Open-access RUSH protocol course improves knowledge and perceived confidence among healthcare learners

The Rapid Ultrasound in Shock (RUSH) protocol is an effective point-of-care ultrasound (POCUS) tool for diagnosing shock, yet access to training is limited by high costs, instructor shortages, and global disruptions like COVID-19. This study evaluates the impact of an open-access RUSH course on enhancing knowledge and perceived confidence among healthcare learners, focusing on those from Low- and lower-middle-income countries (LIC and LMICs) and with varying levels of prior ultrasound experience. The online RUSH protocol course offered by the International Emergency Medicine (iEM) Education Project via iem-course.org. Participants completed pre- and post-course surveys that gathered demographic information and assessed their confidence using a 0-to-10 Likert scale. Pre- and post-course quizzes were included to measure knowledge gain. Quantitative and qualitative analyses were done as appropriate. Of 1,008 participants, 982 completed the pre-course survey; 46.0% reported no formal ultrasound training at their institutions, and 40.2% had never attended an ultrasound course. Participants were from 100 countries, with 67.3% from Asia and 40.5% from LIC and LMICs. Knowledge scores significantly improved from 60.0 (46.7–73.3) to 86.7 (80.0–93.3) (p < 0.001), and perceived confidence also increased (p < 0.001). No differences were found in score improvements between income groups, though those without prior experience showed greater knowledge gains than those with experience (26.7 vs. 20, p = 0.003). Additionally, 20.5% of participants provided feedback, noting high satisfaction and suggesting scenario-based videos, more challenging quizzes, and offline resources to enhance the course. Online education proved to be successful in teaching an advanced ultrasound course by significantly improving knowledge and perceived confidence about the RUSH protocol. The course was attended by a large number of participants globally and was successful for those from LIC and LMICs, and those without prior ultrasound training experience. The online course can be considered as a preparatory phase which saves time for more advanced hands-on practice.