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

Background: 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. Methods: 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. Results: 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. Conclusion: 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.