Background: Objective assessment of skills after training is essential for safe implementation
of lung point-of-care ultrasound (POCUS). In low-and middle-income countries (LMIC) there
is a need for assessment tools without onsite experts to scale up POCUS access.
Objectives: To develop a web-based validated assessment tool and evaluate trainees across
different countries and at different time points after initial training.
Methods: We adapted the objective and validated LUS score (LUS-OSAUS) to a web-based
tool with quiz and practical skills test. Trainees were evaluated after a short (4-day)
standardized lung POCUS training and were classified in distinct groups according to (i) their
geographical location (Benin vs. South-Africa) and (ii) time elapsed since training (Benin 0
months vs. Benin 6 months). Skills test images were read by two blinded experts. We report the
overall success rates and then compare these rates based on location and timing since training,
using the Fischer’s exact test.
Results: A total of 35 out of 43 participants completed the online LUS-OSAUS quiz and skills
test. The overall success rate was 0.84 (95%CI 0.80-0.88), with lower success rates for “correct
depth” 0.54 (0.37-0.71), “correct assessment of pleura” 0.63 (0.45-0.79) and “conclusion” 0.71
(0.54-0.85). There were no differences based on location, with respective rates of 0.86 (0.80-
0.92) and 0.83 (0.75-0.91) (p-value = 0.125) for Benin and South Africa at 0 months,
respectively. Similarly, there were no differences according to timing with success rates of 0.86
(0.80-0.92) and 0.82 (0.72-0.93) (p-value=0.563) for Benin at 0 months and 6 months,
respectively.
Conclusion: Web-based objective and structured assessment of lung POCUS skills in LMIC
following a short-standardized training is feasible and has a good overall success rate with
consistent results across regions and up to 6 months after training. Overall, technical and
POCUS-based clinical conclusion skills are the most difficult to acquire.