Emergency Medicine Residents' Perceptions of Working and Training in a Pandemic Epicenter: A Qualitative Analysis.

INTRODUCTION: We sought to describe the range of emergency medicine (EM) resident physicians' perceptions and experiences of working and training during the initial coronavirus 2019 (COVID-19) pandemic surge at two, large-volume, urban training hospitals in Brooklyn, New York. METHODS: A total of 25 EM resident physicians who worked at either of two large emergency departments (ED) from March 15-April 11, 2020 participated in semi-structured interviews conducted in July and August 2020. Interviews were conducted by the authors who were also emergency medicine resident physicians working in the ED during this time. We asked open-ended questions to residents about their experiences and emotions at work and outside of work, including their relationship with co-workers, patients, and their community. The interviews were audio-recorded and transcribed. We then conducted a thematic analysis to identify, classify, and define themes from interview transcripts. Iterative commonalities and differences between interview response themes were grouped to create a broadly applicable narrative of the residents' perceptions and experiences of working and training during this initial wave of a novel pandemic. Interviewees also responded to a demographics survey. RESULTS: Study participants described four major aspects of their perceptions and experiences of working and training during the stated time, including emotional challenges such as anxiety and feeling underappreciated; protective thoughts, including camaraderie, and sense of duty; workplace challenges such as limited knowledge surrounding COVID-19 and a higher volume of acute patients; and adaptive strategies including increased communication with ED administrators. CONCLUSION: Emergency medicine residents have a unique perspective and were key frontline hospital responders during a prolonged disaster and mass triage event within a local health system. Considering the chronic case and mortality fluctuations and new variants of COVID-19, as well as the anticipation of future infectious disease pandemics, we believe it is important for key decision-makers in resident education, hospital administration, and all levels of public health management to inform themselves about residents' emotional and workplace challenges when establishing hospital and residency program disaster protocols.

Deciphering a Changing Match Environment in Emergency Medicine and Identifying Residency Program Needs.

INTRODUCTION: The Match in emergency medicine (EM) is historically competitive for applicants; however, the 2022 residency Match had a large number of unfilled positions. We sought to characterize the impact of and response to the Match on programs and determine programs' needs for successful recruitment strategies. METHODS: We conducted a web-based survey of EM residency program leadership during March-April 2022. Program characteristics were generated from publicly available data, and descriptive statistics were generated. We analyzed free-text responses thematically. RESULTS: There were 133/277 (48%) categorical EM residency programs that responded. Of those, 53.8% (70/130) reported a negative impression of their Match results; 17.7% (23/130) positive; and the remainder neutral (28.5%; 37/130). Three- and four-year programs did not differ in their risk of unfilled status. Hybrid programs had a higher likelihood of going unfilled (odds ratio [OR] 4.52, confidence interval [CI] 1.7-12.04) vs community (OR 1.62, CI 0.68-3.86) or university programs (0.16, 0.0-0.49). Unfilled programs were geographically concentrated. The quality of applicants was perceived the same as previous years and did not differ between filled and unfilled programs. Respondents worried the expansion of EM residency positions and perceptions of the EM job market were major factors influencing the Match. They expressed interest in introducing changes to the interview process, including caps on applications and interviews, as well as a need for more structural support for programs and the specialty. CONCLUSION: This survey identifies impacts of the changed match environment on a broad range of programs and identifies specific needs. Future work should be directed toward a deeper understanding of the factors contributing to changes in the specialty and the development of evidence-based interventions.

Variability in Emergency Department Procedure Rates and Distributions in a Regional Health System: A Cross-Sectional Observational Study.

STUDY OBJECTIVE: Procedural competency is essential to the practice of emergency medicine. However, there are limited data quantifying emergency department procedural volumes to inform the work of educators and credentialing bodies. In this study, we characterize procedural scope and volume in a regional health care system and compare rates between practice settings and over time. METHODS: Cross-sectional data were acquired from electronic medical records of a regional health care system from March 2017 through February 2022. Nonspecific entries, esoteric procedures, and nonprocedural clinical skills were excluded. Procedural rates were compared: (1) between academic and community hospitals, (2) across study years, and (3) across seasons. Analyses were repeated for pediatric encounters, and with study year 4 removed to assess the influence of the first year of the coronavirus disease 2019 pandemic on results. RESULTS: There were 131,976 instances of 40 qualifying procedures in 1,979,935 unique visits across 9 EDs. Several high-acuity procedures had similar rates in academic and community settings, including cardiac pacing, cricothyrotomy, and lateral canthotomy. Year-over-year procedural rates were stable or increasing for most procedures, with a notable exception of lumbar puncture. Most procedures did not have significant seasonal variation, and most findings were stable when study year 4 was removed from the analysis. CONCLUSION: All procedures were performed in all settings and rates of several emergent procedures were similar in both settings, underscoring the importance of broad procedural competence for all emergency physicians. Educators and credentialing organizations can use these data to inform decisions regarding curriculum design and certification requirements.

