device. Students at each clinical site are responsible for the ultrasounds, and we have not lost any devices to date. Over the last 4 years, the total budget for our integrated POCUS curriculum was less than $15,000 per year. In addition to dividing the cost of handheld ultrasound devices over the 4 years, the Global Ultrasound Institute online platform costs about $5,000 per year, prioritized for the students in clinical clerkships. Assessments Curriculum effectiveness was assessed through student evaluations, self-reported confidence measures, pre- and post-session knowledge assessments administered during the introductory and intensive training sessions, and the final certification examination. Knowledge assessments were tailored to the content and level of each training stage and are therefore not directly comparable across timepoints. Further, students’ progress was assessed during objective structured clinical examinations (OSCEs) and faculty reviews of ultrasound scans during clerkships (Table 2). We developed a final POCUS certification exam aligned with the I-AIM framework (Indication, Acquisition, Interpretation, and Medical decision-making). The written component consisted of 30 original multiple-choice questions spanning the main content areas of our curriculum, reviewed by multiple faculty for accuracy and clarity. While no validated reference standard exists for POCUS knowledge assessments, we calculated Cronbach’s alpha to assess internal consistency. The practical component consisted of a 3-station OSCE assessing cardiac, lung / abdominal, and second / third trimester obstetric ultrasound. The stations evaluated indication recognition, image acquisition technique, and interpretation accuracy using standardized rubrics (Supplementary Table 1). Prior to the examination, faculty assessors completed a calibration session reviewing scoring criteria and anchor examples to ensure inter-rater consistency. Because the curriculum was implemented with cohorts at different stages of training, the assessment strategy varied by cohort. Cohorts completed pre- and post-session knowledge assessments during the introductory and intensive training sessions. The second enrolled class was assessed longitudinally at two clinical timepoints: prior to senior clerkship and at the end of clinical rotations. The third enrolled class, which received the full preclinical curriculum, was assessed at the end of their first year of clerkships. The first graduating class was surveyed during internship and completed the final certification exam prior to graduation. Cross-cohort comparisons were made at equivalent training stages where possible. Ethics Participation in all surveys was voluntary. Informed consent was obtained from all participants through an introductory statement at the beginning of each survey. All survey responses were collected anonymously, with no personally identifiable information linked to individual participants. The study of our curriculum was approved by the University of Global Health Equity Institutional Review Board (Protocol Number 2024_231). Data analysis Data analysis was performed using STATA version 17 (StataCorp, 2021). Changes in pre-post knowledge tests were assessed using Chi square tests for categorical variables and independent samples t-tests for Likert response. Surveys were anonymized and therefore could not be linked for paired analysis. Likert responses were reported as mean ± standard deviation. Cohen’s d was calculated to determine the effect size, defined as small (0.2), medium (0.5), large (0.8), or very large (1.3). 21 Open-ended responses were summarized. Results Preclinical sessions Students were surveyed prior to the first POCUS session (n = 48, 100% response rate). Most students (77%) had no prior ultrasound experience, yet all expressed strong interest in learning POCUS (mean 4.81/5) and nearly all (98%, mean 4.73/5) believed it would improve their understanding of anatomy and physiology. On pre- and post-session assessment of the introductory session, knowledge scores improved from 68.8% to 90.0% (p < 0.001), with the largest gains in probe positioning (+56.2%, p < 0.001) and appropriate probe frequency selection (+27.5%, p = 0.007). Student satisfaction was universal, with all students reporting enjoyment (mean 4.92/5) and interest in additional sessions (mean 4.90/5). At the conclusion of preclinical studies, 66% of students (31/47) wanted more POCUS in the preclinical curriculum, while 30% (14/47) felt the amount was appropriate. Two classes of students were surveyed at the end of preclinical studies about educational impact (n = 86, 97% response rate) and 66% agreed that POCUS improved their understanding of anatomy and physiology (mean 3.73/5). Introduction to the Practice of Medicine Intensive Training The 8-hour intensive training session prior to clinical clerkships produced significant learning gains. Among 47 students, overall knowledge scores on pre- and post-session assessments improved from 69.3% to 93.1% (p < 0.001). All seven assessed confidence domains showed statistically significant improvements with very large effect sizes (Cohen’s d 1.39-2.38, all p < 0.001; Table 3). Student evaluations across three cohorts (n = 96, 77% response rate) demonstrated strong endorsement: 94% agreed that ultrasound helps learn physical examination (mean 4.51/5), 94% recommended retaining ultrasound in the module (mean 4.69/5), and 85% felt there was adequate hands-on time (mean 4.27/5). Clinical clerkships Second Enrolled Class The second enrolled class began POCUS training during the Introduction to the Practice of Medicine module, as the curriculum was implemented after they had completed preclinical training (Figure 1). This cohort was assessed longitudinally at two time points: prior to senior clerkship (n = 36, 100% response rate) and at the end of clinical rotations prior to internship (n = 32, 89% response rate). Prior to the senior internal medicine clerkship, students universally agreed that POCUS training improves clinical decision-making (mean 4.69/5). However, only 69% felt they could perform POCUS independently (mean 3.69/5). At the end of clinical clerkships, students demonstrated high confidence in basic knobology (94%, mean 4.34/5), knowing clinical indications for POCUS (94%, mean 4.34/5), and integrating POCUS into patient care (94%, mean 4.28/5). Students strongly believed POCUS training improved their ability to make clinical decisions (97% agreement, mean 4.47/5). They were less confident in their ability to teach POCUS (69% agreement, mean 3.81/5). Students reported intention to integrate POCUS into future practice, with >94% agreement for FAST, cardiac, lung, abdominal, kidney/bladder, and obstetric examinations (all means >4.35/5). Mean knowledge scores were 77.8% prior to senior clerkships and 78.9% at the end of clinical training (on assessments matched to each training stage), before students went to their internships. Comparing confidence between these two time points (Table 4), overall performing confidence improved significantly (3.71/5 vs 4.12/5, Cohen’s d = 1.11, p < 0.001), as did overall interpreting confidence (3.75/5 vs 4.16/5, Cohen’s d = 0.93, p < 0.001). The largest improvements were observed in obstetric examination confidence, with very large effect sizes for both performing (3.14/5 vs 4.25/5, d = 1.70, p < 0.001) and interpreting (3.14/5 vs 4.16/5, d = 1.45, p < 0.001). Kidney and bladder examination confidence also showed large improvements for both performing (3.47/5 vs 4.16/5, d = 1.03, p < 0.001) and interpreting (3.42/5 vs 4.16/5, d = 1.05, p < 0.001). Procedural guidance confidence improved significantly (2.83/5 vs 3.59/5, d = 0.82, p = 0.001), as did abdominal interpreting confidence (3.81/5 vs 4.25/5, d = 0.66, p = 0.008). Confidence in cardiac, lung, and FAST examinations remained stable, having already reached high levels earlier in training. Thematic analysis of open-ended responses revealed that students valued POCUS training highly. Representative quotes included: “The sessions we had on POCUS during clinicals were important and have improved my skills …, I can’t say I’m an expert but at least I have the knowledge that I can use at the hospital and I’m still learning” and “POCUS training is essential in medical school, especially in low-resource settings where further investigations might not be easily obtained.” Thematic analysis of barriers to POCUS use revealed that while 71% of students cited availability of ultrasound devices during training as facilitating use, 34% reported poor access to ultrasounds in district hospitals as limiting. Additional barriers included need for more training (22%), time constraints (19%), and uncertainty in interpretation (16%). When asked what would increase POCUS use, students identified greater equipment access (84%), availability of expert consultation (36%), and increased interpretation confidence (32%). Third Enrolled Class The third enrolled class received the complete preclinical POCUS curriculum and was assessed at the end of their first year of clinical clerkships (n = 38, 93% response rate). This cohort’s experience reflects the full integrated curriculum as designed. Most students (89%, mean 4.35/5) agreed that preclinical ultrasound training helped with learning POCUS during clinical clerkships. All students performed POCUS clinically at least 6 times during junior clerkships, with median of 21-50 examinations. POCUS was used most frequently during internal medicine (mean rank 3.55/4), followed by pediatrics (2.29), obstetrics/gynecology (2.27), and general surgery (1.87). Students rated all educational modalities helpful: hospital-based teaching sessions (mean 4.95/5), hands-on sessions with standardized patients (mean 4.95/5), and classroom didactics (mean 4.76/5). Among students who used the Global Ultrasound Institute online platform to study (29/38, 76%), 86% found it helpful (mean 4.17/5). This cohort reported high confidence in technical skills, including adjusting depth, adjusting gain, and using probe maneuvers to optimize images (all means >4.5/5). They also reported high confidence in knowing the clinical indications for POCUS (mean 4.39/5) and integrating POCUS findings into patient care decisions (mean 4.37/5). They believed that POCUS training improved their ability to make clinical decisions (mean 4.45/5). Mean knowledge score was 78.9%. Notably, the third enrolled class demonstrated significantly higher overall confidence after just one year of clinical training compared to the second enrolled class at a similar training point (prior to senior clerkship). Overall performing confidence was higher (3.94/5 vs 3.71/5, Cohen’s d = 0.55, p = 0.022), as well as overall interpreting confidence (3.96/5 vs 3.75/5, d = 0.47, p = 0.048). The largest differences were observed in obstetric ultrasound, where the third class reported substantially higher confidence in both performing (4.13/5 vs 3.14/5, d = 1.35, p < 0.001) and interpreting (4.24/5 vs 3.14/5, d = 1.62, p < 0.001), as well as kidney and bladder examinations (performing: 4.08/5 vs 3.47/5, d = 0.89, p < 0.001; interpreting: 3.84/5 vs 3.42/5, d = 0.60, p = 0.011). Cardiac performing confidence was also higher (4.45/5 vs 4.14/5, d = 0.62, p = 0.009). Interestingly, FAST examination confidence was lower in the third class (performing: 3.61/5 vs 4.31/5, d = -1.01, p < 0.001). These findings suggest that earlier integration of preclinical POCUS training may accelerate confidence development during clinical rotations (Supplementary Table 2). Students who completed the full preclinical curriculum reported that this foundation was valuable for clinical learning. Representative quotes included: “This training program is perfect to help students gain deeper understanding of ultrasound before getting in clinical practice”, “Excellent. Please continue the program. Makes students competent in the skill early on”, and “Over time continuous learning and practicing on actual patients has helped me advance.” Internship We surveyed the 30 students from the first graduating class during internship (n = 25, 83% response rate). This cohort had the most limited POCUS training, as the curriculum was implemented latest in their medical school trajectory. Of the 25 respondents, 17 (68%) reported using POCUS clinically during internship. All who used POCUS found it helpful (mean 4.76/5). Major reported barriers included lack of supervisors (56%), insufficient time (52%), lack of confidence to perform independently (36%), and lack of access to ultrasound (24%). Only one respondent (4%) reported disinterest in using POCUS. Representative quotes highlighted the clinical value: “It is a life saver! Sometimes at a hospital it’s hard to get a proper ultrasound especially during night shift!” and “Very helpful diagnostic tool especially in our resource limited settings where key investigations are not readily available.” Final certification exam Prior to graduation, 27 of the 30 students completed the optional final POCUS certification exam, with 3 opting out. On the original 30-item multiple choice question exam, the mean score was 79.8% (standard deviation 10.6%) with an acceptable internal consistency (Cronbach’s alpha 0.7). Four students initially scored below the 70% threshold; three subsequently passed a remediation examination. On the 3-station OSCE exam, the mean overall score was 87.8% (standard deviation 5.2%), with one student requiring and passing remediation. Ultimately, 26 out of 27 students (96%) achieved institutional POCUS certification. Program Evaluation Upon graduation, 17 of the 30 students from the first graduating class (57% response rate) completed a final program evaluation. Most students (94%) rated overall curriculum quality as “good” or better (mean 4.12/5), and all reported POCUS was useful for clinical practice. Most rated ultrasound access during training as at least “good” (88%, mean 4.41/5), though feedback and supervision received lower ratings (65% “good” or better). Consistency of