Toronto Addis Ababa Academic Collaboration Research Articles

Pioneering family medicine: A collaborative global health education partnership in Ethiopia.

In 2013, Ethiopia launched its first Family Medicine (FM) residency programme at Addis Ababa University (AAU). The University of Toronto's Department of Family and Community Medicine (DFCM) was invited to support Addis Ababa University's Department of Family Medicine's (AAU-FM) educational programme activities forming the Toronto Addis Ababa Academic Collaboration in Family Medicine (TAAAC-FM). This paper describes the TAAAC-FM partnership, a capacity-strengthening initiative that focuses on four key levers of academic engagement and transformation: education offerings for AAU-FM trainees, partnership preparation of DFCM faculty, fostering AAU-FM faculty development and leadership, and lastly scholarship, knowledge sharing and mentorship. Toronto Addis Ababa Academic Collaboration in Family Medicine operates on principles of respect, flexibility and cultural sensitivity. Monthly virtual meetings and annual in-person faculty visits fostered curriculum support, teaching and leadership training, ensuring that the programme remained responsive to evolving needs. The partnership has contributed to a Community of Practice (CoP) to advance FM in Ethiopia, promoting shared learning. Addis Ababa University's Department of Family Medicine faculty leads in various roles, engages with global FM communities, and contributes to policy development, demonstrating significant progress in FM education and leadership. Looking ahead, TAAAC-FM aims to adapt its efforts based on the capacity built with AAU-FM, continue faculty development, and strengthen linkages within the global healthcare community. The partnership's success underscores the importance of collaborative, culturally informed high-low resource setting approaches to FM training and healthcare system strengthening, offering valuable insights for similar initiatives.

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

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). 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". 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. 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.

Perceptions and reflections of early graduates of the first emergency medicine residency program in Ethiopia: A qualitative study.

IntroductionA bi-institutional partnership between physicians at Addis Ababa University, Ethiopia and the University of Toronto, Canada led the development and implementation of a novel emergency medicine (EM) postgraduate training program at Addis Ababa University (AAU). Subsequently, the first three cohorts of trainees were invited to participate in the evaluation of the curricular components devised and delivered by Toronto EM physicians as part of the Toronto Addis Ababa Academic Collaboration in EM (TAAAC-EM). We sought to characterise the strengths and weaknesses of the curriculum to improve it for future trainee cohorts.MethodsThis curriculum assessment used semi-structured, in-depth individual interviews to evaluate components of the TAAAC-EM program curriculum. Interviews were conducted with a purposive sampling of graduates from the first three cohorts of the TAAAC-EM program.ResultsTwelve participants were interviewed. The following themes were identified; The TAAAC-EM program built a novel EM culture at AAU and shifted teaching from didactic to learner-centered strategies where teachers serve as role models; The curriculum content of the EM resident program, including didactic and practical sessions, was well received by the graduates interviewed; Challenges identified included lack of continuity in training, and difficulties transitioning to practice in a locally nascent field; Participants evaluated the TAAAC-EM program model as very positive overall, and supported replicating the model by expanding within Ethiopia and beyond.ConclusionsThe challenges identified in the program, including lack of continuity of clinical teaching and meeting the local educational resource needs of new graduates, helped inform program adaptations and improvements. TAAAC-EM, currently in its eleventh year, is now focused on transitioning full teaching responsibilities to local faculty and continuing to support a positive EM teaching culture. We believe that this thriving partnership can serve as a model for future north-south and south-south collaborations in postgraduate medical education.

Maintaining a global health partnership during the COVID-19 pandemic: a road map from the Toronto Addis Ababa Academic Collaboration in Emergency Medicine.