Virtual Town Hall Meetings to Convey Emergency Medicine Residency Program Information to Students.

BACKGROUND: Applying to emergency medicine (EM) residency programs as a medical student is challenging and complicated in a normal year, but the 2020/2021 application cycle was further complicated by the COVID-19 pandemic. Due to the decrease of in-person opportunities for students to connect with residency programs, virtual "town-hall" meetings were developed. In this study our primary objective was to determine whether attendance at a virtual residency program information session improved the perceived knowledge of curriculum information and program exposure to medical students applying to an EM residency. METHODS: Four study sites hosted a total of 12 virtual events consisting of residents, faculty, or both. Standardized pre-event/post-event surveys were conducted to capture medical student perceptions before/after each of the virtual sessions. Apart from measuring the improvement in students' perceived knowledge of a program by gauging their responses to each question, we used a 10-question composite score to compare pre- vs post-event improvement among the participants. RESULTS: The pre-event survey was completed by 195 attendees, and the post-event survey was completed by 123 attendees. The median and mean composite score to this 10-question survey improved from 32.19 to 45, and 31.45 to 44.2, respectively, in the pre- to post-event survey. CONCLUSION: This study showed improvement of medical students' perceived knowledge of residency programs (reflected as increased agreement from pre- to post-event survey). The data demonstrates through question responses that students not only obtained information about the programs but also were able to gain exposure to the culture and "feel" of a program. In a non-traditional application season in which students are unable to pursue their interest in a program through audition rotations, virtual town hall events, along with other asynchronous events, may be a reasonable approach to increasing medical student understanding and awareness of a program and its culture.

Emergency medicine undergraduate simulation training during the COVID-19 pandemic: A course evaluation.

OBJECTIVE: Reduction in patient-facing teaching encounters has limited practical exposure to Emergency Medicine for medical students. Simulation has traditionally provided an alternative to patient-facing learning, with increasing integration in courses. Rapid advancements in technology facilitate simulation of realistic complex simulations encountered in the emergency setting. This study evaluated the efficacy of high-fidelity simulation in undergraduate emergency trauma medicine teaching. METHODS: A consultant trauma expert delivered an introductory lecture, followed by consultant-led small group transoesophageal echocardiogram (TOE) and chest drain simulations, and a splinting station. Participants then responded to a major trauma incident with simulated patients and high-fidelity mannequins. Pre- and post-surveys were administered to assess change in delegates' trauma surgery knowledge and confidence. DESIGN: One-group pretest-posttest research design. SETTING: A higher education institution in the United Kingdom. PARTICIPANTS: A convenience sample of 50 pre-clinical and clinical medical students. RESULTS: Recall of the boundaries of the safe triangle for chest drain insertion improved by 46% (p < 0.01), and knowledge of cardinal signs of a tension pneumothorax improved by 26% (p = 0.02). There was a 22% increase in knowledge of what transoesophageal echocardiograms (TOEs) measure (p = 0.03), and 38% increased knowledge of contraindications for splinting a leg (p < 0.01). The average improvement in knowledge across all procedures when compared to baseline was 35.8% immediately post-simulation and 22.4% at six-weeks post-simulation. Confidence working in an emergency setting increased by 24% (p < 0.001) immediately, and by 27.2% (p < 0.001) at six weeks. CONCLUSIONS: The findings suggest that simulation training within emergency medicine can result in significant increases in both competency and confidence. Benefits were observed over a six-week period. In the context of reduced patient-facing teaching opportunities, emergency medicine simulation training may represent an invaluable mechanism for delivery of teaching.

Establishing a Self-sustaining Emergency Medicine Point-of-Care Ultrasound Curriculum in an Academic Teaching Hospital in Ethiopia.

