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Transforming Medical Education on a Grand Scale: The Rwandan Human Resources for Health Program

Cliff O’Callahan, MD, PhD, FAAP Middlesex Hospital, Middletown, CT

Unite For Sight conference 2014

7 y f severe malaria 1 m f sepsis transf from DH DEATH around 30 d prior 29 wk in

kargaroo care 11 y f bleeding w thrombocytopenia 5 y m trans intestinal obst Preterm 34 wk in for ROS w mec ______________ 4 y m FUO of 3 weeks 1 d 32 wk preterm w jejunal atresia 7 y f nephritic syndrome 12 y m neuro – Guillan Barre? 2 y m cardiac failure VSD w FTT DEATH 4 d ruptured bowel 13 m f bronchiolitis 1 d m HIE II 17 d f r arm abcess, deep on abx 13 y f acute abdomen DEATH 6 Y F ALL on onc ward _______ 2 d m imperforf anus and spina bifida s/p

colostomy 18 m w intusseseption s/p repair 2 y f w pancytopenia 10 y m cardiac prob RHD or congenital 11 y w strangulated umbi hernia and

peritonitis from obstruction w ascaris

premature 30 wk premature 26 wk 600g HIV exp premature 29 wk ______ 13 y m peritonitis w perf appy 16 d f late neo inf w GER 1 y10m f abdom mass 10 y f abdom obstr w worms 37 wk gest gastroscesis DEATH 12 d w intol sclerema 30wk _______ 10 m heamophilia B w intracranial

hemorrhage 9 m f hypovolemic shock due to GE 7 d jaundice 3 d f infection 12 y f disorientation, acute 12 d icteris and sepsis decomp anemia DEATH post op duodenal atresia 14 m m obstruction tonsilitis

Organizational changes include significant increases *the number of residents: 17 to 27 to 42 (eventually 60) *educational sites: 3 to 4 *number of faculty: 10 to 27 (8 from HRH program) *creation of new rotations: 11 to 18 *formal signout: informal to becoming formalized *teaching ward rounds: rare to almost daily in all areas

Operational changes include: •routine departmental meetings

•site- and service-specific regular meetings

•faculty responsibilities and cross coverage of services

•enhanced teaching on ward rounds and in OPD

•implementation of sign-out

•enhanced coverage on weekends and nights

•initiation of data collection registries and quality improvement projects

Educational changes include: •defined rotations with educational expectations

•planned afternoon teaching sessions with faculty presence

•structured morning report and M&M sessions

•routine teaching of EBM, QI basics, interpreting scientific papers

•two year calendar of weekly didactic general pediatrics themes

•monthly evaluations using standardized competencies

•Assignment of faculty advisors who assist them in creating Individual Learning Plans

•The International In-Training exam from the American Board of Pediatrics was administered

•The Department is considering becoming a pilot site using the Global Pediatric Education Consortium’s curriculum foundation

•The twinning process between Rwandan and US faculty is powerful but complicated