teaching across rotations was identified as an area for improvement (53% rated “fair”, mean 3.29/5). Students identified internal medicine (94%), emergency medicine (76%), and obstetrics/gynecology (71%) as rotations where POCUS was most useful. Primary barriers were time (82%), limited supervision (59%), and lack of confidence (53%). Thematic analysis of open-ended responses recommended starting training earlier (45%), increasing rotations with POCUS sessions (45%), and improving supervision (27%). Discussion We describe the development, implementation, and outcomes of an integrated, longitudinal POCUS curriculum at a medical school in rural Rwanda. This represents the first published description of such a curriculum in a low-income country. Our findings demonstrate that comprehensive POCUS education is feasible in low-income settings and produces graduates with strong foundational knowledge and clinical confidence in core ultrasound applications. Our study captures data from multiple student cohorts at different stages of curriculum implementation, providing insight into both early outcomes and the evolving impact of the program. The first graduating class had the most limited POCUS exposure, as the curriculum was established latest in their training. Despite this, 96% of examined students achieved institutional certification, and during internship, 68% reported using POCUS clinically with universal endorsement of its utility. The second enrolled class, who received POCUS training throughout their clinical years, demonstrated significant improvements in confidence from senior clerkship through the end of clinical training. The third enrolled class that received the complete integrated curriculum from preclinical years demonstrated high confidence in core skills after just one year of clinical clerkships, with 89% agreeing that preclinical training facilitated clinical learning. While direct comparison between cohorts is limited by different assessment time points and instruments, these findings suggest that earlier initiation and more complete curriculum exposure may enhance skill development and perceived preparation for clinical practice. The certification examination results from the first graduating class are encouraging given their more limited training exposure. Mean scores of 79.8% on the written examination and 87.8% on the OSCE, with 96% ultimately achieving certification, suggest that even clinical-years-only POCUS training can produce graduates with adequate foundational competence. These outcomes compare favorably to published results from POCUS curricula in high-income settings, though direct comparisons are limited by differences in assessment methods and competency definitions. Longitudinal confidence data from the second enrolled class revealed significant improvements, with largest gains in obstetric (performing d = 1.70, interpreting d = 1.45) and kidney/bladder examinations (performing d = 1.03, interpreting d = 1.05), consistent with dedicated senior clerkship training. Procedural guidance confidence also improved significantly (d = 0.82), but remained lowest, reflecting limited procedural opportunities. Several convergent themes emerged from student feedback across cohorts and training stages. Students consistently recognized the importance and value of POCUS training, expressing desire for additional sessions throughout their education. This enthusiasm, combined with nearly universal intention to integrate POCUS into future practice, suggests successful cultivation of positive attitudes towards point-of-care imaging. Notably, the first graduating class, despite having the most limited training, recommended starting POCUS education earlier, a recommendation that aligns with evidence that earlier ultrasound exposure enhances anatomical understanding and physical exam skills. The third enrolled class’s experience provides early validation of this approach. Not only did 89% endorse that preclinical training helped clinical learning, but they also demonstrated significantly higher confidence after just one year of clinical training compared to the second enrolled class at a similar training point. Remarkably, their confidence in most domains after junior clerkship was comparable to or exceeded the confidence the second class achieved only after completing all clinical rotations. This suggests that comprehensive preclinical POCUS integration may compress the learning curve, allowing students to achieve competency benchmarks earlier in their training trajectory. Our curriculum achieved its goals despite resource constraints through several strategies that may inform implementation in similar settings. First, the use of handheld ultrasound devices reduced equipment costs while maintaining portability across clinical sites. Second, partnership with the Global Ultrasound Institute provided high-quality online educational content, reducing the burden on local faculty to develop teaching materials and allowing face-to-face time to focus on hands-on skill development. Third, engagement from visiting faculty from partner institutions supplemented local teaching capacity, though this model has limitations for long-term sustainability. The primary challenges identified by students across all cohorts relate to the clinical context rather than the curriculum itself. During internship, the most frequently reported barriers were lack of trained supervisors, time constraints, and limited equipment access at district hospitals. These findings highlight a critical gap between educational preparation and practice environment readiness. Even well-trained graduates cannot fully use their skills without supportive infrastructure and ongoing mentorship. Addressing these environmental barriers requires institutional and system-level interventions. Our institution has committed to training all clinical faculty in POCUS during 2026, which should improve supervision availability and modeling of ultrasound use in clinical practice. Broader adoption will require advocacy for equipment procurement at district hospitals and development of mechanisms for remote expert consultation, such as asynchronous scan review capabilities already being done through our online platform. Our study has several limitations. First, confidence measures relied on self-report, which may not reflect actual competence; we did not measure clinical performance outcomes such as diagnostic accuracy or impact on patient management. Second, decreasing response rates among interns and graduating students may introduce selection bias, with more engaged students potentially overrepresented in feedback. Third, as a single-institution study with small cohort sizes, generalizability to other settings requires caution. Fourth, different cohorts were assessed at different time points with evolving survey instruments, limiting direct comparisons across cohorts. Finally, this report focuses on immediate educational outcomes; long-term follow-up will be needed to assess whether graduates maintain POCUS skills and integrate ultrasound into routine clinical practice. Conclusions An integrated, longitudinal POCUS curriculum is feasible in a low-income setting and produces graduates with strong foundational knowledge, clinical confidence, and intention to use ultrasound in practice. Our experience demonstrates that common barriers to POCUS curriculum implementation, including limited trained faculty, curricular time constraints, and equipment costs, can be addressed through strategic partnerships, online learning resources, and portable ultrasound technology. Data from multiple cohorts at different stages of curriculum implementation suggest that earlier initiation of POCUS education may enhance skill development and perceived preparation for clinical practice. The primary remaining challenges relate to the clinical practice environment, particularly supervisor availability and equipment access at district hospitals. Future efforts will focus on expanding faculty development, advocating for infrastructure improvements, and establishing mechanisms for ongoing mentorship and quality assurance. Our curriculum model and lessons learned may inform other institutions seeking to integrate POCUS education into undergraduate medical training in resource-limited settings. Abbreviations POCUS Point-of-care ultrasound LMICs Low- and middle-income countries OSCE Objective structured clinical examination UGHE University of Global Health Equity FAST Focused assessment with sonography for trauma Declarations Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. Participation in all surveys was voluntary. Informed consent was obtained from all participants through an introductory statement at the beginning of each survey. All survey responses were collected anonymously, with no personally identifiable information linked to individual participants. The study of our curriculum was approved by the University of Global Health Equity Institutional Review Board (Protocol Number 2024_231). Clinical trial number: Not applicable. Consent for publication: Not applicable. Availability of data and materials: The datasets generated and analyzed during the current study are not publicly available due to the small cohort sizes which could compromise participant anonymity, but are available from the corresponding author on reasonable request. Competing interests: TW is a faculty instructor for the Global Ultrasound Institute. The University of Global Health Equity has a partnership with the Global Ultrasound Institute for educational content access. This partnership did not influence the design, analysis, or reporting of this study. All other authors declare no competing interests. Funding: No external funding was received for this study. Authors’ contributions: CV, NS, NM, and KR conceived and designed the curriculum. CV, TW, NS, and KR contributed to curriculum implementation. CV, TW, and KR designed the study and collected data. CV performed data analysis and drafted the manuscript. All authors reviewed and approved the final manuscript. Acknowledgements: The authors thank the faculty who contributed to the development and implementation of this curriculum. We are very grateful to our leadership, specifically the Dean of the School of Medicine, Abebe Bekele, who supported and championed this effort. We are particularly grateful to visiting faculty who provided essential teaching support: Aditya Mohanty, Lei Chen, Bruno Vargas, Nell Eisenberg, Andrew Liteplo, Onyinyechi Eke, Juan Lopez Tiboni, Alexander Bonnel, Rebecca Gerrity, Patrick Lanter, Monique Barros de Araujo, Samuel Hatfield, Kelly Bogaert, Anne Erickson, and Maria Small. We also thank our full-time clinical faculty for their ongoing commitment to ultrasound education: Ariane Nina Ndayikeje, Olayinka Ibrahim, Meghna Bhatter, Birhanu Abera Ayana, Zelalem Mengistu Gashew, Anteneh Gadisa Belachew, Biniam Ewnte Zelelew, Barnabas Alayande, Solomon Nega Techane, Adeline Mugeni, and Eden Abate. We acknowledge the standardized patients and clinical patients who generously participated in training sessions, as well as the students whose engagement and feedback shaped this curriculum. Finally, we thank Butterfly, Inc. for waiving subscription fees and the Global Ultrasound Institute for providing educational content, both of which were essential to the feasibility of this program. References Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. Ingelfinger JR, editor. N Engl J Med. 2021;385(17):1593–602. 10.1056/NEJMra1916062 Spampinato MD, Luppi F, Cristofaro E, Benedetto M, Cianci A, Bachechi T, et al. Diagnostic accuracy of Point Of Care UltraSound (POCUS) in clinical practice: A retrospective, emergency department based study. J Clin Ultrasound. 2024;52(3):255–64. 10.1002/jcu.23619 . Szabó GV, Szigetváry C, Szabó L, Dembrovszky F, Rottler M, Ocskay K, et al. Point-of-care ultrasound improves clinical outcomes in patients with acute onset dyspnea: a systematic review and meta-analysis. Intern Emerg Med. 2023;18(2):639–53. 10.1007/s11739-022-03126-2 . Patel PA, Ernst FR, Gunnarsson CL. Evaluation of hospital complications and costs associated with using ultrasound guidance during abdominal paracentesis procedures. J Med Econ. 2012;15(1):1–7. 10.3111/13696998.2011.628723 . Dana E, Nour ADM, Kpa’Hanba GA, Khan JS. Point-of-Care Ultrasound (PoCUS) and Its Potential to Advance Patient Care in Low-Resource Settings and Conflict Zones. Disaster med public health prep. 2023;17:e417. 10.1017/dmp.2023.90 . Reynolds TA, Amato S, Kulola I, Chen CJJ, Mfinanga J, Sawe HR. Impact of point-of-care ultrasound on clinical decision-making at an urban emergency department in Tanzania. Abe T, editor. PLoS ONE. 2018;13(4):e0194774. 10.1371/journal.pone.0194774 Kawooya MG. Training for Rural Radiology and Imaging in Sub-Saharan Africa: Addressing the Mismatch Between Services and Population. J Clin Imaging Sci. 2012;2:37. 10.4103/2156-7514.97747 . Stachura M, Landes M, Aklilu F, Venugopal R, Hunchak C, Berman S, et al. Evaluation of a point-of-care ultrasound scan list in a resource-limited emergency centre in Addis Ababa Ethiopia. Afr J Emerg Med. 2017;7(3):118–23. 10.1016/j.afjem.2017.04.011 . Henwood PC, Mackenzie DC, Liteplo AS, Rempell JS, Murray AF, Leo MM, et al. Point-of-Care Ultrasound Use, Accuracy, and Impact on Clinical Decision Making in Rwanda Hospitals: Point-of-Care Ultrasound Use, Accuracy, and Impact in Rwanda. J Ultrasound Med. 2017;36(6):1189–94. 10.7863/ultra.16.05073 . Ranger BJ, Bradburn E, Chen Q, Kim M, Noble JA, Papageorghiou AT. Portable ultrasound devices for obstetric care in resource-constrained environments: mapping the landscape. Gates Open Res. 2024;7:133. 10.12688/gatesopenres.15088.2 . Falkowski AL, Jacobson JA, Freehill MT, Kalia V. Hand-Held Portable Versus Conventional Cart-Based Ultrasound in Musculoskeletal Imaging. Orthop J Sports Med. 2020;8(2):2325967119901017. 10.1177/2325967119901017 . Perez-Sanchez A, Johnson G, Pucks N, Soni RN, Lund TJS, Andrade AJ, et al. Comparison of 6 handheld ultrasound devices by point-of-care ultrasound experts: a cross-sectional study. Ultrasound J. 2024;16(1):45. 