Developing procedural ultrasound capacity in Malawi through a focused training course

Introduction: Ultrasound is an essential tool in resource limited settings. However, significant barriers limit the adoption of ultrasound-guided procedures, including lack of structured training, supervision, and integration into clinical workflows. This study aimed to develop, implement, and evaluate a focused ultrasound-guided procedure training course and early clinical uptake in a tertiary care setting in Malawi. Methods: This is an implementation pilot. We conducted an informal needs assessment by way of semi-structured stakeholder interviews to inform course development. Quantitative outcomes for one anchor skill (fascia iliaca block) included knowledge testing, OSCE performance, procedure utilization logs during a 6-week support period, and confidence assessments immediately post-course and after 12 months. Results: Twenty-eight doctors from multiple specialties completed the ultrasound-guided procedure course, with 27 completing pre- and post-course assessments. Mean knowledge scores for the anchor skill increased from 47.7% pre-course to 74.8% post-course (p <0.01). All participants demonstrated competency in fascia iliaca block on post-course OSCE assessment. Post-course confidence was high across most domains and remained elevated among respondents at 12-month follow-up. During the six-week post-course support period, seven ultrasound-guided procedures were performed with support from the ultrasound team. Conclusion: Implementation of an affordable ultrasound guided procedure course is feasible in resource limited settings within the appropriate setting. Implementation of a new skill utilizing the same is feasible but efficacy cannot be determined from this study.