Educational needs, self-reported competency and curriculum priorities for point-of-care ultrasound among paediatric surgical providers across Africa: a multinational assessment

In many hospitals, a doctor's ability to see inside a patient's body without making an incision is a matter of life and death. For decades, this view has relied on large, stationary machines operated by specialized technicians, often located far from the patient's bedside. Point-of-care ultrasound, known as POCUS, changes this dynamic. It is a handheld device that allows a clinician to perform an ultrasound examination right where the patient lies, turning the doctor into their own imaging specialist. This tool is particularly vital in pediatric surgery, where children can deteriorate quickly, and conditions like a twisted intestine or internal bleeding from an injury need to be identified immediately. While the technology has become a standard skill in many parts of the world, its adoption in Africa has been uneven, constrained by a lack of equipment, training, and clear guidelines on how to teach it.

A new multinational study seeks to map the landscape of this skill across the African continent. Researchers from institutions in Germany, Tanzania, Turkey, Nigeria, South Africa, and the United Kingdom, working with the Pan-African Paediatric Surgical Association, set out to understand the reality for pediatric surgeons and providers in Africa. They wanted to know if these doctors had access to ultrasound machines, whether they were using them, how confident they felt in their own abilities, and what they needed to learn. To find out, the team sent a detailed survey to pediatric surgical providers in twenty-nine different African countries between March and October 2025. The survey asked about their daily work, the resources available to them, and their opinions on the most important medical conditions to scan for.

The results reveal a stark contrast between the high value placed on this technology and the reality of its use. Out of the 149 doctors who responded, representing a wide geographic spread from East to North Africa, only about one-third reported having an ultrasound machine available in their own department. Nearly a quarter said they had no access to such equipment at all. This lack of access was not random; it fell hardest on younger doctors. Those with less than two years of experience were far more likely to report having no machine available compared to their more senior colleagues. Even where machines existed, the path to using them was often blocked by other hurdles. Many providers cited the high cost of imaging for patients, a shortage of radiologists and sonographers to operate the machines, and hospital policies that restricted ultrasound use to radiology departments only. These structural barriers meant that even when a doctor knew a scan was needed, they often had to wait hours for a formal radiology appointment, a delay that can be critical for a sick child.

Despite these obstacles, the desire to use ultrasound is undeniable. More than a third of the respondents admitted they did not use point-of-care ultrasound in their routine practice, and among those who did, most performed fewer than ten scans a month. However, the gap between current use and potential use is wide. The doctors surveyed identified specific medical scenarios where they felt ultrasound would be most helpful. These included checking for blockages in the bowel, diagnosing a condition where the intestine telescopes into itself, scanning the brains of newborns, and guiding needles for draining infections or placing IV lines. Almost every single respondent expressed a strong interest in receiving formal training, and nearly all supported the idea of making ultrasound a required part of pediatric surgical education.

The study also uncovered a significant gap in confidence and skill. When asked to rate their own abilities, nearly forty percent of the doctors said they had no detectable skills with ultrasound at all. Another eighteen percent felt they had limited skills but lacked the confidence to perform scans independently. Only a tiny fraction, about seven percent, felt capable of teaching others how to do it. The data showed that having access to a machine and having attended a formal training course were the strongest factors linked to feeling competent. Doctors who had taken a structured course were far more likely to feel skilled than those who had not, suggesting that simply having a machine is not enough; guided education is essential.

The findings paint a clear picture of a workforce that recognizes the power of bedside ultrasound but lacks the tools and training to wield it effectively. The researchers conclude that while the demand for education is universal, the current system cannot support it without significant changes. They argue that future efforts must go beyond just teaching doctors how to hold a probe. Successful implementation requires a combination of structured curricula, the development of local teachers who can train others, and a commitment to providing the necessary equipment. By addressing these educational and structural needs, the medical community in Africa can build a stronger, more capable workforce, ensuring that children in diverse healthcare settings have equitable access to timely and accurate diagnosis.