Point-of-care ultrasound (PoCUS) is widely recognised as a valuable tool in modern medicine, enhancing diagnostic accuracy and procedural safety across multiple specialities.¹ Its real-time imaging capabilities reinforce anatomical understanding, improve physical examination skills and support clinical decision-making.² Accordingly, many high-income countries (HICs) have successfully integrated structured PoCUS training into undergraduate medical curricula.^3,4

In contrast, South Africa lacks standardised PoCUS education, resulting in limited student exposure before entering clinical practice.⁵ This absence of structured training may compromise junior doctors’ early proficiency, particularly in resource-limited settings where advanced imaging is not readily available.⁶ Although early exposure to PoCUS has been shown to improve competency, confidence and diagnostic accuracy in medical trainees,^7,8 broader implementation in low- and middle-income countries (LMICs) is hindered by barriers such as insufficient faculty training, limited curriculum capacity and constrained access to ultrasound equipment.⁹

Globally, several postgraduate frameworks have formally recognised the importance of PoCUS. The American Board of Medical Specialities included PoCUS in certification requirements in 2021, with formal assessment introduced in 2022.¹⁰ Similarly, the Accreditation Council for Graduate Medical Education (ACGME) mandates PoCUS training in core applications such as echocardiography and image-guided procedures.¹¹ In Canada, structured postgraduate programmes train residents in cardiac, lung, airway and gastric ultrasound.¹² While these initiatives are aimed at postgraduate trainees, they reflect a broader shift towards recognising PoCUS as a core clinical skill, supporting calls for its integration earlier in medical education to establish foundational competency.

In South Africa, professional bodies such as the Emergency Medicine Society of South Africa (EMSSA) and the South African Society of Anaesthesiologists (SASA) advocate standardised PoCUS education. The EMSSA’s current guidelines primarily address credentialling for clinicians and junior doctors.⁴ While these recommendations do not extend to undergraduates, they highlight a growing national consensus around the value of PoCUS. However, a structured undergraduate training framework and competency assessments remain absent.^4,13

International guidelines recommend incorporating PoCUS into undergraduate medical curricula to enhance clinical training.^2,14 A systematic review by Davis et al.,³ which analysed 95 studies, found ultrasound training most commonly part of anatomy (24%), physical examination (11%) and emergency medicine (8%) courses.

Despite these advances, consensus on the optimal model for PoCUS training remains elusive.^15,16 Curricula vary widely, incorporating didactic lectures and hands-on training, with durations ranging from brief workshops to longitudinal courses.^{3,17,18,19,20,21} Barriers, including curriculum constraints, faculty shortages and equipment limitations, continue to impede implementation in South Africa and globally.^5,22,23

Wells et al.⁴ noted that insufficient PoCUS exposure during South African medical training reduces clinical competency among junior doctors. Addressing these gaps by structured curricular integration and faculty development is essential. However, limited research exists evaluating the impact of PoCUS training at the undergraduate level in South Africa.^5,24

This study evaluates a structured PoCUS training programme implemented at the University of the Witwatersrand. It assesses the programme’s impact on final-year medical students’ knowledge, attitudes and clinical application. As one of the few studies conducted in an LMIC context, its findings may help inform national curriculum development, support the early integration of PoCUS into undergraduate education and guide implementation strategies in similar resource-constrained environments.

A total of 124 final-year medical students volunteered for the study. Of these, 76 attended the in-person PoCUS workshop and completed the baseline questionnaire. Seventy students (92.1%) also completed the follow-up questionnaire and were included in the final analysis, preserving the integrity of the one-group pre-test-post-test design.

Figure 1 and Figure 2 illustrate changes in students’ PoCUS usage patterns and frequency following the training intervention. The proportion of students who reported engaging in supervised hands-on scanning or simulation-based practice increased (p < 0.05), and the number of students with no prior exposure or who had only observed PoCUS decreased. Additionally, the frequency of PoCUS use increased, with more students reporting weekly or more frequent practice post-training (p < 0.05).

Figure 3 displays reported use of specific PoCUS applications before and after training, based on free-text responses subsequently grouped into clinical domains. In addition to reported use, students were asked to identify PoCUS applications with which they were familiar. Before training, awareness was highest in obstetrics and gynaecology (18.6%), while 4.3% of students reported no knowledge of any PoCUS applications. Overall, awareness increased post-training, with the proportion of students reporting no awareness decreasing to 1.4%. Notable increases were observed in awareness of trauma and emergency medicine applications (from 8 to 18 students) and vascular access (0 to 14 students). Despite these improvements, reported post-training PoCUS application use remained concentrated in eFAST and vascular access (p < 0.01).

Figure 4 summarises changes in students’ perceptions of PoCUS. At both time points, PoCUS was consistently rated as a valuable clinical tool, particularly for enhancing physical examination skills and improving patient safety. Post-training, a modest but statistically significant increase was observed in positive perceptions (p < 0.05), with more students strongly agreeing that PoCUS is relevant to their clinical development and should be integrated into undergraduate training.

