Remote Teaching in a Rwandan Emergency Medicine Residency: A Viable Option with Limited In-person Staff During a Pandemic

Abstract

Introduction:Low/middle-income countries (LMIC) in Africa face unique, systemic challenges in medical education. Africa faces a shortage of medical schools; only one school serves 24 countries. 11 countries have no medical school. Residency programs are few. The effect of this shortage is far-reaching. Africa has 3.5% of the world’s health workforce and 1.7% of the world’s physicians, yet 27% of the global disease burden. COVID-19 created further resource constraints, especially in emergency medicine (EM). Non-clinical physician functions such as student and resident education suffered. In Rwanda, we implemented a pre-recorded, remote teaching model to substitute in-person instruction. This study evaluates whether remote teaching is received positively by EM learners and whether it is a viable alternative during times of limited in-person availability.Method:28 lectures were recorded by American EM faculty. The recordings were presented to Rwandan EM residents within their standard didactic curriculum. Lecturers were available in real time via Zoom. Topics were chosen by Rwandan faculty based on curricular needs. Program evaluation followed the Kirkpatrick framework. Attendees completed a post-lecture Likert-scale survey assessing the first Kirkpatrick level related to satisfaction, lecture and learning method quality, and suitability. Qualitative and free-response data was also collected.Results:Responses were analyzed with descriptive statistics using means and standard deviations. The mean response range across questions was 3.6-4.3 (1 = worst, 5 = best); the standard deviation range was 0.4-1.6, indicating an overall positive result. Qualitative feedback, which reached saturation, did not indicate significant dissatisfaction with the quality or suitability. Points for improvement included lecturer accents and rate of speech.Conclusion:When in-person lecturers are unavailable, pre-recorded and remote instructional methods may be a suitable substitute. Future directions may include piloting the project with a multinational cohort or in LMICs with greater technological or resource limitations, and assessing higher Kirkpatrick framework objectives.