Getting It Right the First Time: Defining Regionally Relevant Training Curricula and Provider Core Competencies for Point-of-Care Ultrasound Education on the African Continent - 19/04/17
, Megan Landes, MD, MSc, CCFP-EM b, f, Cheryl Hunchak, MD b, f, g, Justin Paluku, MD h, Luc Malemo Kalisya, MD i, Christian Salmon, EIT, DSc a, j, Mundenga Mutendi Muller, MD k, Benjamin Wachira, MD l, James Mangan, MD m, Kajal Chhaganlal, MD, PhD n, Joseph Kalanzi, MD o, Aklilu Azazh, MD e, f, Sara Berman, MPH b, f, El-Sayed Zied, MD p, Hein Lamprecht, MD qAbstract |
Significant evidence identifies point-of-care ultrasound (PoCUS) as an important diagnostic and therapeutic tool in resource-limited settings. Despite this evidence, local health care providers on the African continent continue to have limited access to and use of ultrasound, even in potentially high-impact fields such as obstetrics and trauma. Dedicated postgraduate emergency medicine residency training programs now exist in 8 countries, yet no current consensus exists in regard to core PoCUS competencies. The current practice of transferring resource-rich PoCUS curricula and delivery methods to resource-limited health systems fails to acknowledge the unique challenges, needs, and disease burdens of recipient systems. As emergency medicine leaders from 8 African countries, we introduce a practical algorithmic approach, based on the local epidemiology and resource constraints, to curriculum development and implementation. We describe an organizational structure composed of nexus learning centers for PoCUS learners and champions on the continent to keep credentialing rigorous and standardized. Finally, we put forth 5 key strategic considerations: to link training programs to hospital systems, to prioritize longitudinal learning models, to share resources to promote health equity, to maximize access, and to develop a regional consensus on training standards and credentialing.
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| Supervising editor: William R. Mower, MD, PhD |
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| Author contributions: MS, HL, LM, JP, SB, MMM, conceived of the commentary and recruited remaining authors for contributions. MS and HL coordinated the conversation. MD, JP, CH, BW, JK, and AK developed lists of core scans. MS, ML, CH, and HL drafted the manuscript, and all authors contributed substantially to the multiple iterations and revisions of the manuscript required for publication. MS takes responsibility for the commentary as a whole. |
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| Authors of this commentary are directors of emergency medicine residencies, ultrasound educational programs, or leaders of developing emergency medicine in the countries identified on the author institution list with the exception of Salmon, C. who is a specialist in building health systems in low resource settings. The conversation was initiated at the African Federation of Emergency Medicine Conference in Ghana (2012), continued at the S. African conference (2014) which then resulted in an email based group devoted to this subject. The initial discussion was among program leaders based in the Sub-Saharan region, after which authors from Egypt were recruited for comment to ensure a more-resourced (and Northern) perspective and Mozambique to ensure those with Portugese language. The corresponding author (Salmon, M.) directs programs in Democratic Republic of Congo where she is based 3-5 months per year and senior author (Lampretch, H.) is the chair of the African Federation of Emergency Medicine Ultrasound Section and directs an Ultrasound Fellowship in South Africa. French authors were included from Democratic Republic of Congo (Malemo, L. and Paluku, J.). Given the manuscript was submitted to an English language based journal, second and third authors (Landes, M., and Hunchak, C.) by default contributed most to the actual writing of the manuscript with English as their first language. Author order was based on who contributed most to the actual writing of the manuscript per World Health Organization recommendations but all authors listed had an active role in the writing and review of the manuscript and meet the 4 criteria for authorship described by the International Committee of Medical Journal Editors (ICJME). |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 69 - N° 2
P. 218-226 - février 2017 Retour au numéro
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