{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:44:58Z","timestamp":1792147498553,"version":"4.4.0"},"reference-count":26,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["89"],"abstract":"<jats:p>Background: The Basic Emergency Care (BEC) course was developed to improve the management of acute illness and injury in resource\u2011limited settings. Although BEC materials are freely available, formal instructor credentialing requires time and resources that may limit rapid implementation. In remote areas, such as Maryland County, Liberia, innovative approaches to BEC training are needed.\nObjective: To evaluate the effectiveness of a BEC course delivered by a mixed instructor team consisting of credentialed and non\u2011credentialed facilitators in improving emergency care knowledge and self\u2011efficacy among healthcare providers in Liberia.\nMethods: We conducted a mixed\u2011methods evaluation of two consecutive five\u2011day BEC courses held in Maryland County, Liberia, in August 2022. Course participants included physicians, medical interns, physician assistants, and nurses. The instructional team included one credentialed BEC Registered Facilitator and four non\u2011credentialed physician specialists. To promote course fidelity, instructors completed an independent review of course materials, participated in a two\u2011day pre\u2011course preparation workshop, and conducted daily planning and debriefing sessions throughout the training. The effectiveness of this model was evaluated by measuring improvements in participants\u2019 emergency care knowledge and confidence using pre\u2011 and post\u2011course examinations and self\u2011efficacy surveys.\nFindings: Participants demonstrated significant improvements in emergency care knowledge, with examination scores increasing from 64.0% pre\u2011course to 86.6% post\u2011course (P &lt; 0.001). Self\u2011efficacy surveys also showed substantial gains in participants\u2019 comfort, confidence, and preparedness to manage critically ill and injured patients. Structured instructor preparation and ongoing coordination supported consistent course delivery despite the mixed facilitator model.\nConclusions: A BEC course delivered by a mixed team of credentialed and non\u2011credentialed instructors significantly improved emergency care knowledge and self\u2011efficacy among Liberian healthcare providers. This pragmatic, resource\u2011conscious approach may offer a scalable strategy for expanding access to BEC training in remote settings while maintaining course quality and educational effectiveness.<\/jats:p>","DOI":"10.5334\/aogh.5477","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:49:57Z","timestamp":1792144197000},"page":"103","source":"Crossref","is-referenced-by-count":0,"title":["Mixed Training Team Implementation of the Basic Emergency Care Course in Liberia"],"prefix":"10.5334","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4922-0288","authenticated-orcid":false,"given":"Nichole","family":"Michaeli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Ekwen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Main","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Anyango","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margi Massa","family":"Mabande","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances","family":"Carter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sterman","family":"Toussaint","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shada","family":"Rouhani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"1","doi-asserted-by":"crossref","unstructured":"Varpilah ST, Safer M, Frenkel E, Baba D, Massaquoi M, Barrow G. Rebuilding human resources for health: A case study from Liberia. Hum Resour Health. 