Zavale Ben Lauro, Spencer Eliah Aronoff, Guilundo Carvalho, Schooley Robert, Patel Sam, Noormahomed Emília Virgínia, Mocumbi Ana Olga
Hospital Maputo Central, Mozambique.
University California San Diego, United States.
Biomed J Sci Tech Res. 2019 Mar;16(4):12159-12165. doi: 10.26717/bjstr.2019.16.002875. Epub 2019 Mar 29.
Medical training in developing countries has continuously faced challenges to produce the needed number of cadres and maintain the needed quality standards. Mozambique, a low-income country in Southern Africa, has a major disparity in distribution of medical doctors in the country and only a small proportion are trained as specialists and/or retained as faculty. In this context, we thought that Information and Communication Technologies (ICT) are an attractive tool to support expansion of medical training and residency programs and designed a strategy for its use to promote changes in the learning environment of a university teaching hospital in this country.
Beginning in 2010-under the Medical Education Partnership Initiative between Universidad Eduardo Mondlane, Mozambique, and University of California San Diego, United States of America - we conducted extensive interviews to 21 UEM faculty and medical trainees to assess barriers to education and medical care at the major referral hospital in Mozambique. Then, changes were made to address the issues raised mainly through building an ICT infrastructure to improve connectivity, improving access to medical information, distributing communication and mobile medical devices, as well as fostering exchange between students, residents and faculty members. These changes were tracked years after to evaluate adoption.
MAIN FINDINGS & DISCUSSION: Internet access with large bandwidth and devices such as tablets and computers were distributed to increase access to medical information. The students: resident ratio improved from 13:1 to 5:1 at the end of the project. Additional 25 new faculty members were involved in clinical training, mainly through incentives such as faculty development courses and research training. Teleconferences and other exchanges using ICT have evolved from being used as a platform for weekly clinical rounds and case discussions, to become a day-to-day tool for implementation of quality improvement processes and research projects. New exchange programs between local and foreign institutions were fostered to create a growing network with over 20 institutions at the end of the program. Importantly, these changes persisted beyond the project, and constituted a driver for transformative education and distance learning.
Context-tailored use of ICT and mobile medical devices transformed medical education by improving the learning environment, addressing scarcity and low quality of trained doctors in a low-income setting of Africa. This strategy has the potential to reduce health disparities and contribute to achieving universal health coverage. Efforts to guaranty sustainability and health professional's retention are warranted.
发展中国家的医学培训一直面临着培养所需数量的专业人员并维持所需质量标准的挑战。莫桑比克是南部非洲的一个低收入国家，国内医生分布存在严重差异，只有一小部分人接受了专科培训和/或留校任教。在此背景下，我们认为信息通信技术（ICT）是支持医学培训和住院医师项目扩展的一个有吸引力的工具，并设计了一项利用该技术的战略，以促进该国一家大学教学医院学习环境的变革。
从2010年开始——在莫桑比克爱德华多·蒙德拉内大学与美国加利福尼亚大学圣地亚哥分校之间的医学教育伙伴关系倡议下——我们对21名爱德华多·蒙德拉内大学的教职员工和医学实习生进行了广泛访谈，以评估莫桑比克主要转诊医院在教育和医疗方面的障碍。然后，主要通过建立信息通信技术基础设施来改善网络连接、增加获取医学信息的机会、分发通信和移动医疗设备，以及促进学生、住院医师和教职员工之间的交流，来解决所提出的问题。几年后对这些变化进行跟踪评估其采用情况。
分配了大带宽的互联网接入以及平板电脑和计算机等设备，以增加获取医学信息的机会。在项目结束时，学生与住院医师的比例从13:1提高到了5:1。另外有25名新教职员工参与临床培训，主要是通过师资发展课程和研究培训等激励措施。使用信息通信技术的电话会议和其他交流活动，已从用作每周临床查房和病例讨论的平台，演变为实施质量改进流程和研究项目的日常工具。促进了本地和外国机构之间新的交流项目，到项目结束时建立了一个由20多个机构组成的不断扩大的网络。重要的是，这些变化在项目结束后依然持续，并成为变革性教育和远程学习的推动因素。
因地制宜地使用信息通信技术和移动医疗设备，通过改善学习环境，解决了非洲低收入地区训练有素的医生稀缺和质量低下的问题，从而改变了医学教育。这一战略有可能减少健康差距，并有助于实现全民健康覆盖。保证可持续性和留住卫生专业人员的努力是必要的。