The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is an educational global health partnership established 10 years ago to support the growth of EM in Ethiopia. In-person global health partnership activities were disrupted by the COVID-19 pandemic. We describe our five-step process for transitioning our global health partnership to a virtual space. Each step was conducted in collaboration between the University of Toronto and Addis Ababa University EM physicians: (1) risk identification and needs assessment, (2) discussing mitigation strategies, (3) crafting and piloting an approach, (4) revising based on pilot results, 5) implementation with continuous evaluation and revision. Teaching was modified iteratively in response to feedback. Our experience shows that virtual teaching, while not a replacement for in-person engagement, can be a valuable tool both to supplement partnership activities when travel is not possible, and to enhance global health partnerships long term. This approach can also inform the transition of other forms of medical education to the virtual space.

Development of a pediatric ophthalmology academic partnership between Canada and Ethiopia: a situational analysis

BackgroundEducational capacity building in pediatric ophthalmology is necessary to address the burden of childhood blindness in Ethiopia. Residency and fellowship training at Addis Ababa University (AAU) have been enhanced with support from the University of Toronto (UofT), following the established Toronto Addis Ababa Academic Collaboration (TAAAC). Our aim was to assess the feasibility of implementing a pediatric ophthalmology fellowship at AAU with support from UofT, modeled by successful postgraduate medical education within TAAAC.MethodsA situational analysis, including a needs assessment, was conducted at Menelik II Hospital, Addis Ababa. Staff expertise, equipment and infrastructure were compared to International Council of Ophthalmology fellowship guidelines. Patient volumes were assessed through medical chart review. Local training needs were evaluated. A strategic working meeting facilitated program specification.ResultsThe faculty consisted of 11 ophthalmologists, including 2 pediatric specialists. Fourteen thousand six hundred twenty-seven medical and three thousand six hundred forty-one surgical pediatric cases were seen in the previous year. A 2-year fellowship incorporating anterior segment, retinoblastoma, strabismus, and retinopathy of prematurity modules was developed. Research collaborations, didactic teaching, and surgical supervision were identified as priorities requiring support. Quality standard indicators included faculty feedback, case log review and formal examination. Telemedicine, development of a larger eye hospital and partnerships to support equipment maintenance were identified as strategies to manage implementation barriers.ConclusionsThe situational analysis provided a way forward for the development of a pediatric ophthalmology fellowship, the first of its kind in Eastern Africa. Learning outcomes are feasible given high patient volumes, qualified staff supervision and sufficient equipment. Strategic partnerships may ensure resource sustainability.

P023: Development of a Canadian Global Health Emergency Medicine (GHEM) Certificate Program based on established best practices

Innovation Concept: Global health fieldwork is valuable for Canadian residents, but is often trainee-organized, short-term, unsupervised, and lacking in preparation and debriefing. In contrast, we have developed a Certificate Program which will be offered to University of Toronto (UofT) emergency medicine (EM) trainees in their final year of residency. This 6-month Program will complement the Transition to Practice stage for residents interested in becoming leaders in GHEM. Methods: We completed a multi-phase needs assessment to inform the structure and content of a GHEM Certificate Program. Phase 1 consisted of 9 interviews with Program Directors (PDs), Assistant PDs, and past fellows from existing GH fellowships in Canada and USA to understand program structure, curriculum, fieldwork and funding. In Phase 2 we interviewed 4 PDs and fellows from UofT fellowship programs to understand local administrative structures. In Phase 3 we collected feedback from 5 UofT residents and 7 faculty with experience in global health to assess interest in a local GHEM Program. All interview data was reviewed and best practices and lessons learned from key stakeholders were summarized into a proposed outline for a 6-month GHEM Certificate Program. Curriculum, Tool, or Material: The Program will comprise of 1) 3 months of preparatory work in Toronto followed by 2) 3 months of fieldwork in Addis Ababa, Ethiopia. Fieldwork will coincide with activities under the Toronto-Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). The GHEM trainee's work will support TAAAC-EM activities. Preparatory months will include training in specific competencies (POCUS, teaching, tropical medicine, QI) and meetings between the trainee and a UofT mentor to design an academic project. During fieldwork, the trainee will do EM teaching (75% of time) and complete their academic project (25% of time). A UofT supervisor will accompany, orient and supervise the trainee for their first 2 weeks in Addis. Throughout fieldwork, the trainee will be required to debrief with their UofT mentor weekly for academic and clinical mentoring. One AAU faculty member will be identified as a local supervisor and will participate in all evaluations of the trainee during fieldwork. Conclusion: This Program will launch with a call for applications in July 2021, expecting the first trainee to complete the Program in 2022-23. We anticipate that this Program will increase the number of Canadian EM trainees committed to global health projects and partnerships throughout their career.