10.1186/s13089-024-00392-3 . Eppel F, Hunstig F, Bélard S, Kreuels B. Concepts for point-of-care ultrasound training in low resource settings: a scoping review. Ultrasound J. 2025;17(1):24. 10.1186/s13089-025-00427-3 . Martin R, Lau HA, Morrison R, Bhargava P, Deiling K. The Rising Tide of Point-of-Care Ultrasound (POCUS) in Medical Education: An Essential Skillset for Undergraduate and Graduate Medical Education. Curr Probl Diagn Radiol. 2023;52(6):482–4. 10.1067/j.cpradiol.2023.06.003 . Henwood PC, Mackenzie DC, Rempell JS, Douglass E, Dukundane D, Liteplo AS, et al. Intensive point-of‐care ultrasound training with long‐term follow‐up in a cohort of Rwandan physicians. Trop Med Int Health. 2016;21(12):1531–8. 10.1111/tmi.12780 . Le DQ, Scarpulla M, Lam H, Kern J, Vroegop S, Yaeger J, et al. The assessment of point-of-care ultrasound (POCUS) in residency: the benefits of a four-year longitudinally integrated curriculum. J Osteopath Med. 2025;125(3):119–26. 10.1515/jom-2024-0046 . Russell FM, Zakeri B, Herbert A, Ferre RM, Leiser A, Wallach PM. The State of Point-of-Care Ultrasound Training in Undergraduate Medical Education: Findings From a National Survey. Acad Med. 2022;97(5):723–7. 10.1097/ACM.0000000000004512 . Johnson JI, Beasley H, Southwick D, Lords AM, Kessler R, Vrablik ME, et al. Development of a hybrid point-of-care ultrasound curriculum for first year medical students in a rural medical education program: a pilot study. BMC Med Educ. 2024;24(1):16. 10.1186/s12909-023-05005-6 . Glass C, Sarwal A, Zavitz J, Nitsche J, Joyner J, Johnson LL, et al. Scoping review of implementing a longitudinal curriculum in undergraduate medical education: The wake forest experience. Ultrasound J. 2021;13(1):23. 10.1186/s13089-021-00206-w . Hoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M et al. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J. 2022;14(1):31. 10.1186/s13089-022-00279-1 Sullivan GM, Feinn R. Using Effect Size—or Why the P Value Is Not Enough. J Graduate Med Educ. 2012;4(3):279–82. 10.4300/JGME-D-12-00156.1 . Tables Table 1: University of Global Health Equity’s point-of-care ultrasound curriculum learning competencies. FAST: focused assessment with sonography for trauma; POCUS: point-of-care ultrasound; IVC: inferior vena cava; GS: gestational sac; CRL: crown rump length; BPD: biparietal diameter; FL: femur length; AC: abdominal circumference; HC: head circumference; IV: intravenous. Domain Knowledge Competencies Skills Competencies GENERAL/ FOUNDATIONAL • Describe basic ultrasound windows for cardiac, lung, abdomen, FAST, soft tissue, and obstetric examinations • Identify clinical indications for POCUS examinations • Identify limitations of POCUS and when alternative imaging is required • Demonstrate proper use of ultrasound machines (probe selection, gain/depth adjustment, Doppler, measurements, image capture) • Apply POCUS in clinical scenarios: determine when to perform, describe assessed findings, integrate into patient management CARDIAC • Identify volume overload (IVC assessment) • Identify pericardial effusion • Identify poor LV contractility • Demonstrate proper windows, positioning, and technique LUNG • Identify pneumothorax • Identify B-lines (interstitial syndrome) • Identify consolidation • Identify pleural effusion • Demonstrate proper windows, positioning, and technique FAST • Identify positive FAST examination findings • Demonstrate proper windows, positioning, and technique ABDOMINAL/ RENAL/ URINARY • Identify liver abscess, cirrhosis, ascites • Identify organomegaly • Identify urinary retention • Identify hydronephrosis • Demonstrate proper windows, positioning, and technique SOFT TISSUE • Identify soft tissue abscess • Demonstrate proper windows, positioning, and technique OBSTETRIC FIRST TRIMESTER: • Pregnancy dating (GS, CRL) • Identify ectopic vs. intrauterine pregnancy • Differentiate pregnancy types (normal, molar, blighted ovum, multiple gestation) SECOND TRIMESTER: • Pregnancy dating (BPD, FL, AC, HC) THIRD TRIMESTER: • Biophysical profile • Fetal biometry • Placental location • Demonstrate proper windows, positioning, and technique for 1st, 2nd, and 3rd trimester examinations (including biometrics) GYNECOLOGIC • Identify and characterize adnexal masses • Measure endometrial thickness • Identify free fluid in peritoneal cavity • Demonstrate proper windows, positioning, and technique PROCEDURAL • Identify safe fluid pocket for thoracentesis/paracentesis • Identify appropriate vein for peripheral IV cannula placement • Demonstrate ultrasound-guided techniques for: - Peripheral IV cannula placement - Thoracentesis (static) - Paracentesis (static) Table 2: Map of competencies onto existing University of Global Health Equity medical school curriculum with brief description of educational sessions. POCUS: point-of-care ultrasound; GUSI: Global Ultrasound Institute; IVC: inferior vena cava; FAST: focused assessment with sonography for trauma; E-FAST: extended focused assessment with sonography for trauma; RUSH: rapid ultrasound for shock and hypotension; OSPE: objective structured practical examination; mini-CEX: mini-clinical evaluation exercise. Year Course/Module Competency Domain Educational Session Description Assessment YEAR 1 Year 1, Semester 2 Homeostasis, Metabolism, and Function General/ Foundational Introduction to ultrasound physics, image acquisition principles, probe selection, transducer manipulations. GUSI video prework. 60-minute didactic with 30-minute small groups to practice ultrasound. None YEAR 2 Year 2, Semester 1 Gastrointestinal System and Nutrition Abdominal Reintroduce ultrasound basics. Identify liver, gallbladder, spleen, portal vein, IVC. Recognize ascites. Prework videos. 30-minute didactic with 30-minute small group scanning session using standardized patients. None Year 2, Semester 2 Cardiovascular System Cardiac Identify cardiac chambers, aortic and mitral valves, IVC. Recognize systolic heart failure, pericardial effusion, valvular pathology. Correlate with cardiac physiology. Prework videos. 15-minute didactic with 30-minute small group scanning session using standardized patients. None Year 2, Semester 2 Respiratory System Lung and Cardiac Identify A-lines and lung sliding. Identify diaphragm. Assess diaphragmatic excursion. Assess IVC diameter variation with respiration. Recognize normal vs. consolidated lung. Prework videos. 15-minute didactic with 30-minute small group scanning session using standardized patients. None Year 2, Semester 2 Renal and Urinary Systems Abdominal/ Renal/ Urinary Image and identify bladder and both kidneys. Recognize hydronephrosis and renal cysts/masses. Prework videos. 15-minute didactic with 30-minute small group scanning session using standardized patients. None YEAR 3 Year 3 Introduction to the Practice of Medicine General/ Foundational, Cardiac, Lung, and FAST Review ultrasound technology, probe selection, knobology. Identify normal anatomy of major organs. Correlate ultrasound with physical exam findings. Demonstrate proper techniques for image acquisition. Recognize cardiac, pulmonary, and FAST exam pathology. GUSI video prework. Two 4-hour sessions with a mix of didactics (total 4 hours) and small group scanning using standardized patients (total 4 hours). Participation grade and OSCE station Year 3 Internal Medicine Junior Clerkship Cardiac and Abdominal Indications for bedside echocardiogram and abdominal ultrasound. Identify volume status via IVC, systolic dysfunction, tamponade, cirrhosis, ascites, liver abscess. Demonstrate parasternal long axis and subxiphoid cardiac views. GUSI videos. 45-minute didactic session. Small group scanning sessions on the wards. OSCE station, logbook, scan reviews Year 3 Surgery Junior Clerkship FAST and Soft Tissue Indications for FAST exam. Identify free fluid in FAST windows. Demonstrate FAST views. Characterize soft tissue abscess vs. cyst vs. cellulitis. Small group scanning sessions on the wards. None Year 3 OB/GYN Junior Clerkship Obstetric Ultrasound not formally included in junior clerkship but students are exposed on the wards/clinic, especially obstetric ultrasound. Multiple choice questions on final exam related to ultrasound. Year 3 Pediatrics Junior Clerkship Lung Indications for lung ultrasound. Identify pneumonia, B-lines, pleural effusion, pneumothorax, consolidation. Assess lung sliding and use M-mode. GUSI videos. 60-minute didactic session. Small group scanning sessions on the wards. OSCE station YEAR 4 Year 4 Diagnostic Radiology General/ Foundational Advantages and limitations of ultrasound. Common emergency conditions. Indications for breast, musculoskeletal, testicular, biliary, and renal ultrasound. OSPE stations (diagnostic ultrasound interpretation) Year 4 Anesthesia and Critical Care Procedural, Cardiac, and Lung Distinguish veins from arteries/nerves. POCUS in critically ill patients. Ultrasound-guided IV placement. Integrate cardiac/lung findings in shock and respiratory failure management. GUSI videos. Practice scanning on the wards. Logbook Year 4 Emergency Medicine FAST and Procedural Indications for E-FAST and RUSH exams. Perform and interpret E-FAST and RUSH. Ultrasound-guided vascular access. GUSI videos. 2-3 didactic sessions. Practice scanning on the wards. Logbook, scan reviews YEAR 5 Year 5, Semester 2 Internal Medicine Senior Clerkship Cardiac, Abdominal/ Renal/Urinary, and Lung Advanced: All 4 cardiac views, assess systolic function, integrate into management. Kidney/bladder in 2 planes, identify hydronephrosis and retention. Measure liver span, identify ascites, determine safe paracentesis pocket. Lung ultrasound for effusion and pneumothorax. Image optimization. GUSI videos. 45-minute didactic session. Small group scanning sessions on the wards. OSCE station, mini-CEX, logbook, scan reviews Year 5, Semester 2 Surgery Senior Clerkship FAST, Soft Tissue, and Procedural Review and advance FAST skills. Perform full FAST and create management plan. Identify soft tissue abscess. Small group scanning sessions on the wards. None Year 5, Semester 2 OB/GYN Senior Clerkship Obstetric Indications for obstetric ultrasound – 1 st , 2 nd , 3 rd trimester. Identify intrauterine pregnancy in 1 st trimester. Determine fetal heart rate. Perform obstetric triage ultrasound (position, placenta, fluid). Multiple gestation, fetal anatomy (head, spine, extremities, abdomen, thorax), retained products, ectopic pregnancy. Perform biometry for gestational age. Perform biophysical profile. Didactic sessions, simulation sessions. Small group scanning sessions on the wards/clinic. Mid-clerkship and final OSCE station, multiple choice questions on ultrasound on clerkship exam, mini-CEX Year 5, Semester 2 Pediatrics Senior Clerkship Cardiac and Lung Indications for pediatric cardiac ultrasound. Identify severe valvular pathology and heart failure. Advanced lung ultrasound with focus on identification of pneumonia. 60-minute didactic session. Small group scanning sessions on the wards. Logbook, scan reviews INTERNSHIP/GRADUATION Internship All Clinical Settings All Domains Continued application and practice of all POCUS skills in supervised clinical settings. GUSI videos (self-directed). Review of uploaded scans by clinical faculty (not required). Pre-internship exit exam includes OSCE station. Table 3: Confidence ratings using a 5-point Likert scale (Strongly Disagree to Strongly Agree) from pre- and post-test surveys before and after the intensive training course during the Introduction to the Practice of Medicine module. POCUS: point-of-care ultrasound; SD: standard deviation. Confidence Item Pre-test mean (SD) n = 47 Post-test mean (SD) n = 47 p-value Cohen’s d I know what POCUS is 3.53 (1.08) 4.70 (0.51) <0.001 1.39 Adjusting depth to improve image quality 2.81 (0.85) 4.53 (0.69) <0.001 2.23 Adjusting gain to improve image quality 2.72 (0.85) 4.53 (0.65) <0.001 2.38 Using probe maneuvers to optimize view 3.17 (0.79) 4.30 (0.78) <0.001 1.44 Distinguishing bone, soft tissue, fluid, and air on ultrasound 3.53 (0.83) 4.55 (0.58) <0.001 1.42 Asking a clinical question with POCUS 2.64 (0.90) 4.26 (0.71) <0.001 2.01 Performing an ultrasound of the heart, lung, and abdomen 2.83 (0.87) 4.28 (0.71) <0.001 1.82 Table 4: Longitudinal changes in POCUS confidence across clinical training. Confidence in performing and interpreting POCUS examinations using a 5-point Likert scale (Strongly Disagree to Strongly Agree) from surveys performed prior to senior clerkship and at the end of clinical rotations prior to internship. Student-level means were calculated and the resulting values summarized for the overall means. POCUS: point-of-care ultrasound; SD: standard deviation; FAST: focused assessment with sonography for trauma. Confidence Item Mean prior to senior clerkship (SD) n = 36 Mean prior to internship (SD) n = 32 p-value Cohen’s d I am confident performing each of the following exams: Cardiac 4.14 (0.49) 4.19 (0.47) 0.678 0.10 Lung 3.97 (0.51) 4.03 (0.65) 0.675 0.10 Abdominal (liver and spleen) 4.14 (0.64) 4.34 (0.55) 0.163 0.34 Kidney and bladder 3.47 (0.65) 4.16 (0.68) <0.001 1.03 FAST 4.31 (0.52) 4.25 (0.51) 0.660 -0.11 Obstetric 3.14 (0.76) 4.25 (0.51) <0.001 1.70 Procedural 2.83 (1.00) 3.59 (0.84) 0.001 0.82 Overall mean 3.71 (0.36) 4.12 (0.37) <0.001 1.11 I am confident interpreting each of the following exams: Cardiac 4.00 (0.48) 4.12 (0.55) 0.321 0.24 Lung 3.81 (0.62) 3.94 (0.67) 0.403 0.20 Abdominal (liver and spleen) 3.81 (0.75) 4.25 (0.57) 0.008 0.66 Kidney and bladder 3.42 (0.73) 4.16 (0.68) <0.001 1.05 FAST 4.31 (0.58) 4.31 (0.59) 0.961 0.01 Obstetric 3.14 (0.83) 4.16 (0.51) <0.001 1.45 Overall mean 3.75 (0.44) 4.16 (0.43) <0.001 0.93 Additional Declarations Competing interest reported. TW is a faculty instructor for the Global Ultrasound Institute. The University of Global Health Equity has a partnership with the Global Ultrasound Institute for educational content access. This partnership did not influence the design, analysis, or reporting of this study. All other authors declare no competing interests. Supplementary Files SupplementaryTables1and2.