Background: Point-of-care ultrasound (POCUS) training has become a standard component of Canadian emergency medicine (EM) residency programs. In resource-limited contexts, including Ethiopia, there is a critical shortage of local clinicians who can perform and teach POCUS. Our aim was to establish an introductory POCUS rotation within the EM residency program at Addis Ababa University (AAU) through The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). Methods: Through stakeholder engagement, the authors completed a quality improvement initiative and conducted a survey of AAU EM faculty and residents to understand which POCUS scans should be included in a core residency POCUS curriculum, "POCUS1". Results: 17 residents completed the POCUS1 program and 16 residents completed the written survey. Focused assessment with sonography for trauma, inferior vena cava, and lung (pneumothorax, pleural effusions, and interstitial syndrome) were identified as core introductory topics. Seventeen residents completed the initial POCUS1 program. Three program graduates were supported to become "POCUS1 Master Instructors" to continue the program during the SARS-CoV-2 global pandemic. Conclusion: The authors identified the highest yield POCUS scans through a written survey, successfully introduced a sustainable core POCUS curriculum at AAU for EM residents, and graduated three master instructors for curriculum continuation. We outline the structure and materials for implementation of POCUS programs for EM trainees and staff in similar low- and middle-income countries.

Experiences, perspectives, and advice for using virtual interviews in post-graduate trainee selection: a national survey of CCFP (EM) program directors.

OBJECTIVE: Due to the COVID pandemic, restrictions were put in place mandating that all residency interviews be transitioned to a virtual format. Canadian CCFP(EM) programs were among the first to embark on this universal virtual interview process for resident selection. Although there have been several recent publications suggesting best practice guidelines for virtual interviews in trainee selection, pragmatic experiences and opinions from Program Directors (PDs) are lacking. This study aimed to elicit the experiences and perspectives of CCFP(EM) PDs after being amongst the first to conduct universal virtual interviews in Canada. METHODS: A 17-item online survey was created and distributed to all CCFP(EM) PDs (n = 17). It explored the virtual interview format employed, perceived advantages and disadvantages of a virtual configuration, confidence in determining a candidate's rank order, and PD preference for employing a virtual interview format in the future. It also elicited practical advice to conduct a smooth and successful virtual interview day. RESULTS: The survey response rate was 76.5% (13/17). Nine respondents (69.2%) agreed that the virtual interview format enabled them to confidently determine a candidate's rank order. With respect to preference for future use of virtual interviews, 23.1% agreed, 38.5% disagreed and 38.5% neither agreed nor disagreed. Inductive thematic analysis of free text responses revealed themes related to virtual interview advantages (time, financial, and resource costs), disadvantages (difficulty promoting smaller programs, getting a 'feel' for candidates and assessing their interpersonal skills), and practical tips to facilitate virtual interview processes. CONCLUSION: Once restrictions are lifted, cost-saving advantages must be weighed against suggested disadvantages such as showcasing program strengths and assessing interpersonal skills in choosing between traditional and virtual formats. Should virtual interviews become a routine part of resident selection, the advice suggested in this study may be considered to help optimize a successful virtual interview process.

RéSUMé: OBJECTIF: En raison de la pandémie de COVID-19, des restrictions ont été mises en place pour obliger toutes les entrevues de résidence à passer à un format virtuel. Les programmes canadiens CCMF(MU) ont été parmi les premiers à se lancer dans ce processus universel d'entrevue virtuelle pour la sélection des résidents. Bien qu'il y ait eu plusieurs publications récentes suggérant des lignes directrices de pratiques exemplaires pour les entrevues virtuelles dans la sélection des stagiaires, les expériences et les opinions pragmatiques des directeurs de programme (DP) font défaut. Cette étude visait à recueillir les expériences et les points de vue des DP du CCMF(MU) après avoir été parmi les premiers à mener des entrevues virtuelles universelles au Canada. MéTHODES: Une enquête en ligne de 17 questions a été créée et distribuée à tous les DP du CCMF(MU) (n=17). Elle a exploré le format d'entretien virtuel employé, les avantages et inconvénients perçus d'une configuration virtuelle, la confiance dans la détermination de l'ordre de classement d'un candidat, et la préférence des DP pour l'emploi d'un format d'entretien virtuel à l'avenir. Elle a également permis de recueillir des conseils pratiques pour mener à bien une journée d'entretiens virtuels. RéSULTATS: Le taux de réponse à l'enquête a été de 76,5 % (13/17). Neuf répondants (69,2 %) ont convenu que le format d'entretien virtuel leur a permis de déterminer avec confiance l'ordre de classement d'un candidat. En ce qui concerne la préférence pour l'utilisation future des entrevues virtuelles, 23,1 % étaient d'accord, 38,5 % étaient en désaccord et 38,5 % n'étaient ni d'accord ni en désaccord. L'analyse thématique inductive des réponses en texte libre a révélé des thèmes liés aux avantages des entretiens virtuels (coûts en temps, en argent et en ressources), aux inconvénients (difficulté à promouvoir les petits programmes, à se faire une idée des candidats et à évaluer leurs compétences interpersonnelles) et aux conseils pratiques pour faciliter les processus d'entretien virtuel. CONCLUSION: Une fois les restrictions levées, les avantages liés à la réduction des coûts doivent être mis en balance avec les inconvénients suggérés, tels que la mise en valeur des points forts du programme et l'évaluation des compétences interpersonnelles, lors du choix entre les formats traditionnels et virtuels. Si les entretiens virtuels devaient devenir un élément de routine dans la sélection des résidents, les conseils suggérés dans cette étude pourraient être pris en compte pour aider à optimiser un processus d'entretien virtuel réussi.

