Design and Implementation of a postgraduate curriculum to support Ethiopia's first emergency medicine residency training program: the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM)

Nazanin Meshkat,Sisay Teklu,Cheryl Hunchak

doi:10.1186/s12909-018-1140-3

Abstract

BackgroundTo design and implement an emergency medicine (EM) postgraduate training curriculum to support the establishment of the first EM residency program at Addis Ababa University (AAU).MethodsIn response to the Ethiopian Federal Ministry of Health mandate to develop EM services in Ethiopia, University of Toronto EM faculty were invited to develop and deliver EM content and expertise for the first EM postgraduate residency training program at AAU. The Toronto Addis Ababa Academic Collaboration-EM (TAAAC-EM) used five steps of a six-step approach to guide curriculum development and implementation: 1. Problem identification and general needs assessment, 2. Targeted needs assessment using indirect methods (interviews and site visits of the learners and learning environment), 3. Defining goals and objectives, 4. Choosing educational strategies and curriculum map development and 5. Implementation.ResultsThe needs assessment identified a learning environment with appropriate, though limited, resources for the implementation of an EM residency program. A lack of educational activities geared towards EM practice was identified, specifically of active learning techniques (ALTs) such as bedside teaching, simulation and procedural teaching. A curriculum map was devised to supplement the AAU EM residency program curriculum. The TAAAC-EM curriculum was divided into three distinct streams: clinical, clinical epidemiology and EM administration. The clinical sessions were divided into didactic and ALTs including practical/procedural and simulation sessions, and bedside teaching was given a strong emphasis. Implementation is currently in its seventh year, with continuous monitoring and revisions of the curriculum to meet evolving needs.ConclusionWe have outlined the design and implementation of the TAAAC-EM curriculum; an evaluation of this curriculum is currently underway. As EM spreads as a specialty throughout Africa and other resource-limited regions, this model can serve as a working guide for similar bi-institutional educational partnerships seeking to develop novel EM postgraduate training programs.

Highlights

To design and implement an emergency medicine (EM) postgraduate training curriculum to support the establishment of the first EM residency program at Addis Ababa University (AAU)
As EM spreads as a specialty throughout Africa and other resource-limited regions, this model can serve as a working guide for similar bi-institutional educational partnerships seeking to develop novel EM postgraduate training programs
Due to poor health care access for myriad reasons including long distances to hospitals, limited transportation, limited ability to pay for care and a severe human health resources (HHR) shortage, patients often present for care in extremis, at late stages of illness and post-injury, making quality emergency care provision imperative

Summary

Introduction

To design and implement an emergency medicine (EM) postgraduate training curriculum to support the establishment of the first EM residency program at Addis Ababa University (AAU). At the turn of the twenty-first century, as in most low and middle-income countries (LMIC), emergency care was provided in rooms within separate outpatient departments (e.g. pediatrics, obstetrics gynecology, surgery and medicine), similar to the pre-emergency medicine (EM) days in North America (Kirsch et al.) [1]. Pre-hospital services, triage systems, resuscitation rooms and emergency protocols were non-existent. Medical trainees and nurses without dedicated EM training managed emergent care cases. The Ethiopian medical system lacked the capacity to respond effectively to the needs of emergency patients leading to high morbidity and mortality. It is estimated that 10–15% of deaths in low and middle-income countries (LMIC) occur during emergency care [2]

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Conclusion