P124: Canadian faculty experience of participating in a global health partnership working to build emergency medicine capacity in Ethiopia

Introduction: Global health partnerships (GHPs) between high income and low income countries are a means of capacity building in education. Literature often focuses on the GHP structure and output, along with retention and experience of local trainees, but neglects the experience of involved faculty. Here, we survey Canadian teaching faculty participating in the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) to describe characteristics of participants and their experience in the program. Methods: EM faculty participating in TAAAC-EM teaching trips from 2011-2016 were invited to complete an online survey in February 2017. Teaching faculty travel for one month and undergo an extensive selection process, pre-departure training and post-trip debriefing. Quantitative and qualitative data were collected and analyzed using basic statistics and inductive thematic analyses respectively. Results: Overall, 19 (N = 30, 63.3%) faculty completed the survey, of which 13 had prior global health experiences (range 1 to > 12 months). On a scale of 1-7, participants rated their mean overall experience as a 5.9 and preparation as a 5.7. Among respondents, 79% would participate in future TAAAC-EM activities, 79% would engage in future global health endeavours, 95% said the experience improved their satisfaction of practicing clinical medicine and 89% said it improved their enjoyment of teaching medicine. However, while 58% stated they would recommend this experience without hesitation to colleagues, the remaining 42% said they would recommend this experience with caveats. This latter group had a lower rated preparedness (MD = 1.398, p = 0.003) and TAAAC-EM experience (MD = 1.545, p = 0.001). Major themes in qualitative responses included that the participants felt that intrinsic motivation and flexible predispositions were necessary to participate. Intrinsic motivation for global health involvement included appreciation and impact for GH, and personal growth. Regarding flexibility, respondents highlighted the importance of having a flexible demeanor to understand, accommodate and ethically address cultural differences and practicing in another context. Conclusion: The type of faculty to recruit for GHPs may require flexible predispositions and intrinsic motivation for GH. These qualities combined with adequate preparation can facilitate overall faculty experiences on global health trips.

Toronto Addis Ababa Academic Collaboration: A Relational, Partnership Model for Building Educational Capacity Between a High- and Low-Income University.

Educational partnerships between academic health sciences centers in high- and low-resource settings are often formed as attempts to address health care disparities. In this Perspective, the authors describe the Toronto Addis Ababa Academic Collaboration (TAAAC), an educational partnership between the University of Toronto and Addis Ababa University. The TAAAC model was designed to help address an urgent need for increased university faculty to teach in the massive expansion of universities in Ethiopia. As TAAAC has developed and expanded, faculty at both institutions have recognized that the need to understand contextual factors and to have clarity about funding, ownership, expertise, and control are essential elements of these types of collaborative initiatives. In describing the TAAAC model, the authors aim to contribute to wider conversations and deeper theoretical understandings about these issues.

P063: Perceptions and reflections of Ethiopian emergency medicine graduates regarding the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) Curriculum: a qualitative evaluation study