Is It All COVID-19? Resident Distress and Reasons for It in 2020.

OBJECTIVE: For resident wellness, it is important to understand and discern the relative contributions of each factor to resident stress. METHODS: After institutional review board approval, a 20-question survey instrument was provided to 90 residents across four specialties (Internal Medicine, Emergency Medicine, General Surgery, and Orthopedic Surgery) at a university-affiliated health system. The survey was completed from October through November 2020 by 63 residents for a 70% participation rate. Qualitative and quantitative analyses were used. RESULTS: The results showed a mean change in status in either direction of 2.66 points on an 11-point scale. Status changes were both positive (less stress) and negative (more stress). Related to the source of change in stress levels, 8 items were seen as predominantly influenced by residency training and 11 factors were predominantly influenced by the pandemic. One item was equally influenced by both. No item was primarily influenced by the sociopolitical climate. For 16 of the 20 items, changes in a negative direction were statistically greater than in a positive direction. CONCLUSIONS: Both positive and negative changes in resident stress status occurred during the pandemic period. Traditional residency stressors remained and because all of the factors were affected by both the pandemic and residency training, efforts to mitigate the negative effects of both need to continue.

Innovating for a Safe Simulation Challenge During a Pandemic: An Avatar Simulation Concept.

SUMMARY STATEMENT: We present a new simulation-based challenge (Sim'Cup) concept, created in response to the COVID-19 pandemic. It took place in 2020, during the European Society of Emergency Medicine and the Societé Française de Médecine d'Urgence (SFMU) conferences. Usually, during the conferences, a Sim'Cup is held with onsite participants who are involved in a consecutive series of face-to-face simulations organized in 2 qualifying rounds, followed by a final round. When congresses were transformed into online events, the Sim'Cup had to evolve into a virtual format as well. We developed the e-Sim'Cup concept as follows: participants staying safely at home, piloting the trainers, as if they were their own avatar, in a simulation room with a full-scale high-fidelity manikin (Gaumard, Laerdal) using real-time scenarios. Participants gave instructions to the avatars through a smartphone and via a website. Each team participated in 2 scenarios. At the end of each scenario, teams had to undergo a self-debriefing, followed by a short debriefing with the organizers. Twenty-seven participants divided into 9 teams participated in 1 of the 2 e-Sim'Cup events.We evaluated the impact of this approach using the Educational Practices Questionnaire, and we also analyzed the participants' perception of their satisfaction and their feelings of improvement with this virtual format. Moreover, we conducted qualitative analyses of the self-debriefings. Thirteen participants filled out the questionnaire, giving a combined high Educational Practices Questionnaire score [72 (66.5-77) of 80], which reflects the presence of educational best practices during the e-Sim'Cups. They appreciated the adjusted Sim'Cup format and believed that they were able to improve their communication, clinical skills, and self-confidence. The qualitative analysis suggested that the approach was perceived as immersive by the 27 participants, with some challenges due to technical problems but an overall feeling of improvement regarding their crisis resource management skills. The hybrid remote simulation concept satisfied the participants who believed that it improved important skills in emergency medicine. The increasing number of remote activities and conferences lead us to believe that our e-Sim'Cup concept can be easily reproducible in any simulation center, as it requires only the application of the educational concept and either the use of the website or the use of some widely available technical devices.

Impact of COVID-19 on Emergency Medicine Residency Programs: A Cross-Sectional Study in New York State.