2011;9(1):11. doi:10.1186\/1478-4491-9-11.","DOI":"10.1186\/1478-4491-9-11"},{"key":"2","doi-asserted-by":"crossref","unstructured":"Lee PT, Kruse GR, Chan BT, et al. An analysis of Liberia\u2019s 2007 national health policy: Lessons for health systems strengthening and chronic disease care in poor, post\u2011conflict countries. Global Health. 2011;7(1):37. doi:10.1186\/1744-8603-7-37.","DOI":"10.1186\/1744-8603-7-37"},{"key":"3","doi-asserted-by":"crossref","unstructured":"Harris B, Gebrekidan MZ, Karamagi H, et al. Setting the scene for post\u2011Ebola health system recovery and resilience in Liberia: Lessons learned and the way forward. Arch Med. 2017;4(1):42. doi:10.21767\/2254-9137.100061.","DOI":"10.21767\/2254-9137.100061"},{"key":"4","doi-asserted-by":"crossref","unstructured":"Nyenswah TG, Kateh F, Bawo L, et al. Ebola and its control in Liberia, 2014\u20132015. Emerg Infect Dis. 2016;22(2):169\u2013177. doi:10.3201\/eid2202.151456.","DOI":"10.3201\/eid2202.151456"},{"key":"5","unstructured":"World Health Organization. Density of physicians (per 10,000 population). WHO Data. Updated April 30, 2025. Accessed June 5, 2026. https:\/\/data.who.int\/indicators\/i\/CCCEBB2\/217795A."},{"key":"6","unstructured":"The World Bank. Nurses and midwives (per 1,000 people) \u2013 Liberia (Indicator SH.MED.NUMW.P3). World Development Indicators. Published 2025. Accessed June 5, 2026. https:\/\/data.worldbank.org\/indicator\/SH.MED.NUMW.P3?locations=LR."},{"key":"7","doi-asserted-by":"crossref","unstructured":"Attah R, Lievens T, Vujicic M, Brown\u2011Annan J. Health worker attitudes toward rural service in Liberia: Results from qualitative research. Health, Nutrition and Population (HNP) Discussion Paper. World Bank; 2010. https:\/\/hdl.handle.net\/10986\/13598.","DOI":"10.1596\/13598"},{"key":"8","doi-asserted-by":"crossref","unstructured":"Sanoe I, Beyan\u2011Davies K, Anyango S, et al. The role of family medicine training in addressing workforce challenges in rural Liberia: Early implementation experience. Ann Glob Health. 2021;87(1):96. doi:10.5334\/aogh.3249.","DOI":"10.5334\/aogh.3249"},{"key":"9","unstructured":"Partners In Health. Liberia. Accessed June 5, 2026. https:\/\/www.pih.org\/country\/liberia."},{"key":"10","unstructured":"Partners In Health. Training Liberia\u2019s next generation of doctors and nurses. Published January 25, 2020. Accessed June 5, 2026. https:\/\/www.pih.org\/article\/training-liberias-next-generation-doctors-and-nurses."},{"key":"11","doi-asserted-by":"crossref","unstructured":"Towns K, Dolo I, Pickering AE, et al. Evaluation of emergency care education and triage implementation: An observational study at a hospital in rural Liberia. BMJ Open. 2023;13(5):e067343. doi:10.1136\/bmjopen-2022-067343.","DOI":"10.1136\/bmjopen-2022-067343"},{"key":"12","unstructured":"World Health Organization. Basic emergency care. Accessed June 5, 2026. https:\/\/www.who.int\/teams\/integrated-health-services\/clinical-services-and-systems\/emergency-and-critical-care\/bec."},{"key":"13","doi-asserted-by":"crossref","unstructured":"Epps L, Ramachandran A, Yi S, et al. Implementation and outcomes of a comprehensive emergency care curriculum at a low\u2011resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit. PLoS One. 2023;18(3):e0282690. doi:10.1371\/journal.pone.0282690.","DOI":"10.1371\/journal.pone.0282690"},{"key":"14","doi-asserted-by":"crossref","unstructured":"Ismail BM, Ali MM, Sydlowski MM, Hussein M, Michaeli N. Implementing the WHO\/ICRC Basic Emergency Care course training for health workers in conflict\u2011affected regions in Somalia. Afr J Emerg Med. 2026;16(2):100965. doi:10.1016\/j.afjem.2026.100965.","DOI":"10.1016\/j.afjem.2026.100965"},{"key":"15","doi-asserted-by":"crossref","unstructured":"Kivlehan SM, Dixon J, Kalanzi J, et al. Strengthening emergency care knowledge and skills in Uganda and Tanzania with the WHO\u2011ICRC Basic Emergency Care Course. Emerg