Medical internship training during the COVID-19 pandemic ­ A case of 'sacrificial pawns' or not?

Background: Newly qualified medical practitioners in South Africa (SA) are part of the frontline health care workers who face Africa's most severe coronavirus disease 2019 (COVID-19) pandemic. The experiences of interns during the pandemic reflect SA's preparedness to respond in a crisis and inform strategies that could be adopted to balance training and service in resource-challenged contexts. Aim: To explore the strengths, weaknesses, opportunities and threats posed during the first wave of the COVID-19 pandemic as reflected on by interns within the clinical training platforms in SA. Setting: Public hospitals in KwaZulu-Natal. Methods: An online questionnaire consisting of eight open-ended questions based on the SWOT framework related to personal and professional perspectives to clinical training during the COVID-19 pandemic was developed using SurveyMonkey. All data were collected remotely via social media platforms. Data were thematically analyzed. Results: Forty-six interns reflected on personal and systemic challenges as the major threats and weaknesses in intern training during the COVID-19 pandemic. Extrapolating on strengths and opportunities, there were three overarching learnings interns reflected on. These related to being a medical professional, communities of practice and the development and enhancement of clinical and non-clinical competencies. Existing challenges in the environment exacerbated the threats posed by COVID-19 and innovative strategies related to improving support, feedback, broadening the intern curriculum and online training. Conclusion: Although the clinical environment where interns learn and work is often stressful and overpowered by high service burdens, there are unique opportunities to enhance self-directed learning and graduate competencies, even in the midst of the COVID-19 pandemic.

Needs assessment for a formal emergency medicine residency program in southern Madagascar

Introduction:World Health Organization data for Madagascar reveal that the nation's under age five mortality rate is 56/1000, and that its maternal mortality rate is 440/100,000. Malaria, leprosy, plague, and tuberculosis remain significant communicable disease threats. Malnutrition rates are improving but continue to impact negatively on the general health of the Malagasy population, especially in the southern region with its 1.9 million inhabitants. There are no emergency medicine (EM) training programs to serve the southern half of Madagascar, which has a large urban population in Fianarantsoa. This study aimed to assess the need for and potential feasibility of an emergency medicine training program in southern Madagascar. Methods:We met with the institutional leadership on site at the university hospital in Fianarantsoa. A needs assessment was performed on multiple domains. Domain 1: existing hospital infrastructure and its physical plant and emergency centre (EC) space allotment. Domain 2: existing clinical and technological resources. Domain 3: educational resources and the existing curriculum for EM. Domain 4: medical student educational program and availability of prospective residency candidates. Domain 5: pre-hospital care and emergency medical services.Results: The size of the EC is adequate for the current census. Clinical resources are typical of many developing countries, with significant need for technological advancement and support, which we delineate in the body of our paper. There is an existing curriculum in Antananarivo and in Majanga, as well as one available through the African Federation for Emergency Medicine. The medical school in the area is relatively new, with graduating classes numbering approximately 30. There is no organised pre-hospital care system, no 9-1-1 equivalent, and no pre-hospital treatment from within metropolitan Fianarantsoa. Conclusions:While the needs assessment indicates substantial need for emergency medicine development in southern Madagascar, the yield (particularly for the metropolitan Fianarantsoa area) would serve the population well

Improvement of medical education through the establishment of a medical chief resident position in Rwanda

Background: The Chief Medical Resident (CMR) role is a well established, one-year position that has existed in the United States (US) for many years. Through collaboration between Yale University Primary Care Internal Medicine Residency Program and the University of Rwanda/College of Medicine and Health Sciences, the Internal Medicine Residency Program in Rwanda began a collaborative training program for Rwandan medical chief residents two years ago. Aims:This paper describes the selection and collaborative training process of the new Rwandan CMRs in teaching hospitals in Rwanda. We also report on evaluation of the role, its impact, and evolving challenges from the perspectives of the current residents through a quantitative survey. Methodology: A survey was directed to residents of the Internal Medicine residency training program. The survey was conducted at the two tertiary teaching sites in Rwanda: Butare University Teaching Hospital (CHUB) and Kigali University Teaching Hospital (CHUK) where chief residents are assigned. On a Likert scale, a group of continuing residents were asked to grade items assessing a change in several educational aspects. The second group of residents, which consisted of first-year residents, was mainly asked questions directed at describing their perception on the chief resident role. Results: In total, 38 residents out of the 40 at the two tertiary hospitals took the survey. Of the 38 residents who took the survey,74% of respondents agreed or strongly agreed on the statement about improvement in educational conferences. 69.6 % of residents noted an improvement in medical education due to having a chief resident in the program. An overall improvement of the residency training program was observed by 78.3% of our study participants. In general (73.7%), residents perceive chief residents as their role model, with first-year residents (100%) being the most enthusiastic about this statement. Conclusion: The chief resident role establishment has made a positive impact in medical education in Internal Medicine/ University of Rwanda. Chief residents play a big role in medical education and are regarded as role models by their fellow residents

Surgical Resident Doctor's Perspective of their Training in the Southeast Region of Nigeria

There are several problems militating against satisfactory residency training in Nigeria. These problems may not be effectively identified and resolved if the opinion of the trainee doctors is ignored. Objectives: To review surgical residents' perspectives of their training program in South-eastern Nigeria; with the aim of suggesting evidence-based innovative changes to enable the programs meet global trends and standards. Materials and Methods: A total of 90 semi-structured and pre-tested questionnaires were evenly distributed (30 per hospital) to the surgical residents at three tertiary healthcare facilities in South-eastern Nigeria. Information sought included sociodemographic variables; level in the residency training; rating of program and different aspects; learning environments/opportunities; and suggestions on ways to improve either part or overall program. Results: Analysis of 56 properly completed questionnaires (response rate=62.2) shows that the respondents were aged 29 to 53 years [mean(SD) = 35.3(1.7)]; mostly males (91.1) and junior residents (75). A significant majority of residents (47 or 83.8) rated the surgical residency training in their respective centers as inadequate. Grand rounds were roundly criticized as having misplaced objectives and tending toward fault-finding by Consultants. Suggested interventions for improvement included enhanced supervision/mentoring/teaching by senior colleagues; inclusion of didactic lecture sessions; research trainings; and foreign postings. Conclusion: There exist gaps between expectations of surgical residents and the training offered. These create needed support for an evidenced-based review of surgical residency training program to enable it meet the aspirations of trainees and the ever-changing trend in Medicine. More studies on surgical residents covering other regions of Nigeria; and including the trainers (Consultants); will be of immense value