The PEARLS Program: Point-of-Care Ultrasound for Emergency and Acute Care in Resource-Limited Settings

Abstract

Introduction: Point-of-care ultrasound (POCUS) can be very useful in low-resource settings, where access to radiology is often limited. The PEARLS (POCUS in Emergency and Acute care in Resource-Limited Settings) program is a scalable, innovative approach to POCUS training for clinicians in low- and middle-income countries (LMICs), where access to imaging modalities is frequently limited. Methods: A review of the PEARLS program was conducted using participant data that were gathered from participants in Vanuatu, Tonga, and Papua New Guinea (PNG), tracking the number and type of scans uploaded and overall engagement with the training. The PEARLS program begins with a three-day in-person course focused on hands-on practice using portable ultrasound devices. Clinicians are provided with devices and guided on how to store images securely online. After the course, each participant is paired with an experienced coach who offers ongoing remote support through regular image reviews and a series of follow-up lectures. One year later, the program team revisits the site, and selected participants are transitioned into faculty roles to help train others in a train-the-trainer model. Results: Across 40 participants, a total of 576 scans were uploaded following training. The extended FAST exam was the predominant modality, followed by critical care echocardiography and first-trimester pregnancy assessments. Although remote mentoring maintained high levels of engagement, only one participant achieved the full competency benchmark of 25 uploaded scans. Discussion: These findings illustrate that a longitudinal training model with remote mentorship can improve POCUS proficiency in LMIC settings. However, challenges such as inconsistent internet access and equipment sharing persist, potentially limiting sustained competency. Conclusion: The PEARLS program presents a scalable, sustainable framework for POCUS education in resource-limited environments, fostering local expertise and enhancing acute care diagnostics.