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Laparoscopic surgery has been shown to have many favorable effects on surgical outcomes and postoperative recovery times. However, the cost of currently available training programs, such as the Fundamentals of Laparoscopic Surgery (FLS), limits their adoption in developing countries. To address this cost constraint, educators at the Justinian University Hospital (JUH) in Northern Haiti used local materials to build their own laparoscopic skills box trainer. This trainer is used to teach all surgical and OB/GYN residents in their laparoscopic skills program. The progressive curriculum consists of seven modules, three of which are for all trainees and four of which are specifically for surgery and OB/GYN (2). The seven modules are arranged in the order of difficulty; they start with basic maneuvers and progress to complex skills. This report describes both the preparation of the seven models and evaluation of the skills that are learned. This approach may facilitate global access to feasible, progressive, and sustainable laparoscopic training.

Background: With the various applications of point-of-care ultrasound (PoCUS) steadily increasing, many medical schools across North America are incorporating PoCUS training into their undergraduate curricula. The Faculty of Medicine at Memorial University also intends to introduce PoCUS training into its own undergraduate medical program. The proposed approach is to introduce a PoCUS curriculum focusing on anatomy and physiology while developing cognitive and psychomotor skills that are later transferred into clinical applications. This has been the common approach taken by most undergraduate ultrasound programs in the United States. This project highlights the development and the challenges involved in creating an objective assessment tool that meets the unique needs of this proposed undergraduate ultrasound curriculum. Methods: After a thorough review of existing literature and input from experts in PoCUS, a prototype global rating scale (GRS) and three exam-specific checklists were created by researchers. The exam-specific checklists include aorta exam, subxiphoid cardiac exam, and focused abdominal exam. A panel of 18 emergency room physicians certified in PoCUS were recruited to evaluate the GRS and three checklists. This was accomplished using a modified Delphi technique. The items were rated on a 5-point Likert scale. If an item received a mean score of less than 4, it was deemed unimportant for the assessment of PoCUS performance in undergraduate medical learners and was excluded. Experts were also encouraged to provide comments and suggest further items to be added to the GRS or checklists. Items were modified according to these comments. All of the edits were then sent back to the experts for revisions. Results: A consensus was achieved after three rounds of surveys, with the final GRS containing nine items. The final aorta checklist contained nine items, and the subxiphoid cardiac and focused abdominal checklists each contained 11 items. Conclusion: By using a modified Delphi technique, we developed a single GRS and three checklists. A panel of independent PoCUS practitioners supports the content validity of these tools. Research is currently ongoing to evaluate their validity for assessing PoCUS competency in undergraduate medical students.