Feasibility of point-of-care ultrasound training and remote quality assurance for community physicians in conflict-affected Syria.

BACKGROUND

Point-of-care ultrasound (PoCUS) can extend diagnostic capabilities where conventional imaging is unavailable, yet evidence on its implementation in active conflict zones remains scarce. We describe the operational feasibility of a PoCUS training, device deployment, and remote quality assurance program for community physicians working in village clinics in Syria.

METHODS

Nine physicians from five community clinics, none of whom had prior PoCUS training and whose ultrasound experience was limited to specialty-specific applications, participated in a two-day in-person PoCUS training course adapted to a conflict-affected, resource-constrained setting. The curriculum focused on cardiac, lung, FAST, and soft-tissue applications. At course completion, each clinic received a handheld ultrasound device (iQ, Butterfly Network, Inc, Guilford, CT, USA). The participants subsequently uploaded examinations to a cloud-based platform for remote expert review and feedback. Outcomes included immediate post-course satisfaction, perceived confidence, and early post-course PoCUS use over 6 months of follow-up. PoCUS competency was not objectively assessed.

RESULTS

Overall satisfaction was high (mean, 9.2/10; SD, 0.8), and eight participants (89%; 95% CI, 57-98%) would recommend the course to colleagues. All participants reported that hands-on practice increased their confidence. The duration of hands-on practice received the lowest rating (mean, 2.9/5), and six of seven participants who offered suggestions recommended more training time. During follow-up, four physicians from four clinics uploaded 12 examinations; 11 of 12 examinations (92%; 95% CI, 65-99%) were classified as adequate quality on initial review by a single, non-blinded expert reviewer.

CONCLUSION

A brief, context-adapted PoCUS training program with device deployment and remote expert feedback was operationally feasible and well received by community physicians in conflict-affected Syria. Early post-course use was observed but limited, and competency was not assessed. These findings demonstrate the feasibility of implementation rather than educational effectiveness or clinical impact, and provide a framework for larger prospective studies incorporating extended hands-on training, structured competency assessment, standardized blinded image-quality review, and longer follow-up.