Med J. 2021;38(8):636\u2013642. doi:10.1136\/emermed-2020-209718.","DOI":"10.1136\/emermed-2020-209718"},{"key":"16","doi-asserted-by":"crossref","unstructured":"Michaeli N, Beck A, De Luca G, et al. A prospective, longitudinal, comparative analysis of the World Health Organization\/International Committee of the Red Cross Basic Emergency Care Course on emergency medicine knowledge and confidence among recent medical school graduates. Int J Emerg Med. 2025;18(1):8. doi:10.1186\/s12245-024-00797-w.","DOI":"10.1186\/s12245-024-00797-w"},{"key":"17","doi-asserted-by":"crossref","unstructured":"Muwanguzi P, Tumusiime SI, Nabunya R, et al. Implementation of the WHO\/ICRC Basic Emergency Care Course in Sub\u2011Saharan Africa: A scoping review. Emerg Care Med. 2026;3(2):17. doi:10.3390\/ecm3020017.","DOI":"10.3390\/ecm3020017"},{"key":"18","doi-asserted-by":"crossref","unstructured":"Olufadeji A, Usoro A, Akubueze CE, et al. Results from the implementation of the World Health Organization Basic Emergency Care Course in Lagos, Nigeria. Afr J Emerg Med. 2021;11(2):231\u2013236. doi:10.1016\/j.afjem.2021.02.004.","DOI":"10.1016\/j.afjem.2021.02.004"},{"key":"19","doi-asserted-by":"crossref","unstructured":"Tenner AG, Sawe HR, Amato S, et al. Results from a World Health Organization pilot of the Basic Emergency Care Course in sub\u2011Saharan Africa. PLoS One. 2019;14(11):e0224257. doi:10.1371\/journal.pone.0224257.","DOI":"10.1371\/journal.pone.0224257"},{"key":"20","unstructured":"World Health Organization. Basic emergency care. OpenWHO. Accessed June 4, 2026. https:\/\/openwho.org\/channel\/Basic%2Bemergency%2Bcare\/537171."},{"key":"21","unstructured":"World Health Organization. Basic Emergency Care (BEC) course. WHO Academy. Published 2025. Accessed June 4, 2026. https:\/\/whoacademy.org\/coursewares\/course-v1:WHOA+0006_BEC_EN+2025."},{"key":"22","unstructured":"World Health Organization. WHO\/ICRC Basic Emergency Care (BEC): Frequently asked questions. Accessed June 4, 2026. https:\/\/cdn.who.int\/media\/docs\/default-source\/integrated-health-services-(ihs)\/csy\/bec_faq.pdf."},{"key":"23","unstructured":"International Federation for Emergency Medicine. Basic Emergency Care (BEC) guidelines. Accessed June 4, 2026. https:\/\/www.ifem.cc\/bec_guidelines."},{"key":"24","unstructured":"African Federation for Emergency Medicine. BEC course accreditation. Accessed June 4, 2026. https:\/\/afem.africa\/project\/bec-accreditation\/."},{"key":"25","doi-asserted-by":"crossref","unstructured":"Werner K, Risko N, Kalanzi J, Wallis LA, Reynolds TA. Cost\u2011effectiveness analysis of the multi\u2011strategy WHO emergency care toolkit in regional referral hospitals in Uganda. PLoS One. 2022;17(12):e0279074. doi:10.1371\/journal.pone.0279074.","DOI":"10.1371\/journal.pone.0279074"},{"key":"26","doi-asserted-by":"crossref","unstructured":"Michaeli N, De Luca G, Gitau M, et al. Evaluation of the World Health Organization\u2013International Committee of the Red Cross Basic Emergency Care Course for senior medical students. Int J Emerg Med. 2023;16(1):29. doi:10.1186\/s12245-023-00487-z.","DOI":"10.1186\/s12245-023-00487-z"}],"container-title":["Annals of Global Health"],"original-title":[],"link":[{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5477\/files\/6ad1f26a99165.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5477\/files\/6ad1f28895ac4.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5477\/files\/6ad1f26a99165.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:50:09Z","timestamp":1792144209000},"score":1,"resource":{"primary":{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/10.5334\/aogh.5477"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.5334\/aogh.5477","relation":{},"ISSN":["2214-9996"],"issn-type":[{"value":"2214-9996","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]}}}