Efficacy of a novel smartphone-based ultrasonography curriculum in rapidly training low- and middle-income country trauma care providers.

Abstract

Hemorrhage is the leading cause of preventable trauma death in Cameroon, yet only 4% of injured patients receive imaging capable of diagnosing hemorrhage. Smartphone-based ultrasonography (SBU) may enable extended focused assessment of sonography for trauma (eFAST) in resource-poor settings, but a context-informed eFAST curriculum is needed to rapidly train providers in Cameroon to identify life-threatening injuries. We hypothesized that trauma providers in Cameroon could gain eFAST competence following a novel SBU training. We developed a novel 5-hour SBU eFAST curriculum, which underwent iterative revision and testing on Cameroonian medical students until 80% of three cohorts achieved skill metrics. The curriculum was then administered to all trauma providers at three Cameroonian hospitals and evaluated for educational efficacy, usability, and acceptability. Extended focused assessment of sonography for trauma competence was defined as achieving usable images on a validated quality scale and >80% on a knowledge assessment including image interpretation. Usability and acceptability were evaluated using the System Usability Scale and Likert surveys. Five providers participating in train-the-trainers (TT) program went on to administer additional trainings; performance was compared between TT- and investigator-led trainings. Twenty-six students and 26 trauma care providers received SBU training. Overall, 81% (n = 21) of medical students achieved eFAST competence. Educational efficacy improved from 60% to 100% over three curriculum iterations. Subsequently, 100% (n = 26) of trauma care providers achieved SBU competence. Smartphone-based ultrasonography usability (interquartile range, 70-82.5) and acceptability were extremely high; all providers agreed that SBU will improve diagnosis of hemorrhage (Likert interquartile range, 5-5). There were no statistical differences in provider competence between investigator- and TT-led trainings. Cameroonian trauma care providers can attain eFAST competence following one 5-hour SBU training. A multisite prospective trial will assess SBU feasibility and effectiveness in expanding diagnostic capacity and reducing preventable deaths. Therapeutic/Care Management; Level III.