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 07 May, 2026 Reviews received at journal 04 May, 2026 Reviews received at journal 19 Apr, 2026 Reviewers agreed at journal 19 Apr, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviewers invited by journal 16 Apr, 2026 Editor invited by journal 08 Apr, 2026 Editor assigned by journal 11 Mar, 2026 Submission checks completed at journal 10 Mar, 2026 First submitted to journal 09 Mar, 2026 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8981205","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626015812,"identity":"30680b6b-f511-4d02-ab93-f4aa988c07df","order_by":0,"name":"Chandler Villaverde","email":"","orcid":"","institution":"University of Global Health Equity","correspondingAuthor":false,"prefix":"","firstName":"Chandler","middleName":"","lastName":"Villaverde","suffix":""},{"id":626015813,"identity":"571fc2e9-3794-44c7-b01d-12b71726593c","order_by":1,"name":"Tanping Wong","email":"","orcid":"","institution":"Weill Cornell Medicine","correspondingAuthor":false,"prefix":"","firstName":"Tanping","middleName":"","lastName":"Wong","suffix":""},{"id":626015814,"identity":"573f3cdd-e70a-41e1-9716-326d2cef8430","order_by":2,"name":"Natnael Shimelash","email":"","orcid":"","institution":"University of Global Health Equity","correspondingAuthor":false,"prefix":"","firstName":"Natnael","middleName":"","lastName":"Shimelash","suffix":""},{"id":626015815,"identity":"f7f6edeb-0ad2-487e-ad96-5b6b15a08be9","order_by":3,"name":"Natalie McCall","email":"","orcid":"","institution":"University of Global Health Equity","correspondingAuthor":false,"prefix":"","firstName":"Natalie","middleName":"","lastName":"McCall","suffix":""},{"id":626015818,"identity":"ae3edecf-3273-4cd7-85f7-9ea9f86d9d8d","order_by":4,"name":"Kelsey Ripp","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYBACCQbGBgaGCgYGAxK1nCFNCxAwtpGiRXL24bbHhfMO221nb2B8XPGLCC3SfIntxjO3HU7e2XOA2fBsHxFa5HgY26R5gVoMbiSwSTb2EK1lDlDL/QdEapEGa2k4bGdwg4FNsuEHEVokexjbjWccS08wOJPYbNjYQIQWiTPszx4X1FjbGxw/fPBhwx8itAABGzOQSGwAxSkogojWYg9hE2nLKBgFo2AUjCwAAGodNitGG0adAAAAAElFTkSuQmCC","orcid":"","institution":"University of Global Health Equity","correspondingAuthor":true,"prefix":"","firstName":"Kelsey","middleName":"","lastName":"Ripp","suffix":""}],"badges":[],"createdAt":"2026-02-26 20:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8981205/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8981205/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107834305,"identity":"90d81c38-5178-4952-8512-759b54095f1f","added_by":"auto","created_at":"2026-04-26 15:44:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114667,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram of point-of-care ultrasound education integration into existing medical school curriculum. The time each class started the POCUS curriculum during their medical training is indicated. POCUS: point-of-care ultrasound; BMS: Basic Medical Science; IPM: Introduction to the Practice of Medicine.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8981205/v1/df7f325eae3095aa9e282158.png"},{"id":107873016,"identity":"68074390-3079-41f2-b513-463446f7f4e3","added_by":"auto","created_at":"2026-04-27 08:00:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":509174,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8981205/v1/99e824cb-c93a-481c-a203-5f22350467c1.pdf"},{"id":107870163,"identity":"f3edc4a1-1ca5-4544-bb59-c9ed1f3486cd","added_by":"auto","created_at":"2026-04-27 07:38:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":40520,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTables1and2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8981205/v1/0777630e998403b06076ad41.docx"}],"financialInterests":"Competing interest reported. TW is a faculty instructor for the Global Ultrasound Institute. The University of Global Health Equity has a partnership with the Global Ultrasound Institute for educational content access. This partnership did not influence the design, analysis, or reporting of this study. All other authors declare no competing interests.","formattedTitle":"Integrated Point-of-Care Ultrasound Training in a Rwandan Medical School: Curriculum Development, Implementation, and Outcomes","fulltext":[{"header":"Background","content":"\u003cp\u003ePoint-of-care ultrasound (POCUS) is the use of ultrasound by the treating clinician at the bedside, with immediate interpretation and clinical integration of the imaging results.\u003csup\u003e1\u003c/sup\u003e Multiple studies demonstrate the clinical utility of POCUS in improving patient care outcomes. POCUS achieves diagnostic accuracy exceeding 96% compared to formal imaging, with faster diagnosis and higher odds of appropriate therapy.\u003csup\u003e2,3\u003c/sup\u003e POCUS also enhances procedural safety compared to landmark-based techniques.\u003csup\u003e4\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe impact of POCUS is potentially greater in low- and middle-income countries (LMICs) where access to advanced imaging modalities remains limited.\u003csup\u003e5\u0026ndash;7\u003c/sup\u003e In an emergency department in Ethiopia, 95% of POCUS scans provided clinically useful information and changed management plans in 45% of patients.\u003csup\u003e8\u003c/sup\u003e In an emergency department in Tanzania, POCUS changed the diagnostic impression or disposition plan in 29% of cases.\u003csup\u003e6\u003c/sup\u003e In Rwanda, POCUS routinely changed the medications administered (42%) and disposition (30%).\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eAccess to ultrasound technology is increasing, with affordable and durable handheld devices able to operate without internet connections or reliable electricity while maintaining diagnostic accuracy.\u003csup\u003e10\u0026ndash;12\u003c/sup\u003e This combination of utility and accessibility creates an ideal environment for increased training in resource-limited settings. A recent scoping review of POCUS training programs in LMICs demonstrated widespread interest in and feasibility of POCUS education, though 81% of studies described short courses and only five studies involved medical students.\u003csup\u003e13\u003c/sup\u003e Successful implementation requires longitudinal training programs rather than one-off sessions, with ongoing support and context-specific protocols adapted to the local needs.\u003csup\u003e13,14\u003c/sup\u003e One study from Rwanda of an intensive and longitudinal POCUS training program demonstrated sustained improvements in competency and universal increased job satisfaction and perceived quality of patient care.\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIntegration of POCUS training into undergraduate medical education represents a strategic approach to building sustainable diagnostic capacity in low-income settings. Early exposure to ultrasound during medical school improves anatomical understanding, physical exam skills, and performance on knowledge tests.\u003csup\u003e14\u003c/sup\u003e Students who complete a longitudinal POCUS training during medical school report improved skills compared to their peers during subsequent residency training.\u003csup\u003e16\u003c/sup\u003e This approach is particularly important in LMICs, where many graduates enter independent practice without post-graduate training, making undergraduate medical education the primary opportunity to develop POCUS competency.\u003c/p\u003e\n\u003cp\u003eIn a recent survey of 122 medical schools in the United States, 57% had an approved POCUS curriculum, but only 8% offered integrated, longitudinal curricula.\u003csup\u003e17\u003c/sup\u003e Reported barriers to implementation of POCUS training in undergraduate medical education include lack of trained faculty, lack of available time in the current curriculum, and lack of equipment.\u003csup\u003e16,17\u003c/sup\u003e Despite these barriers, there is evidence of successful integration of POCUS into early medical school education in the rural United States using a combination of online resources, remote collaborations, and local faculty development with improvements in student knowledge and confidence.\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eWhile there are descriptions of integrated, longitudinal POCUS curricula in medical schools, the published literature focuses on high-resource settings.\u003csup\u003e19\u003c/sup\u003e We describe the first published integrated POCUS curriculum in a medical school in a low-income country. Our description covers curriculum development, student experiences, and knowledge outcomes. We emphasize sustainable use of resources that may be applied in similar contexts, where graduates are expected to be competent general practitioners upon graduation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eSetting\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Global Health Equity (UGHE) is a medical school in rural northern Rwanda. The university was founded in 2015 by Partners In Health in partnership with the government of Rwanda, with an emphasis on equity and community-based learning. The school offers a 6.5-year dual degree of a Bachelor of Medicine and Bachelor of Surgery (MBBS) and a Master of Science in Global Health Delivery (MGHD). The first class of 30 medical students enrolled in 2019 and graduated in January 2026. Class sizes have gradually increased to 60 students per year. The curriculum includes an organ-system-based preclinical phase (2 years), clinical clerkships (2.5 years), internship (1 year), and an integrated Masters curriculum (1 year). While the university has one main affiliated teaching hospital (Butaro Level 2 Teaching Hospital), students rotate at sites across the country during their clinical years. Clinical clerkships are intentionally delivered in resource-limited rural district teaching hospitals to expose students to the settings where they will practice upon graduation. During internship, students are assigned to work in hospitals across the country and are not supervised by UGHE clinical faculty. Upon graduation, students are assigned to work as independent general practitioners in hospitals across the country.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResources available\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAs the first class of students began their clinical rotations, the school only had three full time clinical faculty. The university relies on global partnerships with foreign institutions for educational support. There are now over 17 full-time clinical faculty, including general practitioners and specialty-trained physicians. The school had an established Simulation and Skills Centre with one cart-based ultrasound prior to introduction of the POCUS curriculum.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDevelopment of curriculum\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo develop our POCUS curriculum, we began by reviewing published international consensus recommendations for undergraduate medical education.\u003csup\u003e20\u003c/sup\u003e After discussing the proposed competencies with our clinical faculty working in district hospitals in each core specialty, we refined the list to what should be expected of a general practitioner in our local context. The final competency list was then agreed upon and approved by academic leadership (Table 1). Using published curricula of integrated POCUS training programs to guide timing and pacing of education, we mapped our competencies onto the existing medical school curriculum, matching each learning objective to a preclinical organ-system-based module or clinical clerkship, ensuring regular exposure to POCUS educational sessions (Table 2).\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eImplementation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe curriculum was first implemented in 2022, at the time the school had three cohorts at different stages of training. The inaugural cohort, who graduated in January 2026, and the second cohort were already in their clinical clerkships, while the third cohort was still in the preclinical phase of training (Figure 1).\u003c/p\u003e\n\u003cp\u003eApproval was obtained from preclinical faculty to integrate 30- to 90-minute didactic and practical sessions into relevant preclinical modules. An intensive 8-hour training was incorporated into the Introduction to the Practice of Medicine module delivered immediately prior to the start of clinical clerkships. Integration of POCUS into clinical clerkships included both dedicated didactic and hands-on teaching sessions as well as routine use of POCUS during clinical rotations. Students submitted ultrasound examinations for faculty review during designated clerkships. During internship, students were given shared access to handheld ultrasounds at their internship sites and could submit scans for review by faculty. To further increase exposure and interest in POCUS, annual ultrasound competitions were held with teams comprised of students from multiple different years of training.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResources required\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo actualize the curriculum, we needed to address three common barriers: lack of trained faculty, lack of available time, and lack of equipment.\u003csup\u003e16,17\u003c/sup\u003e We initially relied on two core clinical faculty trained in POCUS to coordinate and deliver teaching sessions. We also recruited visiting faculty from partner institutions outside of Rwanda to volunteer time to teach ultrasound, with over 15 visiting faculty contributing to POCUS education since the curriculum was implemented. This includes three visiting faculty from the United States who were involved in the inception and development of the curriculum and remained involved in its ongoing implementation and assessment. Some visiting faculty returned annually to provide continued support. In addition to scheduled teaching sessions, they spent time supervising student ultrasound exams in the wards and helped run the annual ultrasound competition.