Assessment of Point-of-Care Ultrasound Training for Clinical Educators in Malawi, Tanzania and Uganda.

Integrating point-of-care ultrasound (POCUS) to enhance diagnostic availability in resource-limited regions in Africa has become a main initiative for global health services in recent years. In this article, we present lessons learned from introducing POCUS as part of the Global Health Service Partnership (GHSP), a collaboration started in 2012 between the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Peace Corps and Seed Global Health to provide health care work force education and training in resource-limited countries. A cross-sectional survey of GHSP clinical educators trained to use POCUS and provided with hand-held ultrasound during their 1-y deployment during the period 2013-2017. The survey consisted of 35 questions on the adequacy of the training program and how useful POCUS was to their overall clinical and educational mission. Clinical educators engaged in a series of ultrasound educational initiatives including pre-departure training, bedside training in the host institutions, online educational modules, educational feedback on transmitted images and training of local counterparts. In this study 63 GHSP clinical educators who participated in the POCUS trainings were identified, and 49 were included at the study (78% response rate). They were assigned to academic institutions in Tanzania (n = 24), Malawi (n = 21) and Uganda (n = 18). More than 75% reported use of POCUS in clinical diagnoses and 50% in determining treatment, and 18% reported procedural application of ultrasound in their practice. The top indications for POCUS were cardiac exams, second- and third-trimester obstetric exams, lung and pleura, liver and spleen and gynecology/first-trimester obstetrics. The largest perceived barriers were lack of ultrasound knowledge by the clinical educators, lack of time, equipment security, difficulty accessing the Internet and equipment problems. We concluded that our multiphase POCUS training program has increased the utility, acceptability and usage of POCUS in resource-limited settings.

Teaching suffering: the testimonial-commentary method.

Attempts to define professionalism and humanism suggest that qualities such as compliance to values, patient access, doctor-patient relationship, demeanor, professional management, personal awareness, and motivation are prominent thematic components. In this communication, we present a method for instruction in the values of humanism that may help to overcome the "curricular inertia that plagues medical education." Our approach is structured around a technique of testimonial-commentary as a novel approach to teaching humanism that does not rely upon the traditional role-modeling format. To develop effective medical school curricula for teaching humanism, we cannot rely upon the textbooks of normal and abnormal human anatomy and physiology. We must delve into the "unscientific" realms of human identity ranging from sensuality to brutality: self-preservation to sacrifice. Underneath it all, we must acknowledge that there are the ties that bind us together as people. The Seminar on Human Suffering challenges medical school educators to work with the community at large to insure that physicians will be able to serve those that seek their counsel.

Medical schools in sub-Saharan Africa.

Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, team-based education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa.

Integrating Emerging Infections Education into Medical Education: An Innovative Approach.

INTRODUCTION: All graduating physicians should be competent with the basic principles of contagious disease outbreak detection and management. In order to educate our students and residents on this important topic, we created a three-hour workshop that included a case-based simulation exercise, and we offered a two-week medical student course in Emerging Infections and Bioterrorism. METHODS: Twenty-two emergency medicine residents and sixty-four senior medical students rotating in the emergency department of an urban university tertiary referral center participated in a three-hour workshop between July 2005 and April 2006. Pre- and post- workshop surveys given immediately before and immediately following each session were used to determine participant satisfaction and self-reported knowledge and confidence in outbreak response. In March 2006 we offered a medical student elective course in Emerging Infections and Bioterrorism. Thirteen fourth-year medical students from a variety of specialties attended the two-week course. The course focused on selected topics in emerging and re-emerging infections and addressed general principles of infection control and biological disaster planning for healthcare facilities. A survey was given to all graduating fourth-year medical students in 2005 and 2006, before and after creation of the didactic course, to evaluate their comfort and perceived knowledge of outbreak detection and containment. RESULTS: Overall, both students who participated in the workshop and those who participated in the didactic course (with or without the workshop) showed improvement in self-reported knowledge of outbreak detection and management, although the effect was statistically significant only for those participating in the didactic course. Due to the small numbers of emergency medicine residents who completed the surveys, we cannot comment on the effectiveness of the resident workshop, although there was a trend toward improved self-reported knowledge after the workshop. Students pursuing internal medicine, pediatrics, emergency medicine, and ENT were most likely to report that outbreak education was very important. Nearly all participants felt outbreak preparedness was not covered in existing curricula, and 92% thought the workshop was beneficial. CONCLUSIONS: Most participants felt that outbreak preparedness was not adequately addressed in their curricula and almost all wanted more instruction. In addition, the didactic course and workshop improved self-reported student knowledge of the basic principles of contagious disease outbreak detection and management. Based on the results of our study, we propose integration of a three-hour simulation-based workshop with other instructional endeavors in emerging infections and biopreparedness into medical education curricula. We recommend the offering of a more comprehensive course for those pursuing emergency medicine and the primary care specialties, as they will be the most likely to encounter an outbreak. A web-based course may be a desirable alternative for institutions that could not otherwise add this training to their curriculum due to logistical reasons or time constraints. Further research is needed to determine the feasibility and effectiveness of these educational strategies.

