Salmon Margaret, Landes Megan, Hunchak Cheryl, Paluku Justin, Malemo Kalisya Luc, Salmon Christian, Muller Mundenga Mutendi, Wachira Benjamin, Mangan James, Chhaganlal Kajal, Kalanzi Joseph, Azazh Aklilu, Berman Sara, Zied El-Sayed, Lamprecht Hein
InnovationsCZ, San Fransisco, CA; Global Health Emergency Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Eastern Congo Ultrasound Initiative, Goma, Democratic Republic of Congo; African Federation of Emergency Medicine Ultrasound Section.
Global Health Emergency Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Toronto-Addis Ababa Academic Collaboration in Emergency Medicine, Toronto, Ontario, Canada.
Ann Emerg Med. 2017 Feb;69(2):218-226. doi: 10.1016/j.annemergmed.2016.07.030. Epub 2016 Dec 11.
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.
大量证据表明,即时超声检查(PoCUS)在资源有限的环境中是一种重要的诊断和治疗工具。尽管有这些证据,但非洲大陆的当地医疗保健提供者获得和使用超声的机会仍然有限,即使在产科和创伤等可能具有高影响力的领域也是如此。目前有8个国家设有专门的急诊医学研究生住院医师培训项目,但对于PoCUS的核心能力尚无共识。目前将资源丰富地区的PoCUS课程和授课方法转移到资源有限的卫生系统的做法,没有认识到接受系统所面临的独特挑战、需求和疾病负担。作为来自8个非洲国家的急诊医学领导者,我们基于当地的流行病学和资源限制,介绍一种实用的算法方法,用于课程开发和实施。我们描述了一种组织结构,该结构由PoCUS学习者和倡导者的联系学习中心组成,以保持认证的严格性和标准化。最后,我们提出5个关键的战略考虑因素:将培训项目与医院系统联系起来,优先考虑纵向学习模式,共享资源以促进健康公平,最大限度地扩大获取机会,并就培训标准和认证达成区域共识。