INTRODUCTION: The 2019 novel coronavirus pandemic has caused significant disruptions in the clinical operations of hospitals as well as clinical education, training, and research at academic centers. New York State was among the first and largest epicenters of the pandemic, resulting in significant disruptions across its 29 emergency medicine (EM) residency programs. We conducted a cross-sectional observational study of EM residency programs in New York State to assess the impact of the pandemic on resident education and training programs. METHODS: We surveyed a cross-sectional sample of residency programs throughout New York State in June 2020, in the timeframe immediately after the state's first "wave" of the pandemic. The survey was distributed to program leadership and elicited information on pandemic-prompted curricular modifications and other educational changes. The survey covered topics related to disruptions in medical education and sought details on solutions to educational issues encountered by programs. RESULTS: Of the 29 accredited EM residency programs in New York State, leadership from 22 (76%) responded. Of these participating programs, 11 (50%) experienced high pandemic impact on clinical services, 21 (95%) canceled their own trainees' off-service rotations, 22 (100%) canceled or postponed visiting medical student rotations, 22 (100%) adopted virtual conference formats (most within the first week of the pandemic wave), and 11 (50%) stopped all prospective research (excluding COVID-19 research), while most programs continued retrospective research. CONCLUSION: This study highlights the profound educational impact of the pandemic on residency programs in one of the hardest- and earliest-hit regions in the United States. Specifically, it highlights the ubiquity of virtual conferencing, the significant impact on research, and the concerns about canceled rotations and missed training opportunities for residents, as well as prehospital and non-physician practitioner trainees. This data should be used to prompt discussion regarding the necessity of alternate educational modalities for pandemic times and the sequelae of implementing these plans.

Executive summary of the 2021 SAEM consensus conference: From bedside to policy: Advancing social emergency medicine and population health through research, collaboration, and education.

BACKGROUND: Social emergency medicine (social EM) examines the intersection of emergency care and the social factors that influence health outcomes. In 2021, the SAEM consensus conference focused on social EM and population health, with the goal of prioritizing research topics, creating collaborations, and advancing the field of social EM. METHODS: Organization of the conference began in 2019 within SAEM. Cochairs were identified and a planning committee created the framework for the conference. Leaders for subgroups were identified, and subgroups performed literature reviews and identified additional stakeholders within EM and community organizations. As a result of the COVID-19 pandemic, the conference format was modified. RESULTS: A total of 246 participants registered for the conference and participated in some capacity at three distinct online sessions. Research prioritization subgroups were as follows-group 1: ED screening and referral for social and access needs; group 2: structural competency; and group 3: race, racism, and antiracism. Thirty-two "projects in progress" were presented within five domains-identity and health: people and places; health care systems; training and education; material needs; and individual and structural violence. CONCLUSIONS: Despite ongoing challenges posed by the COVID-19 pandemic, the 2021 SAEM consensus conference brought together hundreds of stakeholders to define research priorities and create collaborations to push the field forward.

An Emergency Medicine Virtual Clerkship: Made for COVID, Here to Stay.

INTRODUCTION: Safety concerns surrounding the coronavirus 2019 pandemic led to the prohibition of student rotations outside their home institutions. This resulted in emergency medicine (EM)-bound students having less specialty experience and exposure to outside programs and practice environments, and fewer opportunities to gain additional Standardized Letters of Evaluation, a cornerstone of the EM residency application. We filled this void by implementing a virtual clerkship. METHODS: We created a two-week virtual, fourth-year visiting clerkship focused on advanced medical knowledge topics, social determinants of health, professional development, and professional identity formation. Students completed asynchronous assignments and participated in small group-facilitated didactic sessions. We evaluated the virtual clerkship with pre- and post-medical knowledge tests and evaluative surveys. RESULTS: We hosted 26 senior medical students over two administrations of the same two-week virtual clerkship. Students had a statistically significant improvement on the medical knowledge post-tests compared to pre-tests (71.7% [21.5/30] to 76.3% [22.9/30]). Students reported being exposed to social determinants of health concepts they had not previously been exposed to. Students appreciated the interactive nature of the sessions; networking with other students, residents, and faculty; introduction to novel content regarding social determinants of health; and exposure to future career opportunities. Screen time, technological issues, and mismatch between volume of content and time allotted were identified as potential challenges and areas for improvement. CONCLUSION: We demonstrate that a virtual EM visiting clerkship is feasible to implement, supports knowledge acquisition, and is perceived as valuable by participants. The benefits seen and challenges faced in the development and implementation of our clerkship can serve to inform future virtual clerkships, which we feel is a complement to traditional visiting clerkships even though in-person clerkships have been re-established.