Introduction: The first-ever EM postgraduate training program in Ethiopia was launched at Addis Ababa University in 2010. EM faculty from the University of Toronto were invited to design and implement an EM rotation-based curriculum with tri-annual teaching trips to support the overall AAU EM program. To date, three cohorts of EM specialists (n=15) have graduated from the three-year program. After six years of implementation, we undertook a qualitative evaluation of the TAAAC-EM curriculum. Methods: Data collection took place in 2016 in Ethiopia via in-person graduate interviews (n=12). Participants were interviewed by a trained research assistant who used a semi-structured interview guide. Standard interview, transcription and analysis protocols were utilized. Qualitative software (QSR-NVIVO 9) was used for thematic grouping and analysis. Results: Graduates of AAU’s EM residency training program reported very positive experiences with the TAAAC-EM curriculum overall. All graduates acknowledged the positive impact of TAAAC-EM’s emphasis on bedside teaching, a unique component of the TAAAC-EM model compared to traditional teaching methods at AAU. Graduates felt that TAAAC-EM teachers were effective in creating a novel culture of EM at AAU and in role-modeling ethical, evidence-based EM practice. When asked about specific areas for program improvement, the following themes emerged: 1) a desire to shift delivery of the didactic clinical epidemiology curriculum to the senior residency years (PGY2-3) to coincide with completion of a required residency research project; 2) a desire for increased simulation and procedural teaching sessions and 3) the need for more nuanced context specificity in the curriculum delivery to incorporate local guidelines and practice patterns. A lack of educational supports during non-TAAAC-EM visits was also identified as an area for further work. Conclusion: Interviewing graduates of AAU’s EM residency training program proved important for determining areas of curriculum improvement for future trainees. It also provided critical input to TAAAC-EM strategic planning discussions as the partnership considers expanding its scope beyond Addis Ababa.

Tackling challenges of global health electives: Resident experiences of a structured and supervised medicine elective within an existing global health partnership

The Toronto-Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) deploys teaching teams of Canadian EM faculty to Addis Ababa to deliver a longitudinal residency curriculum. Canadian trainees participate in these teams as a formally structured and supervised elective in global health (GH) and EM, which has been designed to enhance the strength of GH electives and address key challenges highlighted in the literature. The purpose of this qualitative study was to identify, describe, and evaluate strengths and weaknesses of this elective in relation to its purposeful structure. Residents who completed the elective were invited to participate in face-to-face interviews to discuss their experiences. The findings show that the residents both chose this elective because of its purposefully designed features, and that these same features increased their enjoyment and the educational benefit of the elective. Supervised bedside teaching, relationships shared with Ethiopian residents, and the positive impact the experience had on their clinical practice in Canada were identified as the primary strengths. Purposeful and thoughtful design of global health electives can enhance the resident learning experience and mitigate challenges for trainees seeking global health training opportunities.

Perceptions and Reflections of Emergency Medicine Graduates, Regarding the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) Curriculum: A Qualitative Evaluation Study

Perceptions and Reflections of Emergency Medicine Graduates, Regarding the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) Curriculum: A Qualitative Evaluation Study

Decolonization in health professions education: reflections on teaching through a transgressive pedagogy

Canadian health educators travel to the global south to provide expertise in health education. Considering the history of relations between the north and south, educators and healthcare providers from Canada should critically examine their practices and consider non-colonizing ways to relate to their Southern colleagues. Using her experience as a teacher with the Toronto Addis Ababa Academic Collaboration in Nursing, the author explored issues of identity and representation as a registered nurse and PhD candidate teaching in Ethiopia. Transgressive pedagogy was used to question how her personal, professional, and institutional identities impacted her role as a teacher. Thinking and acting transgressively can decrease colonizing relations by acknowledging boundaries and limitations within present ideas of teaching and global health work and help moving beyond them. The act of being transgressive begins with a deeper understanding and consciousness of who we are as people and as educators. Working responsibly in the global south means being critical about historical relations and transparent about one's own history and desires for teaching abroad.

The Toronto Addis Ababa Academic Collaboration in Nursing: Living the Concept of Counterparts

This article was migrated. The article was marked as recommended. A 2010 Lancet Commission on global higher education for the health professions called for institutional and instructional reforms worldwide in order to keep pace with pressing global health care needs. Among their many recommendations is an awareness of the value of international collaboration to enhance educational quality. In this article, we reflect on our experience of building such a collaboration in nursing. Using the concept of counterparts as articulated by DeSantis (1993; 1995), we describe the highlights as well as the lessons of our work together in developing the research component of the Masters of Science in Nursing (MScN) at Addis Ababa University in Ethiopia. We extend DeSantis' (1995) emphasis on roles in the relationship for understanding what constitutes success in international collaborations. Beyond identifying roles and responsibilities, our story calls attention to the value of cultivating relationships in which interdependence, mutuality, and issues of reciprocity are at the fore.

