A Responsibly-Minded Approach to Virtual Echocardiography Training of Non-Specialists in Haiti and Beyond

PROBLEM: Cardiovascular disease in Haiti is a major public health issue, yet fewer than 17 cardiologists are present nationwide. Consequently, general practitioners assume a substantial portion of demand for complex disease management. Following their experience of the 2019 International Cardiology Curriculum Accessible by Remote Distance Learning (ICARDs), the authors identified a desire for practical instruction in echocardiography and a low-cost, effective imaging tool to screen for pertinent heart conditions. Current geopolitical challenges in Haiti render in-person echocardiography training unfeasible. A novel remote echocardiology curriculum for internal medicine residents could meet this challenge in a manner that is effective, sustainable, and sensitive to the Haitian context. APPROACH: University Hospital of La Paix served as the pilot intervention site for the Focused Echocardiography Training Intervention Package (FETIP). Portable ultrasound devices and a telemedicine-enabled robot were selected to mediate remote training, which was delivered in September of 2023 to 16 internal medicine residents over the course of 12 weeks. The first phase of training included live didactic sessions created and delivered by board-certified cardiologists. In the second phase, residents received hands-on training in image acquisition under direct supervision. The third phase centered on image interpretation skills. A diverse Training Advisory Board oversaw the implementation of FETIP and offered guidance for ongoing refinements. OUTCOMES: Results demonstrate improvement in three primary endpoints: fundamentals of knowledge, image acquisition, and image interpretation. Residents not only improved their technical performance but also applied echocardiography in appropriate clinical contexts, identifying previously unrecognized cases of heart failure. NEXT STEPS: The challenges in cardiovascular care in Haiti are ongoing, yet technology-driven training models like FETIP provide meaningful support to Haitian physicians, leading to future self-sufficiency in echocardiography. Further, the authors' experience offers the global medical community a scalable framework for echocardiography training for use in other resource-limited settings.