Priorities in global emergency medicine development.

EM initiatives are gaining global acceptance as a result of emergency physicians; local advocates; national, transnational, and international EM organizations; and governmental leadership, organizations, and agencies involved in international health and an evolving global health agenda. Spanning the spectrum from basic initiatives to improve acute care services to mature EM specialty development, all countries acknowledge the need for emergency care. The level of EM development in a country is fluid and depends on many variables, including status of health development, burden of disease,resources, advocacy, available expertise, and public demand. Emergency physicians should support the promotion of EM in the context of essential public health and primary care initiatives in these developing countries. Additionally, emergency physicians should work closely with stakeholders, health policy experts, health economics, and international organizations involved in health care to promote the advancement of EM worldwide.

Using distance-based technologies for emergency medicine training and education.

Cost-effective and sustainable ways of continuing to improve emergency medical services and education worldwide must be pursued if the field is to continue to expand globally. Distance-based learning and the use of telecommunications advances present us with an ideal opportunity to improve international medical education. Such technologies can overcome the financial and logistic constraints of travel and can complement existing exchanges.

The World Health Channel: an innovation for health and development.

The issues of the digital divide and of accessing health information in areas of greatest need has been addressed by many. It has been a key component of the discussion of the World Summit for the Information Society and also the focus of an important new initiative, the Global Review for Health Information. Only approximately 1 in 700 people in Africa have internet access compared to a rate worldwide of approximately 10%. Access to essential health information and knowledge management for health care has been deemed a priority for the development of health systems and for the care of patients in areas with limited resources, prompting recent efforts by international organisations and by both governmental and non-governmental agencies (see Godlee et al, 2004 and McConnell, 2004). Health care in developing countries can be limited by many different resources: lack of health care workers with sufficient training, lack of diagnostic equipment, lack of treatment facilities or essential pharmaceuticals; and lack of education or expertise in many relevant areas. Much of the health care done in developing countries is by local lay persons or practitioners or by volunteers working with a variety of NGOs. These volunteers are often very dedicated young people with a vision of health-for-all that is often frustrated in the limited time they are able to spend in these areas and further constrained by meager resources (including availability of appropriate information). The availability of medical expertise and consultation depends largely on the geographical location of the health practitioner and of the patient as well as the level of integration with local practitioners and extent of outside agency involvement. Futhermore, there are often many NGOs working simultaneously on similar projects in the same region without knowledge of each other's activities. Often this occurs simply because a lack of communication exists between organisations, resulting in unnecessary duplication of effort. The availability of medical expertise and consultation depends largely on the geographical location of the health practitioner and of the patient as well as the level of integration with local practitioners and extent of outside agency involvement. The health care worker in developing countries is frequently faced with a paucity of information appropriate to the clinical situations on hand as well as a lack of locally available expertise. The lack of access to health care and other vital resources is one factor in the much lower (by approximately 1/3) life expectancy in the least developed countries campared to industrialised nations. In many developing countries there is only one doctor for 5-10,00 people, compared to a ratio of 1:200 in many developed countries. Textbooks, if they exist, may be 10-20 years out of date and are often directed more at the needs of developed countries. There is thus a growing need for wider availability of training and information on health care in developing countries and support for health care workers. There is also a need for increased communication and collaboration between governmental and non-governmental organisations working in international health to share education, resources and to coordinate efforts in areas supporting improved health care delivery. In recognition of this, the Institute for Sustainable Health Education and Development (www.ished.org) is launching the World Health Channel (WHC) in the spring of 2005 in collaboration with WorldSpace. This will allow access to critical health information in developing countries and place the emphasis on issues important for clinical care for front line health workers in these areas.