Toronto Addis Ababa Academic Collaboration in Family Medicine: an overview of the dawn of family medicine in Ethiopia through an inter-institutional model

Toronto Addis Ababa Academic Collaboration in Family Medicine: an overview of the dawn of family medicine in Ethiopia through an inter-institutional model

Long-Distance Collaboration Proves Helpful to Ethiopians, Canadians

Long-Distance Collaboration Proves Helpful to Ethiopians, Canadians

From Toronto to East Africa: a medical library partnership

In 2008, I had the opportunity to go to Ethiopia (Fig. 1) to assess current medical library resources and services provided at the Black Lion Hospital, which is the major teaching hospital for Addis Ababa University (AAU), Addis Ababa, Ethiopia. I attended the Addis Ababa International Educational Symposium, Addis Ababa, Ethiopia, where the Ethiopian Ministry of Education put forth the desired and ambitious goal of increasing Ph.D. graduates in all disciplines by 5000 and Masters graduates by 10 000 within the next 10 years (medical subspecialists are included with Ph.D.s under this requirement). Universities worldwide with an interest in educational partnerships were invited to this symposium in order to help AAU meet its goal of dramatically increasing its number of academics. My invitation came from Dr. Clare Pain from the University of Toronto’s Wilson Centre, Toronto. Dr. Pain is the Toronto-based lead and Dr. Atalay Alem is the Ethiopian-based lead for the Toronto Addis Ababa Psychiatry Partnership (TAAPP, www.utoronto.ca/ethiopia) (Fig. 2). For the last 7 years TAAPP has provided training at AAU for psychiatry residents, in the first, and currently the only, psychiatry training program in the country. The partnership between AAU and Emmanuel Psychiatry Hospital, Addis Ababa, Ethiopia (www.utoronto.ca/ethiopia), has included generous assistance from Mount Sinai Hospital’s Psychiatry Department, Toronto; The Peter A. Silverman Centre for International Health, Mount Sinai Hospital; and the University of Toronto’s Wilson Centre and Department of Psychiatry. TAAPP has laid the ground work and created the founding principles for the partnership developed for the advancement of medical library services. In 2003, Ethiopia had 11 foreign-trained psychiatrists out of a total of 1800 physicians in a country with a population greater than 77 million. This translates roughly into a ratio of 1 physician per 42 000 patients. In comparison, according to Statistics Canada 2009, Canada has approximately 60 000 physicians for a population of approximately 32 million. Canada’s physician to patient ratio is approximately 1 physician per 533 patients. Today there are 39 practicing psychiatrists in Ethiopia and a thriving psychiatric residency program with approximately six new residents graduating every year. The previously mentioned success of TAAPP has now transformed and expanded into over a dozen programs including library science, internal medicine, paediatrics rehabilitation medicine, nursing, emergency medicine, etc. This new group of disciplines is organized under a collaboration called the Toronto Addis Ababa Academic Collaboration (TAAAC, www.taaac.ca). To increase Ph.D. graduates and subspecialists in medicine, it is a priority to further develop medical library services throughout Ethiopia. My attendance at the 2008 Addis Ababa International Educational Symposium was an opportunity to assess current Ethiopian medical library services. This initial assessment has led to a multi-year library-to-library partnership between the University of Toronto’s fully affiliated teaching hospital, Mount Sinai, and the AAU’s Central Medical Library at the Black Lion Hospital. The partnership agreement developed at this symposium between the Chief Medical Librarian and myself is posted at www.TAAAC.ca under the Programs tab, under Library Services. Our partnership addresses three goals to further develop medical library services and training in Ethiopia: