Treatment of seriously ill patients is often complicated by prolonged or complex transfers between hospitals in sub-Saharan Africa. Difficulties or inefficiency in these transfers can lead to poor outcomes for patients. “On-call” triage systems have been utilized to facilitate communication between facilities and to avoid poor outcomes associated with patient transfer. This study attempts to examine the effects of a pilot study to implement such a system in Rwanda.

Data collection occurred prospectively in two stages, pre-intervention and intervention, in the emergency department (ED) at Kigali University Teaching Hospital (CHUK). All patients transferred during the pre-determined timeframe were enrolled. Data were collected by ED research staff via a standardized form. Statistical analysis was performed using STATA version 15.0. Differences in characteristics were assessed using χ2 or Fisher’s exact tests for categorical variables and independent sample t-tests for normally distributed continuous variables.

During the “on call” physician intervention, the indication for transfer was significantly more likely to be for critical care (P <.001), transfer times were faster (P <.001), patients were more likely to be displaying emergency signs (P <.001), and vital signs were more likely to be collected prior to transport (P <.001) when compared to the pre-interventional phase.

The “[Emergency Medicine] EM Doc On Call” intervention was associated with improved timely interhospital transfer and clinical documentation in Rwanda. While these data are not definitive due to multiple limitations, it is extremely promising and worthy of further study.

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.

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.

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.

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.

Improving access to emergency health services can reduce morbidity and mortality for patients with acute emergent conditions. The WHO and ICRC developed the Basic Emergency Care course to train frontline providers in a systematic approach to common and treatable life-threatening conditions. This study aims to evaluate the knowledge retention of Rwandan emergency care providers after implementation of this course.

A prospective, quasi-experimental, nonrandomized study was conducted at the University Teaching Hospital of Kigali (CHUK) in Rwanda. A formal survey was conducted to understand the current composition and training of Rwandan emergency care providers. Baseline and post-course assessments of knowledge were collected via an existing 25 multiple choice question survey tool which is an already established part of the BEC curriculum. Forty providers who care for patients with acute emergent illness were included. Data collected included age, gender, preferred language, as well as information about professional background, knowledge and skills. Providers with both baseline and post-test results were included in the analysis (n=40).

Of the 40 Rwandan providers, 47.5% (n=19) male and 52.5% (n=21) female, 26 were nurses, six were doctors, six were prehospital providers, one was both a prehospital provider and nurse, and one was a midwife. The mean age was 36.3. Out of 25, the mean baseline score was 17.8 (SD=3.2) and this significantly increased to a mean posttest score of 21.9 (SD=2.4). 85% (n=34) of providers’ knowledge improved, 2.5% (n=1) of provider’s knowledge stayed the same, and 12.5% (n=5) of providers' knowledge decreased. The difference between the pre and post-test scores was found to be statistically significant, 4.1 (SD=3.4), (P<0.0001).

This study demonstrated that implementing the BEC course has significantly improved the emergency provider knowledge base. Further studies are needed to demonstrate the impact of BEC training on patient care and morbidity/mortality outcomes.