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo optimize the time of available faculty, UGHE partnered with the Global Ultrasound Institute to obtain access to high quality educational POCUS content with libraries of normal and abnormal images for learners to review. This allowed faculty to spend less time teaching basic concepts and more time teaching hands-on sessions. The platform also enabled students to upload scans for faculty to review, allowing visiting faculty to provide feedback remotely. To reduce the dependence on visiting faculty, we hosted training-of-trainer educational sessions for interested core faculty, with an institutional commitment to train all full-time clinical faculty in POCUS by the end of 2026.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor hands-on sessions, we predominantly relied on standardized patients recruited from the local community. For obstetrics sessions, we recruit pregnant women from the community to serve as scanning models. Standardized patients consented and were compensated. During the clinical years, hands-on sessions were held on the wards using consenting patients to demonstrate pathology.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEquipment was the most expensive part of POCUS integration. We purchased a total of 16 handheld Butterfly iQ+ ultrasounds and associated tablets (Butterfly Inc., Burlington, MA). Butterfly waived annual subscription fees to allow use for global medical education. These ultrasounds were distributed to different clinical sites to ensure each clinical rotation has access to a device. Students at each clinical site are responsible for the ultrasounds, and we have not lost any devices to date.\u003c/p\u003e\n\u003cp\u003eOver the last 4 years, the total budget for our integrated POCUS curriculum was less than $15,000 per year. In addition to dividing the cost of handheld ultrasound devices over the 4 years, the Global Ultrasound Institute online platform costs about $5,000 per year, prioritized for the students in clinical clerkships.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAssessments\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eCurriculum effectiveness was assessed through student evaluations, self-reported confidence measures, pre- and post-session knowledge assessments administered during the introductory and intensive training sessions, and the final certification examination. Knowledge assessments were tailored to the content and level of each training stage and are therefore not directly comparable across timepoints. Further, students\u0026rsquo; progress was assessed during objective structured clinical examinations (OSCEs) and faculty reviews of ultrasound scans during clerkships (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe developed a final POCUS certification exam aligned with the I-AIM framework (Indication, Acquisition, Interpretation, and Medical decision-making). The written component consisted of 30 original multiple-choice questions spanning the main content areas of our curriculum, reviewed by multiple faculty for accuracy and clarity. While no validated reference standard exists for POCUS knowledge assessments, we calculated Cronbach\u0026rsquo;s alpha to assess internal consistency. The practical component consisted of a 3-station OSCE assessing cardiac, lung / abdominal, and second / third trimester obstetric ultrasound. The stations evaluated indication recognition, image acquisition technique, and interpretation accuracy using standardized rubrics (Supplementary Table 1). Prior to the examination, faculty assessors completed a calibration session reviewing scoring criteria and anchor examples to ensure inter-rater consistency.\u003c/p\u003e\n\u003cp\u003eBecause the curriculum was implemented with cohorts at different stages of training, the assessment strategy varied by cohort. Cohorts completed pre- and post-session knowledge assessments during the introductory and intensive training sessions. The second enrolled class was assessed longitudinally at two clinical timepoints: prior to senior clerkship and at the end of clinical rotations. The third enrolled class, which received the full preclinical curriculum, was assessed at the end of their first year of clerkships. The first graduating class was surveyed during internship and completed the final certification exam prior to graduation. Cross-cohort comparisons were made at equivalent training stages where possible.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipation in all surveys was voluntary. Informed consent was obtained from all participants through an introductory statement at the beginning of each survey. All survey responses were collected anonymously, with no personally identifiable information linked to individual participants. The study of our curriculum was approved by the University of Global Health Equity Institutional Review Board (Protocol Number 2024_231).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using STATA version 17 (StataCorp, 2021). Changes in pre-post knowledge tests were assessed using Chi square tests for categorical variables and independent samples t-tests for Likert response. Surveys were anonymized and therefore could not be linked for paired analysis. Likert responses were reported as mean \u0026plusmn; standard deviation. Cohen\u0026rsquo;s d was calculated to determine the effect size, defined as small (0.2), medium (0.5), large (0.8), or very large (1.3).\u003csup\u003e21\u003c/sup\u003e Open-ended responses were summarized.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003ePreclinical sessions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudents were surveyed prior to the first POCUS session (n = 48, 100% response rate). Most students (77%) had no prior ultrasound experience, yet all expressed strong interest in learning POCUS (mean 4.81/5) and nearly all (98%, mean 4.73/5) believed it would improve their understanding of anatomy and physiology. On pre- and post-session assessment of the introductory session, knowledge scores improved from 68.8% to 90.0% (p \u0026lt; 0.001), with the largest gains in probe positioning (+56.2%, p \u0026lt; 0.001) and appropriate probe frequency selection (+27.5%, p = 0.007). Student satisfaction was universal, with all students reporting enjoyment (mean 4.92/5) and interest in additional sessions (mean 4.90/5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt the conclusion of preclinical studies, 66% of students (31/47) wanted more POCUS in the preclinical curriculum, while 30% (14/47) felt the amount was appropriate. Two classes of students were surveyed at the end of preclinical studies about educational impact (n = 86, 97% response rate) and 66% agreed that POCUS improved their understanding of anatomy and physiology (mean 3.73/5).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIntroduction to the Practice of Medicine Intensive Training\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe 8-hour intensive training session prior to clinical clerkships produced significant learning gains. Among 47 students, overall knowledge scores on pre- and post-session assessments improved from 69.3% to 93.1% (p \u0026lt; 0.001). All seven assessed confidence domains showed statistically significant improvements with very large effect sizes (Cohen\u0026rsquo;s d 1.39-2.38, all p \u0026lt; 0.001; Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudent evaluations across three cohorts (n = 96, 77% response rate) demonstrated strong endorsement: 94% agreed that ultrasound helps learn physical examination (mean 4.51/5), 94% recommended retaining ultrasound in the module (mean 4.69/5), and 85% felt there was adequate hands-on time (mean 4.27/5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical clerkships\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSecond Enrolled Class\u003c/p\u003e\n\u003cp\u003eThe second enrolled class began POCUS training during the Introduction to the Practice of Medicine module, as the curriculum was implemented after they had completed preclinical training (Figure 1). This cohort was assessed longitudinally at two time points: prior to senior clerkship (n = 36, 100% response rate) and at the end of clinical rotations prior to internship (n = 32, 89% response rate).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrior to the senior internal medicine clerkship, students universally agreed that POCUS training improves clinical decision-making (mean 4.69/5). However, only 69% felt they could perform POCUS independently (mean 3.69/5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt the end of clinical clerkships, students demonstrated high confidence in basic knobology (94%, mean 4.34/5), knowing clinical indications for POCUS (94%, mean 4.34/5), and integrating POCUS into patient care (94%, mean 4.28/5). Students strongly believed POCUS training improved their ability to make clinical decisions (97% agreement, mean 4.47/5). They were less confident in their ability to teach POCUS (69% agreement, mean 3.81/5). Students reported intention to integrate POCUS into future practice, with \u0026gt;94% agreement for FAST, cardiac, lung, abdominal, kidney/bladder, and obstetric examinations (all means \u0026gt;4.35/5). Mean knowledge scores were 77.8% prior to senior clerkships and 78.9% at the end of clinical training (on assessments matched to each training stage), before students went to their internships.\u003c/p\u003e\n\u003cp\u003eComparing confidence between these two time points (Table 4), overall performing confidence improved significantly (3.71/5 vs 4.12/5, Cohen\u0026rsquo;s d = 1.11, p \u0026lt; 0.001), as did overall interpreting confidence (3.75/5 vs 4.16/5, Cohen\u0026rsquo;s d = 0.93, p \u0026lt; 0.001). The largest improvements were observed in obstetric examination confidence, with very large effect sizes for both performing (3.14/5 vs 4.25/5, d = 1.70, p \u0026lt; 0.001) and interpreting (3.14/5 vs 4.16/5, d = 1.45, p \u0026lt; 0.001). Kidney and bladder examination confidence also showed large improvements for both performing (3.47/5 vs 4.16/5, d = 1.03, p \u0026lt; 0.001) and interpreting (3.42/5 vs 4.16/5, d = 1.05, p \u0026lt; 0.001). Procedural guidance confidence improved significantly (2.83/5 vs 3.59/5, d = 0.82, p = 0.001), as did abdominal interpreting confidence (3.81/5 vs 4.25/5, d = 0.66, p = 0.008). Confidence in cardiac, lung, and FAST examinations remained stable, having already reached high levels earlier in training.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThematic analysis of open-ended responses revealed that students valued POCUS training highly. Representative quotes included: \u0026ldquo;The sessions we had on POCUS during clinicals were important and have improved my skills \u0026hellip;, I can\u0026rsquo;t say I\u0026rsquo;m an expert but at least I have the knowledge that I can use at the hospital and I\u0026rsquo;m still learning\u0026rdquo; and \u0026ldquo;POCUS training is essential in medical school, especially in low-resource settings where further investigations might not be easily obtained.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eThematic analysis of barriers to POCUS use revealed that while 71% of students cited availability of ultrasound devices during training as facilitating use, 34% reported poor access to ultrasounds in district hospitals as limiting. Additional barriers included need for more training (22%), time constraints (19%), and uncertainty in interpretation (16%). When asked what would increase POCUS use, students identified greater equipment access (84%), availability of expert consultation (36%), and increased interpretation confidence (32%).\u003c/p\u003e\n\u003cp\u003eThird Enrolled Class\u003c/p\u003e\n\u003cp\u003eThe third enrolled class received the complete preclinical POCUS curriculum and was assessed at the end of their first year of clinical clerkships (n = 38, 93% response rate). This cohort\u0026rsquo;s experience reflects the full integrated curriculum as designed.\u003c/p\u003e\n\u003cp\u003eMost students (89%, mean 4.35/5) agreed that preclinical ultrasound training helped with learning POCUS during clinical clerkships. All students performed POCUS clinically at least 6 times during junior clerkships, with median of 21-50 examinations. POCUS was used most frequently during internal medicine (mean rank 3.55/4), followed by pediatrics (2.29), obstetrics/gynecology (2.27), and general surgery (1.87).\u003c/p\u003e\n\u003cp\u003eStudents rated all educational modalities helpful: hospital-based teaching sessions (mean 4.95/5), hands-on sessions with standardized patients (mean 4.95/5), and classroom didactics (mean 4.76/5). Among students who used the Global Ultrasound Institute online platform to study (29/38, 76%), 86% found it helpful (mean 4.17/5).\u003c/p\u003e\n\u003cp\u003eThis cohort reported high confidence in technical skills, including adjusting depth, adjusting gain, and using probe maneuvers to optimize images (all means \u0026gt;4.5/5). They also reported high confidence in knowing the clinical indications for POCUS (mean 4.39/5) and integrating POCUS findings into patient care decisions (mean 4.37/5). They believed that POCUS training improved their ability to make clinical decisions (mean 4.45/5). Mean knowledge score was 78.9%.