The 1994 Rwandan war and genocide left more than 1 million people dead; millions displaced; and the country’s economic, social, and health infrastructure destroyed. Despite remaining one of the poorest countries in the world, Rwanda has made remarkable gains in health, social, and economic development over the last 20 years, but modern emergency care has been slow to progress. Rwanda has recently established the Human Resources for Health program to rapidly build capacity in multiple sectors of its healthcare delivery system, including emergency medicine. This project involves multiple medical and surgical residencies, nursing programs, allied health professional trainings, and hospital administrative support. A real strength of the program is that trainers work with international faculty at Rwanda’s referral hospital, but also as emergency medicine specialty trainers when returning to their respective district hospitals. Rwanda’s first emergency medicine trainees are playing a unique and important role in the implementation of emergency care systems and education in the country’s district hospitals. While there has been early vital progress in building emergency medicine’s foundations in Rwanda, there remains much work to be done. This will be accomplished with careful planning and strong commitment from the country’s healthcare and emergency medicine leaders.
Objectives: Stroke and transient ischemic attack (TIA) are common disorders treated by Canadian emergency physicians. The diagnosis and management of these conditions is timesensitive and complex, requiring that emergency physicians have adequate training. This study sought to determine the extent of stroke and TIA training in Canadian emergency medicine residency programs. Methods: A two-page survey was emailed to directors of all English-speaking emergency medicine residency programs in Canada. This included both the Fellow of the Royal College of Physicians of Canada (FRCPC) and the College of Family Physicians Enhanced Training [CCFP(EM)] residency programs. The number of mandatory and elective rotations, lectures, and examinations relevant to stroke and TIA were assessed. Results: Nine FRCPC programs responded (of 11; RR = 82%) and 11 CCFP(EM) programs responded (of 18; RR = 61%), representing 20 of 29 programs in Canada (RR: 20/29 = 69%). Mandatory general neurology (3/9) and stroke neurology (2/9) rotations were offered in a minority of FRCPC programs and not at all in CCFP(EM) programs (0/11). Neuroradiology rotations were mandatory in 1/9 FRCPC programs and no CCFP(EM) programs (0/11). Acute ischemic stroke was allocated 3 hours of lecture time per year in all residency programs, regardless of route of training. Despite the fact that 100% of respondents train residents in facilities that administer thrombolysis for stroke, only 1/11 (9%) CCFP(EM) programs and 0/9 FRCPC programs have residents act as stroke team leaders. Conclusions: Formal training in stroke and TIA is limited in Canadian emergency medicine residency programs. Enhanced training opportunities should be developed as this disease is sudden, life-threatening, and can have disabling or fatal consequences, and therapeutic options are time sensitive. . Des stages obligatoires en neurologie générale (3/9) et en neurologie des AVC (2/9) étaient offerts dans un petit nombre de programmes du CRMCC et dans aucun programme du CMFC (CA) (0/11). Les stages en neuroradiologie étaient obligatoires dans 1/9 programme du CRMCC et dans aucun programme du CMFC (CA) (0/11). Trois heures d'exposé magistral par année portaient sur les AVC ischémiques aigus dans tous les programmes de résidence, indépendamment du parcours de formation. Malgré le fait que tous les répondants disaient donner de la formation dans des établissements où l'on avait recours à la thrombolyse pour traiter les AVC, les résidents agissaient à titre chefs d'équipe en AVC dans un 1/11 programme (9 %) seulement du CMFC (CA) et dans 0/9 programme du CRMCC. Conclusions: La formation officielle, offerte dans les programmes de résidence en médecine d'urgence au Canada sur les AVC et les AIT est minimale. Il faudrait accroître les possibilités de formation approfondie puisque que la maladie se manifeste subitement, qu'elle met en danger la vie du malade, qu'elle peut laisser des séquelles invalidantes et même être mortelle, et que le temps influe sur les possibilités de traitement.
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