GLOBAL EM
EM Training in Low- and Middle-Income Countries: The Impact of Rwanda's Pioneering EM Residency Program
SAEM PULSE | MARCH-APRIL 2024
By Alvaro Uribe, Anna Dobbins, MPH, on behalf of the SAEM Global Emergency Medicine Academy
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Despite having some of the greatest need for emergency care, the lack of emergency medicine training programs in low- and middle-income countries (LMICs) is an often-overlooked health inequity. To address this, the first emergency medicine residency program (EMRP) in Rwanda was established at the University Teaching Hospital of Kigali (KUTH) in August 2015. Nine years later, the program has transformed emergency medicine in Rwanda, saving lives and building a generation of skilled, experienced, and motivated emergency medicine (EM) physicians. The EMRP (officially a Master of Medicine in Emergency Medicine & Critical Care) is a four-year experience, consisting of weekly didactics, medical
simulation, quarterly assessments, clinical rotations, research, and individual international mentorship. In order to graduate, residents must complete a comprehensive written exam, objective structured clinical exams (OSCEs), case simulation assessment, and a publishable medical dissertation. The didactic curriculum covers seven EM and critical care modules each year with a peer-to-peer learning approach, allowing senior residents to gain experience in medical teaching. The program also includes guest lectures featuring faculty from all over the globe, including the United States, UK, Tanzania, Kenya, and Uganda. In addition to didactic sessions, the
EMRP addresses the research gap in East Africa through a researchbased curriculum intended to foster the development of medical research and cultivate qualified knowledgeable researchers. Residents are expected to complete a research methods course during their first year, a quality improvement plan during their second year, and a publishable medical dissertation by their final year. The impact of the EMRP has been substantial. A study by Adam Aluisio, MD, of Brown University, found that in-hospital mortality decreased by 43% after the program was established. Dr. Aluisio attributes some of this impact to the program being the only de novo specialty in the Rwandan health system.