Mixed Training Team Implementation of the Basic Emergency Care Course in Liberia

Background: The Basic Emergency Care (BEC) course was developed to improve the management of acute illness and injury in resource-limited 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. Objective: To evaluate the effectiveness of a BEC course delivered by a mixed instructor team consisting of credentialed and non-credentialed facilitators in improving emergency care knowledge and self-efficacy among healthcare providers in Liberia. Methods: We conducted a mixed-methods evaluation of two consecutive five-day 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-credentialed physician specialists. To promote course fidelity, instructors completed an independent review of course materials, participated in a two-day pre-course preparation workshop, and conducted daily planning and debriefing sessions throughout the training. The effectiveness of this model was evaluated by measuring improvements in participants' emergency care knowledge and confidence using pre- and post-course examinations and self-efficacy surveys. Findings: Participants demonstrated significant improvements in emergency care knowledge, with examination scores increasing from 64.0% pre-course to 86.6% post-course (P < 0.001). Self-efficacy surveys also showed substantial gains in participants' 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. Conclusions: A BEC course delivered by a mixed team of credentialed and non-credentialed instructors significantly improved emergency care knowledge and self-efficacy among Liberian healthcare providers. This pragmatic, resource-conscious approach may offer a scalable strategy for expanding access to BEC training in remote settings while maintaining course quality and educational effectiveness.