Figure 5 illustrates students’ PoCUS knowledge scores before and after the training. Baseline scores were low across domains, with significant post-training improvements observed (overall increase: 14.66%; p < 0.01). The most substantial gains were observed in questions related to vascular applications (from 47.6% to 64.8%) and eFAST (from 51.4% to 67.7%).

PoCUS is increasingly recognised as a fundamental skill for modern clinicians, with growing evidence supporting its integration into undergraduate medical education.²⁶ This study contributes to that body of work by demonstrating that a structured PoCUS training programme significantly improved final-year medical students’ knowledge, attitudes and use of ultrasound.

Supervised PoCUS use increased from 37.1% to 47.1%, while passive observation decreased from 47.1% to 14.3%. However, independent use remained static at 1.4%, suggesting that, despite improved knowledge and confidence, students may have lacked self-perceived competence to perform scans independently or encountered institutional barriers limiting clinical autonomy, highlighting the need for sustained supervision and accessible mentorship models. These findings align with prior research indicating that single-session training is insufficient for achieving long-term proficiency or independent clinical application.^23,27

Implementation barriers remain particularly prominent in LMICs. In HICs, integration is typically facilitated by consistent mentorship, dedicated curricular time and widespread ultrasound machine availability.¹⁴ In contrast, PoCUS programmes in South Africa and similar LMICs are frequently constrained by limited resources, inconsistent faculty expertise and a lack of protected scanning time during clinical rotations.^9,28 A national study from Denmark reported that, despite 95.7% of interns receiving formal PoCUS education, insufficient supervision and limited hands-on exposure impeded skill development.²⁶ These findings highlight that equipment availability alone is inadequate and must be complemented by repeated hands-on practice, structured feedback and faculty development.^24,26

Students demonstrated significantly improved perceptions of PoCUS post-training, recognising its value in enhancing procedural safety (p < 0.05), supporting physical examination skills (p < 0.05) and contributing to clinical decision-making (p < 0.001). However, post-training awareness and usage focused mainly on a narrow set of applications, particularly eFAST and vascular access. While these are often prioritised in acute care, the findings may reflect a lack of exposure to more diverse clinical applications. This highlights the need for multidisciplinary and longitudinal clinical integration to broaden competence across a wider range of PoCUS applications.^3,15

The intervention’s interactive, hands-on design likely contributed to the observed improvements in knowledge and confidence, particularly in high-yield domains such as eFAST (51.4% to 67.7%) and vascular access (47.6% to 64.8%). These results echo previous findings that practical workshops outperform didactic teaching in promoting student engagement and knowledge retention.^29,30 Nonetheless, concerns persisted regarding limited practical time and inadequate access to scanning machines during clinical rotations. In HICs, longitudinal PoCUS integration through embedded curricula and consistent clinical exposure has been shown to mitigate these barriers and support continued skill acquisition.¹⁵

Student satisfaction was high, with mean Likert scale ratings exceeding 6.6 out of 7 across all measured domains. Qualitative feedback revealed enthusiasm and a desire for extended practical sessions, additional learning resources such as pre- and post-course materials and greater consistency in teaching approaches among instructors. These insights are consistent with international literature, highlighting the global demand for structured, ongoing PoCUS education.^17,31

Compared to established models in HICs, this study illustrates the unique implementation challenges in LMICs, particularly faculty shortages, limited equipment access and fragmented curricula. While even resource-rich settings face mentorship and time constraints, LMICs require scalable, context-specific solutions. These may include student-led ultrasound interest groups, peer-assisted learning models and shared-use mobile ultrasound machines.²⁸ Low-cost simulation tools and asynchronous online modules may further enhance skill retention and accessibility. Collectively, these strategies could promote continuous learning and mitigate skill attrition without extensive resource investment.^24,25

This study demonstrates that structured PoCUS training significantly enhances undergraduate medical students’ knowledge, attitudes and use of ultrasound, particularly in high-yield applications such as eFAST and vascular access. While these outcomes are encouraging, persistent challenges, including limited access to ultrasound machines, faculty variability and insufficient opportunities for ongoing practice, continue to hinder independent clinical application.

Medical curricula may adopt longitudinal models supported by structured mentorship, sustained clinical exposure and context-appropriate innovations such as peer-assisted learning and low-cost simulation to advance PoCUS integration in LMICs. As one of the few studies evaluating undergraduate PoCUS training in a resource-constrained setting, these findings offer valuable insights for medical educators and policymakers seeking to expand diagnostic capacity and ultrasound access in LMICs. Embedding PoCUS education early and consistently in undergraduate programmes is essential to prepare future clinicians for resource-sensitive, point-of-care decision-making.