UME-to-GME PandEMonium in COVID-19: Large-Scale Implementation of a Virtual ACGME Milestone-Based Curriculum for Senior Medical Students Matched Into Emergency Medicine.

BACKGROUND: The COVID-19 pandemic displaced newly matched emergency medicine "pre-interns" from in-person educational experiences at the end of medical school. This called for novel remote teaching modalities. OBJECTIVE: This study assesses effectiveness of a multisite Accreditation Council for Graduate Medical Education (ACGME) sub-competency-based curricular implementation on Slack during the first wave of the COVID-19 pandemic in the United States. METHODS: Emergency medicine residency programs were recruited via national organization listservs. Programs designated instructors to manage communications and teaching for the senior medical students who had matched to their programs (pre-interns) in spring/summer 2020. Pre- and post-surveys of trainees and instructors assessed perceived preparedness for residency, perceived effectiveness of common virtual educational modalities, and concern for the pandemic's effects on medical education utilizing a Likert scale of 1 (very unconcerned) to 5 (very concerned). Data were analyzed using descriptive statistics and the t test. RESULTS: Of 276 possible residency programs, 28 enrolled. Of 324 possible pre-interns, 297 (91.7%) completed pre-surveys in April/May and 249 (76.9%) completed post-surveys in June/July. The median weeks since performing a physical examination was 8 (IQR 7-12), since attending in-person didactics was 10 (IQR 8-15) and of rotation displacement was 4 (IQR 2-6). Perceived preparedness increased both overall and for 14 of 21 ACGME Milestone topics taught. Instructors reported higher mean concern (4.32, 95% CI 4.23-4.41) than pre-interns (2.88, 95% CI 2.74-3.02) regarding the pandemic's negative effects on medical education. CONCLUSIONS: Pre-interns reported improvements in residency preparedness after participating in this ACGME sub-competency-based curriculum on Slack.

A Novel, Low-cost, Low-fidelity Pericardiocentesis Teaching Model.

INTRODUCTION: Pericardiocentesis is a high-risk/low-frequency procedure important to emergency medicine (EM). However, due to case rarity it is not often performed on a patient during residency training. Because the coronavirus disease 2019 pandemic limited cadaver-based practice, we developed a novel, low-cost, low-fidelity pericardiocentesis model using three dimensional-printing technology to provide advances on prior home-made models. METHODS: Residents watched a 20-minute video about performing a pericardiocentesis and practiced both a blind and ultrasound-guided technique. We assessed model fidelity, convenience, and perceived provider competence via post-workshop questionnaire. RESULTS: A total of 24/26 (93%) individuals practicing on the ultrasound-guided model and 22/24 (92%) on the blind approach model agreed or strongly agreed that the models reasonably mimicked a pericardial effusion. CONCLUSION: Our low-cost, low-fidelity model is durable, mimics the clinical case, and is easy to use. It also addresses known limitations from prior low-fidelity models.

An International Virtual Classroom: The Emergency Department Experience at Weill Cornell Medicine and Weill Bugando Medical Center in Tanzania.

Emergency medicine (EM) is rapidly being recognized as a specialty around the globe. This has particular promise for low- and middle-income countries (LMICs) that experience the largest burden of disease for emergency conditions. Specialty education and training in EM remain essentially an apprenticeship model. Finding the required expertise to educate graduate learners can be challenging in regions where there are low densities of specialty providers.We describe an initiative to implement a sustainable, bidirectional partnership between the Emergency Medicine Departments of Weill Cornell Medicine (WCM) in New York, NY, USA, and Bugando Medical Center (BMC) in Mwanza, Tanzania. We used synchronous and asynchronous telecommunication technology to enhance an ongoing emergency medicine education collaboration.The Internet infrastructure for this collaboration was created by bolstering 4G services available in Mwanza, Tanzania. By maximizing the 4G signal, sufficient bandwidth could be created to allow for live 2-way audio/video communication. Using synchronous and asynchronous applications such as Zoom and WhatsApp, providers at WCM and BMC can attend real-time didactic lectures, participate in discussion forums on clinical topics, and collaborate on the development of clinical protocols. Proof of concept exercises demonstrated that this system can be used for real-time mentoring in EKG interpretation and ultrasound technique, for example. This system was also used to share information and develop operations flows during the COVID-19 pandemic. The use of telecommunication technology and e-learning in a format that promotes long-term, sustainable interaction is practical and innovative, provides benefit to all partners, and should be considered as a mechanism by which global partnerships can assist with training in emergency medicine in LMICs.