Evaluating a PEN-Plus training of trainers program in cardiac point-of-care ultrasound in Sub-Saharan Africa: Protocol and initial results

IntroductionAccess to cardiac diagnostics is limited in rural areas of low- and lower middle-income countries (LMICs). The Package of Essential Noncommunicable Disease Interventions - Plus (PEN-Plus) strategy decentralizes and integrates care for severe noncommunicable diseases, including cardiac disease, to more accessible facilities for this population. Given the shortage of healthcare providers, training frontline clinicians to perform simplified cardiac point-of-care ultrasound (POCUS) and equipping them to train others is essential. This study describes a novel approach to preparing non-specialists as trainers and mentors in cardiac POCUS. MethodsThis study evaluates the effectiveness and implementation outcomes of a training of trainers (ToT) program within the PEN-Plus strategy. Midlevel providers and generalists from five African countries were nominated by their employers as candidate trainers. The seven selected candidates participated in virtual and in-person training, which covered essential teaching skills and provided supervised cardiac POCUS teaching simulation. The Kirkpatrick model provided the program evaluation framework. Results of the initial post-training assessment encompassing Level 1 (Reaction) and Level 2 (Learning Assessment) are presented here. Level 3 (Behavior) will be assessed at 6 months and examine skills application, training environment, and barriers. Level 4 (Results) will be evaluated using the RE-AIM implementation framework at 12 months. Exploratory analyses will examine links between initial training assessment variables and short-term implementation outcomes. Preliminary resultsMost trainers reported high satisfaction with the ToT program. All strongly agreed that content was relevant and they would recommend the program to colleagues. Experts scored most trainers as Excellent or Very Good in all Level 2 domains. Most trainers attained the highest score across all competencies on trainee evaluations.