\u003c/p\u003e\n\u003cp\u003eNotably, the third enrolled class demonstrated significantly higher overall confidence after just one year of clinical training compared to the second enrolled class at a similar training point (prior to senior clerkship). Overall performing confidence was higher (3.94/5 vs 3.71/5, Cohen\u0026rsquo;s d = 0.55, p = 0.022), as well as overall interpreting confidence (3.96/5 vs 3.75/5, d = 0.47, p = 0.048). The largest differences were observed in obstetric ultrasound, where the third class reported substantially higher confidence in both performing (4.13/5 vs 3.14/5, d = 1.35, p \u0026lt; 0.001) and interpreting (4.24/5 vs 3.14/5, d = 1.62, p \u0026lt; 0.001), as well as kidney and bladder examinations (performing: 4.08/5 vs 3.47/5, d = 0.89, p \u0026lt; 0.001; interpreting: 3.84/5 vs 3.42/5, d = 0.60, p = 0.011). Cardiac performing confidence was also higher (4.45/5 vs 4.14/5, d = 0.62, p = 0.009). Interestingly, FAST examination confidence was lower in the third class (performing: 3.61/5 vs 4.31/5, d = -1.01, p \u0026lt; 0.001). These findings suggest that earlier integration of preclinical POCUS training may accelerate confidence development during clinical rotations (Supplementary Table 2).\u003c/p\u003e\n\u003cp\u003eStudents who completed the full preclinical curriculum reported that this foundation was valuable for clinical learning. Representative quotes included: \u0026ldquo;This training program is perfect to help students gain deeper understanding of ultrasound before getting in clinical practice\u0026rdquo;, \u0026ldquo;Excellent. Please continue the program. Makes students competent in the skill early on\u0026rdquo;, and \u0026ldquo;Over time continuous learning and practicing on actual patients has helped me advance.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInternship\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe surveyed the 30 students from the first graduating class during internship (n = 25, 83% response rate). This cohort had the most limited POCUS training, as the curriculum was implemented latest in their medical school trajectory. Of the 25 respondents, 17 (68%) reported using POCUS clinically during internship. All who used POCUS found it helpful (mean 4.76/5). Major reported barriers included lack of supervisors (56%), insufficient time (52%), lack of confidence to perform independently (36%), and lack of access to ultrasound (24%). Only one respondent (4%) reported disinterest in using POCUS. Representative quotes highlighted the clinical value: \u0026ldquo;It is a life saver! Sometimes at a hospital it\u0026rsquo;s hard to get a proper ultrasound especially during night shift!\u0026rdquo; and \u0026ldquo;Very helpful diagnostic tool especially in our resource limited settings where key investigations are not readily available.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFinal certification exam\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePrior to graduation, 27 of the 30 students completed the optional final POCUS certification exam, with 3 opting out. On the original 30-item multiple choice question exam, the mean score was 79.8% (standard deviation 10.6%) with an acceptable internal consistency (Cronbach\u0026rsquo;s alpha 0.7). Four students initially scored below the 70% threshold; three subsequently passed a remediation examination. On the 3-station OSCE exam, the mean overall score was 87.8% (standard deviation 5.2%), with one student requiring and passing remediation. Ultimately, 26 out of 27 students (96%) achieved institutional POCUS certification.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eProgram Evaluation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eUpon graduation, 17 of the 30 students from the first graduating class (57% response rate) completed a final program evaluation. Most students (94%) rated overall curriculum quality as \u0026ldquo;good\u0026rdquo; or better (mean 4.12/5), and all reported POCUS was useful for clinical practice. Most rated ultrasound access during training as at least \u0026ldquo;good\u0026rdquo; (88%, mean 4.41/5), though feedback and supervision received lower ratings (65% \u0026ldquo;good\u0026rdquo; or better). Consistency of teaching across rotations was identified as an area for improvement (53% rated \u0026ldquo;fair\u0026rdquo;, mean 3.29/5). Students identified internal medicine (94%), emergency medicine (76%), and obstetrics/gynecology (71%) as rotations where POCUS was most useful. Primary barriers were time (82%), limited supervision (59%), and lack of confidence (53%). Thematic analysis of open-ended responses recommended starting training earlier (45%), increasing rotations with POCUS sessions (45%), and improving supervision (27%).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe describe the development, implementation, and outcomes of an integrated, longitudinal POCUS curriculum at a medical school in rural Rwanda. This represents the first published description of such a curriculum in a low-income country. Our findings demonstrate that comprehensive POCUS education is feasible in low-income settings and produces graduates with strong foundational knowledge and clinical confidence in core ultrasound applications.\u003c/p\u003e \u003cp\u003eOur study captures data from multiple student cohorts at different stages of curriculum implementation, providing insight into both early outcomes and the evolving impact of the program. The first graduating class had the most limited POCUS exposure, as the curriculum was established latest in their training. Despite this, 96% of examined students achieved institutional certification, and during internship, 68% reported using POCUS clinically with universal endorsement of its utility. The second enrolled class, who received POCUS training throughout their clinical years, demonstrated significant improvements in confidence from senior clerkship through the end of clinical training. The third enrolled class that received the complete integrated curriculum from preclinical years demonstrated high confidence in core skills after just one year of clinical clerkships, with 89% agreeing that preclinical training facilitated clinical learning. While direct comparison between cohorts is limited by different assessment time points and instruments, these findings suggest that earlier initiation and more complete curriculum exposure may enhance skill development and perceived preparation for clinical practice.\u003c/p\u003e \u003cp\u003eThe certification examination results from the first graduating class are encouraging given their more limited training exposure. Mean scores of 79.8% on the written examination and 87.8% on the OSCE, with 96% ultimately achieving certification, suggest that even clinical-years-only POCUS training can produce graduates with adequate foundational competence. These outcomes compare favorably to published results from POCUS curricula in high-income settings, though direct comparisons are limited by differences in assessment methods and competency definitions.\u003c/p\u003e \u003cp\u003eLongitudinal confidence data from the second enrolled class revealed significant improvements, with largest gains in obstetric (performing d\u0026thinsp;=\u0026thinsp;1.70, interpreting d\u0026thinsp;=\u0026thinsp;1.45) and kidney/bladder examinations (performing d\u0026thinsp;=\u0026thinsp;1.03, interpreting d\u0026thinsp;=\u0026thinsp;1.05), consistent with dedicated senior clerkship training. Procedural guidance confidence also improved significantly (d\u0026thinsp;=\u0026thinsp;0.82), but remained lowest, reflecting limited procedural opportunities.\u003c/p\u003e \u003cp\u003eSeveral convergent themes emerged from student feedback across cohorts and training stages. Students consistently recognized the importance and value of POCUS training, expressing desire for additional sessions throughout their education. This enthusiasm, combined with nearly universal intention to integrate POCUS into future practice, suggests successful cultivation of positive attitudes towards point-of-care imaging.\u003c/p\u003e \u003cp\u003eNotably, the first graduating class, despite having the most limited training, recommended starting POCUS education earlier, a recommendation that aligns with evidence that earlier ultrasound exposure enhances anatomical understanding and physical exam skills. The third enrolled class\u0026rsquo;s experience provides early validation of this approach. Not only did 89% endorse that preclinical training helped clinical learning, but they also demonstrated significantly higher confidence after just one year of clinical training compared to the second enrolled class at a similar training point. Remarkably, their confidence in most domains after junior clerkship was comparable to or exceeded the confidence the second class achieved only after completing all clinical rotations. This suggests that comprehensive preclinical POCUS integration may compress the learning curve, allowing students to achieve competency benchmarks earlier in their training trajectory.\u003c/p\u003e \u003cp\u003eOur curriculum achieved its goals despite resource constraints through several strategies that may inform implementation in similar settings. First, the use of handheld ultrasound devices reduced equipment costs while maintaining portability across clinical sites. Second, partnership with the Global Ultrasound Institute provided high-quality online educational content, reducing the burden on local faculty to develop teaching materials and allowing face-to-face time to focus on hands-on skill development. Third, engagement from visiting faculty from partner institutions supplemented local teaching capacity, though this model has limitations for long-term sustainability.\u003c/p\u003e \u003cp\u003eThe primary challenges identified by students across all cohorts relate to the clinical context rather than the curriculum itself. During internship, the most frequently reported barriers were lack of trained supervisors, time constraints, and limited equipment access at district hospitals. These findings highlight a critical gap between educational preparation and practice environment readiness. Even well-trained graduates cannot fully use their skills without supportive infrastructure and ongoing mentorship.\u003c/p\u003e \u003cp\u003eAddressing these environmental barriers requires institutional and system-level interventions. Our institution has committed to training all clinical faculty in POCUS during 2026, which should improve supervision availability and modeling of ultrasound use in clinical practice. Broader adoption will require advocacy for equipment procurement at district hospitals and development of mechanisms for remote expert consultation, such as asynchronous scan review capabilities already being done through our online platform.\u003c/p\u003e \u003cp\u003eOur study has several limitations. First, confidence measures relied on self-report, which may not reflect actual competence; we did not measure clinical performance outcomes such as diagnostic accuracy or impact on patient management. Second, decreasing response rates among interns and graduating students may introduce selection bias, with more engaged students potentially overrepresented in feedback. Third, as a single-institution study with small cohort sizes, generalizability to other settings requires caution. Fourth, different cohorts were assessed at different time points with evolving survey instruments, limiting direct comparisons across cohorts. Finally, this report focuses on immediate educational outcomes; long-term follow-up will be needed to assess whether graduates maintain POCUS skills and integrate ultrasound into routine clinical practice.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAn integrated, longitudinal POCUS curriculum is feasible in a low-income setting and produces graduates with strong foundational knowledge, clinical confidence, and intention to use ultrasound in practice. Our experience demonstrates that common barriers to POCUS curriculum implementation, including limited trained faculty, curricular time constraints, and equipment costs, can be addressed through strategic partnerships, online learning resources, and portable ultrasound technology. Data from multiple cohorts at different stages of curriculum implementation suggest that earlier initiation of POCUS education may enhance skill development and perceived preparation for clinical practice. The primary remaining challenges relate to the clinical practice environment, particularly supervisor availability and equipment access at district hospitals. Future efforts will focus on expanding faculty development, advocating for infrastructure improvements, and establishing mechanisms for ongoing mentorship and quality assurance. Our curriculum model and lessons learned may inform other institutions seeking to integrate POCUS education into undergraduate medical training in resource-limited settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePOCUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePoint-of-care ultrasound\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow- and middle-income countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOSCE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eObjective structured clinical examination\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUGHE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUniversity of Global Health Equity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFAST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFocused assessment with sonography for trauma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. Participation in all surveys was voluntary. Informed consent was obtained from all participants through an introductory statement at the beginning of each survey. All survey responses were collected anonymously, with no personally identifiable information linked to individual participants. The study of our curriculum was approved by the University of Global Health Equity Institutional Review Board (Protocol Number 2024_231). Clinical trial number: Not applicable.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets generated and analyzed during the current study are not publicly available due to the small cohort sizes which could compromise participant anonymity, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: TW is a faculty instructor for the Global Ultrasound Institute. The University of Global Health Equity has a partnership with the Global Ultrasound Institute for educational content access. This partnership did not influence the design, analysis, or reporting of this study. All other authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: No external funding was received for this study.