Point-of-care ultrasound tele-didactic teaching for prehospital emergency personnel (POCUS TT study): a randomized non-inferiority trial

BACKGROUND: Point-of-care ultrasound (POCUS) is increasingly used in prehospital emergency medical services (EMS), including non-physician providers. However, access to high-quality hands-on training is often limited. Tele-didactic approaches may provide a scalable alternative, but comparative evidence is scarce. This study evaluated whether tele-didactic training is non-inferior to face-to-face instruction for teaching the extended Focused Assessment with Sonography for Trauma (eFAST) protocol. METHODS: In this multicenter, prospective, randomized controlled non-inferiority trial, non-physician EMS personnel from Austria and Hungary with limited prior POCUS experience were randomly assigned to either tele-didactic or face-to-face hands-on training. All participants first completed a standardized e-learning course, followed by a one-hour practical training session according to group allocation. Performance was subsequently evaluated in a simulated scenario using the Objective Structured Assessment of Ultrasound Skills (OSAUS; range 7-35), with assessments conducted by blinded experts. The inferiority limit was set at a difference in means of 7 OSAUS score points. The analysis was conducted according to the per-protocol principle. Secondary outcomes included OSAUS subdomain scores, time to task completion, cognitive load as measured by the NASA Task Load Index, and user experience. RESULTS: A total of 90 participants were analyzed (45 per group). Mean OSAUS scores were 26.6 ± 4.6 (face-to-face) and 27.6 ± 4.3 (tele-didactic), with a mean difference of 1.0 (lower 97.5% confidence limit: -0.8), demonstrating non-inferiority (p < 0.001). No significant differences were observed in adjusted analyses or OSAUS subdomains. Time to completion and cognitive load were comparable between groups. Tele-didactic training showed high technical feasibility and user satisfaction, with minimal technical issues. CONCLUSION: Tele-didactic training achieved comparable short-term performance outcomes and was well accepted by participants, supporting its potential as a feasible approach to expanding access to eFAST training for non-physician EMS providers. TRIAL REGISTRATION: This study was registered on clinicaltrials.gov (NCT06824675; 07-Feb-2025).