WHO Basic Emergency Care (BEC) training in Liberia: pre-course, post-course, and one-year outcomes

Liberia faces persistent gaps in emergency care training. The World Health Organization (WHO) Basic Emergency Care (BEC) Course was developed in 2018 to support training of frontline emergency care providers in resource-limited settings. While prior studies have shown short-term knowledge gains and confidence improvements, limited data exists regarding longer-term retention. This study sought to evaluate knowledge acquisition, knowledge retention, and self-reported confidence immediately after and one year following WHO Basic Emergency Care training.

We conducted two four-day WHO BEC trainings for graduating medical students and practicing providers at A.M. Dogliotti School of Medicine in Monrovia, Liberia. Participants completed knowledge tests, self-assessment surveys, and course evaluations before training, immediately after training, and at one-year follow-up. Paired pre/post comparisons were analyzed using Wilcoxon signed-rank tests, and cohort comparisons for post-course practical case scenarios and course evaluations used Fisher's exact test and unpaired t-tests, respectively.

Some 40 participants completed training, including 30 medical students, nine nurses, and one general practitioner. 33 of 40 participants (82.5%) completed the one-year follow-up assessment. Median knowledge scores increased from 76% pre-course to 96% immediately post-course and remained higher than baseline at one year (88%; all p < 0.0001). Self-reported confidence also improved substantially, including comfort managing emergency patients and preparedness to see emergency care patients, with gains sustained at one year. Improvements were observed across key emergency care domains, including shock, airway management, pediatric and adult emergencies, and emergency pharmacology. Course evaluations were highly positive across all domains, with mean ratings ranging from 3.8 to 5.0 out of 5.

WHO BEC training was associated with substantial improvements in emergency care knowledge and confidence among Liberian providers, with evidence of knowledge retention at one year. These findings support implementation of WHO BEC training as a sustainable strategy to strengthen emergency care capacity in resource-limited African settings.