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions: CV, NS, NM, and KR conceived and designed the curriculum. CV, TW, NS, and KR contributed to curriculum implementation. CV, TW, and KR designed the study and collected data. CV performed data analysis and drafted the manuscript. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: The authors thank the faculty who contributed to the development and implementation of this curriculum. We are very grateful to our leadership, specifically the Dean of the School of Medicine, Abebe Bekele, who supported and championed this effort. We are particularly grateful to visiting faculty who provided essential teaching support: Aditya Mohanty, Lei Chen, Bruno Vargas, Nell Eisenberg, Andrew Liteplo, Onyinyechi Eke, Juan Lopez Tiboni, Alexander Bonnel, Rebecca Gerrity, Patrick Lanter, Monique Barros de Araujo, Samuel Hatfield, Kelly Bogaert, Anne Erickson, and Maria Small. We also thank our full-time clinical faculty for their ongoing commitment to ultrasound education: Ariane Nina Ndayikeje, Olayinka Ibrahim, Meghna Bhatter, Birhanu Abera Ayana, Zelalem Mengistu Gashew, Anteneh Gadisa Belachew, Biniam Ewnte Zelelew, Barnabas Alayande, Solomon Nega Techane, Adeline Mugeni, and Eden Abate. We acknowledge the standardized patients and clinical patients who generously participated in training sessions, as well as the students whose engagement and feedback shaped this curriculum. Finally, we thank Butterfly, Inc. for waiving subscription fees and the Global Ultrasound Institute for providing educational content, both of which were essential to the feasibility of this program.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eD\u0026iacute;az-G\u0026oacute;mez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. Ingelfinger JR, editor. N Engl J Med. 2021;385(17):1593\u0026ndash;602. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMra1916062\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra1916062\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpampinato MD, Luppi F, Cristofaro E, Benedetto M, Cianci A, Bachechi T, et al. Diagnostic accuracy of Point Of Care UltraSound (POCUS) in clinical practice: A retrospective, emergency department based study. 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J Graduate Med Educ. 2012;4(3):279\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4300/JGME-D-12-00156.1\u003c/span\u003e\u003cspan address=\"10.4300/JGME-D-12-00156.1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: University of Global Health Equity\u0026rsquo;s point-of-care ultrasound curriculum learning competencies. FAST: focused assessment with sonography for trauma; POCUS: point-of-care ultrasound; IVC: inferior vena cava; GS: gestational sac; CRL: crown rump length; BPD: biparietal diameter; FL: femur length; AC: abdominal circumference; HC: head circumference; IV: intravenous.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDomain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge Competencies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkills Competencies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGENERAL/ FOUNDATIONAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Describe basic ultrasound windows for cardiac, lung, abdomen, FAST, soft tissue, and obstetric examinations\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify clinical indications for POCUS examinations\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify limitations of POCUS and when alternative imaging is required\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Demonstrate proper use of ultrasound machines (probe selection, gain/depth adjustment, Doppler, measurements, image capture)\u003c/p\u003e\n \u003cp\u003e\u0026bull; Apply POCUS in clinical scenarios: determine when to perform, describe assessed findings, integrate into patient management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCARDIAC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Identify volume overload (IVC assessment)\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify pericardial effusion\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify poor LV contractility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Demonstrate proper windows, positioning, and technique\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLUNG\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Identify pneumothorax\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify B-lines (interstitial syndrome)\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify consolidation\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify pleural effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Demonstrate proper windows, positioning, and technique\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFAST\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Identify positive FAST examination findings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Demonstrate proper windows, positioning, and technique\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eABDOMINAL/ RENAL/ URINARY\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Identify liver abscess, cirrhosis, ascites\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify organomegaly\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify urinary retention\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify hydronephrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Demonstrate proper windows, positioning, and technique\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSOFT TISSUE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Identify soft tissue abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Demonstrate proper windows, positioning, and technique\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOBSTETRIC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003eFIRST TRIMESTER:\u003c/p\u003e\n \u003cp\u003e\u0026bull; Pregnancy dating (GS, CRL)\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify ectopic vs. intrauterine pregnancy\u003c/p\u003e\n \u003cp\u003e\u0026bull; Differentiate pregnancy types (normal, molar, blighted ovum, multiple gestation)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSECOND TRIMESTER:\u003c/p\u003e\n \u003cp\u003e\u0026bull; Pregnancy dating (BPD, FL, AC, HC)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTHIRD TRIMESTER:\u003c/p\u003e\n \u003cp\u003e\u0026bull; Biophysical profile\u003c/p\u003e\n \u003cp\u003e\u0026bull; Fetal biometry\u003c/p\u003e\n \u003cp\u003e\u0026bull; Placental location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Demonstrate proper windows, positioning, and technique for 1st, 2nd, and 3rd trimester examinations (including biometrics)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGYNECOLOGIC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Identify and characterize adnexal masses\u003c/p\u003e\n \u003cp\u003e\u0026bull; Measure endometrial thickness\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify free fluid in peritoneal cavity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Demonstrate proper windows, positioning, and technique\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePROCEDURAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Identify safe fluid pocket for thoracentesis/paracentesis\u003c/p\u003e\n \u003cp\u003e\u0026bull; Identify appropriate vein for peripheral IV cannula placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026bull; Demonstrate ultrasound-guided techniques for:\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; - Peripheral IV cannula placement\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; - Thoracentesis (static)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; - Paracentesis (static)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Map of competencies onto existing University of Global Health Equity medical school curriculum with brief description of educational sessions. POCUS: point-of-care ultrasound; GUSI: Global Ultrasound Institute; IVC: inferior vena cava; FAST: focused assessment with sonography for trauma; E-FAST: extended focused assessment with sonography for trauma; RUSH: rapid ultrasound for shock and hypotension; OSPE: objective structured practical examination; mini-CEX: mini-clinical evaluation exercise.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCourse/Module\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCompetency Domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Session Description\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYEAR 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 1, Semester 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eHomeostasis, Metabolism, and Function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eGeneral/\u003c/p\u003e\n \u003cp\u003eFoundational\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eIntroduction to ultrasound physics, image acquisition principles, probe selection, transducer manipulations. GUSI video prework. 60-minute didactic with 30-minute small groups to practice ultrasound.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYEAR 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 2, Semester 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eGastrointestinal System and Nutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eAbdominal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eReintroduce ultrasound basics. Identify liver, gallbladder, spleen, portal vein, IVC. Recognize ascites. Prework videos. 30-minute didactic with 30-minute small group scanning session using standardized patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 2, Semester 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eCardiovascular System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eCardiac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eIdentify cardiac chambers, aortic and mitral valves, IVC. Recognize systolic heart failure, pericardial effusion, valvular pathology. Correlate with cardiac physiology. Prework videos. 15-minute didactic with 30-minute small group scanning session using standardized patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 2, Semester 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eRespiratory System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eLung and Cardiac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eIdentify A-lines and lung sliding. Identify diaphragm. Assess diaphragmatic excursion. Assess IVC diameter variation with respiration. Recognize normal vs. consolidated lung. Prework videos. 15-minute didactic with 30-minute small group scanning session using standardized patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 2, Semester 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eRenal and Urinary Systems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eAbdominal/\u003c/p\u003e\n \u003cp\u003eRenal/\u003c/p\u003e\n \u003cp\u003eUrinary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eImage and identify bladder and both kidneys. Recognize hydronephrosis and renal cysts/masses. Prework videos. 15-minute didactic with 30-minute small group scanning session using standardized patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYEAR 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eIntroduction to the Practice of Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eGeneral/\u003c/p\u003e\n \u003cp\u003eFoundational, Cardiac, Lung, and FAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eReview ultrasound technology, probe selection, knobology. Identify normal anatomy of major organs. Correlate ultrasound with physical exam findings. Demonstrate proper techniques for image acquisition. Recognize cardiac, pulmonary, and FAST exam pathology. GUSI video prework. Two 4-hour sessions with a mix of didactics (total 4 hours) and small group scanning using standardized patients (total 4 hours).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eParticipation\u003c/p\u003e\n \u003cp\u003egrade and OSCE\u003c/p\u003e\n \u003cp\u003estation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eInternal Medicine Junior Clerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eCardiac and\u003c/p\u003e\n \u003cp\u003eAbdominal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eIndications for bedside echocardiogram and abdominal ultrasound. Identify volume status via IVC, systolic dysfunction, tamponade, cirrhosis, ascites, liver abscess. Demonstrate parasternal long axis and subxiphoid cardiac views. GUSI videos. 45-minute didactic session. Small group scanning sessions on the wards.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eOSCE station, logbook, scan reviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eSurgery Junior Clerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eFAST and Soft Tissue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eIndications for FAST exam. Identify free fluid in FAST windows. Demonstrate FAST views. Characterize soft tissue abscess vs. cyst vs. cellulitis. Small group scanning sessions on the wards.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eOB/GYN Junior Clerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eObstetric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eUltrasound not formally included in junior clerkship but students are exposed on the wards/clinic, especially obstetric ultrasound.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMultiple choice questions on final exam related to ultrasound.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003ePediatrics Junior Clerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eIndications for lung ultrasound. Identify pneumonia, B-lines, pleural effusion, pneumothorax, consolidation. Assess lung sliding and use M-mode. GUSI videos. 60-minute didactic session. Small group scanning sessions on the wards.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eOSCE station\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYEAR 4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eDiagnostic Radiology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eGeneral/\u003c/p\u003e\n \u003cp\u003eFoundational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eAdvantages and limitations of ultrasound. Common emergency conditions. Indications for breast, musculoskeletal, testicular, biliary, and renal ultrasound.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eOSPE stations (diagnostic ultrasound interpretation)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eAnesthesia and Critical Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eProcedural, Cardiac, and Lung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eDistinguish veins from arteries/nerves. POCUS in critically ill patients. Ultrasound-guided IV placement. Integrate cardiac/lung findings in shock and respiratory failure management. GUSI videos. Practice scanning on the wards.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eLogbook\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eEmergency Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eFAST and Procedural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eIndications for E-FAST and RUSH exams. Perform and interpret E-FAST and RUSH. Ultrasound-guided vascular access. GUSI videos. 2-3 didactic sessions. Practice scanning on the wards.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eLogbook, scan reviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYEAR 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 5, Semester 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eInternal Medicine Senior Clerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eCardiac, Abdominal/\u003c/p\u003e\n \u003cp\u003eRenal/Urinary, and Lung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eAdvanced: All 4 cardiac views, assess systolic function, integrate into management. Kidney/bladder in 2 planes, identify hydronephrosis and retention. Measure liver span, identify ascites, determine safe paracentesis pocket. Lung ultrasound for effusion and pneumothorax. Image optimization. GUSI videos. 45-minute didactic session. Small group scanning sessions on the wards.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eOSCE station, mini-CEX, logbook, scan reviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 5, Semester 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eSurgery Senior Clerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eFAST, Soft Tissue, and Procedural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eReview and advance FAST skills. Perform full FAST and create management plan. Identify soft tissue abscess. Small group scanning sessions on the wards.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 5, Semester 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eOB/GYN Senior Clerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eObstetric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eIndications for obstetric ultrasound \u0026ndash; 1\u003csup\u003est\u003c/sup\u003e, 2\u003csup\u003end\u003c/sup\u003e, 3\u003csup\u003erd\u003c/sup\u003e trimester. Identify intrauterine pregnancy in 1\u003csup\u003est\u003c/sup\u003e trimester. Determine fetal heart rate. Perform obstetric triage ultrasound (position, placenta, fluid). Multiple gestation, fetal anatomy (head, spine, extremities, abdomen, thorax), retained products, ectopic pregnancy. Perform biometry for gestational age. Perform biophysical profile. Didactic sessions, simulation sessions. Small group scanning sessions on the wards/clinic.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eMid-clerkship and final OSCE station, multiple choice questions on ultrasound on clerkship exam, mini-CEX\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eYear 5, Semester 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003ePediatrics Senior Clerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eCardiac and Lung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eIndications for pediatric cardiac ultrasound. Identify severe valvular pathology and heart failure. Advanced lung ultrasound with focus on identification of pneumonia. 60-minute didactic session. Small group scanning sessions on the wards.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eLogbook, scan reviews\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eINTERNSHIP/GRADUATION\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eInternship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eAll Clinical Settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003eAll Domains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eContinued application and practice of all POCUS skills in supervised clinical settings. GUSI videos (self-directed). Review of uploaded scans by clinical faculty (not required).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003ePre-internship exit exam includes OSCE station.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: Confidence ratings using a 5-point Likert scale (Strongly Disagree to Strongly Agree) from pre- and post-test surveys before and after the intensive training course during the Introduction to the Practice of Medicine module. POCUS: point-of-care ultrasound; SD: standard deviation.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eConfidence Item\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePre-test mean (SD)\u003c/p\u003e\n \u003cp\u003en = 47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePost-test mean (SD)\u003c/p\u003e\n \u003cp\u003en = 47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eI know what POCUS is\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.53 (1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.70 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eAdjusting depth to improve image quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2.81 (0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.53 (0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eAdjusting gain to improve image quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2.72 (0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.53 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eUsing probe maneuvers to optimize view\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.17 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.30 (0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eDistinguishing bone, soft tissue, fluid, and air on ultrasound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e3.53 (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.55 (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eAsking a clinical question with POCUS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2.64 (0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.26 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003ePerforming an ultrasound of the heart, lung, and abdomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2.83 (0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e4.28 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4: Longitudinal changes in POCUS confidence across clinical training. Confidence in performing and interpreting POCUS examinations using a 5-point Likert scale (Strongly Disagree to Strongly Agree) from surveys performed prior to senior clerkship and at the end of clinical rotations prior to internship. Student-level means were calculated and the resulting values summarized for the overall means. POCUS: point-of-care ultrasound; SD: standard deviation; FAST: focused assessment with sonography for trauma.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eConfidence Item\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMean prior to senior clerkship (SD)\u003c/p\u003e\n \u003cp\u003en = 36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003eMean prior to internship (SD)\u003c/p\u003e\n \u003cp\u003en = 32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eI am confident performing each of the following exams:\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eCardiac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4.14 (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.19 (0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.97 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.03 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eAbdominal (liver and spleen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4.14 (0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.34 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eKidney and bladder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.47 (0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.16 (0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eFAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4.31 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.25 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e-0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eObstetric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.14 (0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.25 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eProcedural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2.83 (1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.59 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eOverall mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.71 (0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.12 (0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 624px;\"\u003e\n \u003cp\u003eI am confident interpreting each of the following exams:\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eCardiac\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4.00 (0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.12 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.81 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.94 (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eAbdominal (liver and spleen)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.81 (0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.25 (0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eKidney and bladder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.42 (0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.16 (0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eFAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e4.31 (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.31 (0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.961\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eObstetric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.14 (0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.16 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eOverall mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.75 (0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.16 (0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Point-of-care ultrasound, Curriculum development, Resource-limited","lastPublishedDoi":"10.21203/rs.3.rs-8981205/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8981205/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 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eKnowledge scores improved significantly following educational sessions, from 68.8% to 90.0% after the introductory session (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and from 69.3% to 93.1% after intensive training (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with very large effect sizes on confidence measures (Cohen\u0026rsquo;s d 1.39\u0026ndash;2.38). Longitudinal assessment of one cohort demonstrated significant improvements in overall performing confidence (d\u0026thinsp;=\u0026thinsp;1.11, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and interpreting confidence (d\u0026thinsp;=\u0026thinsp;0.93, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) across clinical training, with largest gains in obstetric (d\u0026thinsp;=\u0026thinsp;1.70) and renal/bladder (d\u0026thinsp;=\u0026thinsp;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\u0026thinsp;=\u0026thinsp;0.55, p\u0026thinsp;=\u0026thinsp;0.022; interpreting: d\u0026thinsp;=\u0026thinsp;0.47, p\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAn 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.\u003c/p\u003e","manuscriptTitle":"Integrated Point-of-Care Ultrasound Training in a Rwandan Medical School: Curriculum Development, Implementation, and Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-26 15:44:08","doi":"10.21203/rs.3.rs-8981205/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T10:10:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T18:13:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-19T19:45:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"169609060087671265222815738594361860463","date":"2026-04-19T19:11:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222077204611898777194657901351082602883","date":"2026-04-18T09:56:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-16T19:12:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-08T18:39:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-11T15:37:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-10T05:50:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-09T17:25:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce265cea-e4e4-4641-90a2-9d9cecc0c81a","owner":[],"postedDate":"April 26th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T10:10:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T18:13:18+00:00","index":54,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T10:26:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-26 15:44:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8981205","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8981205","identity":"rs-8981205","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}