The East African Training Initiative. A Model Training Program in Pulmonary and Critical Care Medicine for Low-Income Countries

Abstract

Despite an extensive burden of lung disease in East Africa, there are remarkably few pulmonary physicians in the region and no pulmonary subspecialty training programs. We developed a unique training program for pulmonary medicine in Ethiopia. The East African Training Initiative (EATI) is a 2-year fellowship program at Tikur Anbessa (Black Lion) Specialized Teaching Hospital, the largest public hospital in Ethiopia and the teaching hospital for the Addis Ababa University School of Medicine. The first year is devoted to clinical care and procedural skills. Lectures, conferences, daily inpatient and outpatient rounds, and procedure supervision by visiting faculty provide the clinical knowledge foundation. In the second year, training in clinical research is added to ongoing clinical training. Before graduation, fellows must pass rigorous written and oral examinations and achieve high marks on faculty evaluations. Funding derives from several sources. Ethiopian trainees are paid by the Ethiopian Ministry of Health and the Addis Ababa University School of Medicine. The World Lung Foundation and the Swiss Lung Foundation supply travel and housing costs for visiting faculty, who receive no other stipend. The first two trainees graduated in January 2015, and a second class of three fellows completed training in January 2016. All five presented research abstracts at the annual meetings of the International Union Against Tuberculosis and Lung Disease in 2014 and 2015. The EATI has successfully provided pulmonary medicine training in Ethiopia and has capacity for local leadership. We believe that EATI could be a model for other resource-limited countries.

Global Critical Care: Moving Forward in Resource-Limited Settings

“…In contrast, longitudinal academic partnerships ( Table 2) can provide knowledge exchange platforms and build local ICU faculty expertise, but these depend on continuous on-site mentorship and training by visiting international faculty. Important factors for sustainability and avoidance of redundancy include integration with local medical education systems (pre-and post-graduate), alignment with priorities of local health authorities, development of academic partnerships in the country or region of interest [67], and adaptation to local cultural values [68,69]. In addition, it is essential to have a secure source of funding to ensure programmatic sustainability, retention of newly, highly trained faculty and continued expansion.…”

“…Ethiopia. This is a collaborative effort between the health ministry, the AAU, international faculty, the World Lung Foundation and the Swiss Lung Foundation [69] and had graduated nine specialists as of January 2019.…”

Postgraduate Medical Education in Sub-Saharan Africa: A Scoping Review Spanning 26 Years and Lessons Learned

“…18 The expansion in UME has not been matched by increases in PGME capacity, and the specialist workforce in Africa is substantially inadequate, with shortages in many specialties. 13,15,19,20 The SAMSS study identified only 436 PGME programs in the region. 6 Strategic expansion of specialist training programs would benefit from understanding the lessons that can be learned from existing programs.…”

Infrastructure and Organization of Adult Intensive Care Units in Resource-Limited Settings

“…The survival effects were most prominent in patients requiring mechanical ventilation. Postgraduate training programs in intensive care medicine for physicians have been established in selected resource-limited settings such as India [28], Ethiopia [29], Brazil [30], China [31], and South Africa [32], but the literature fails to report on outcome changes after its establishment.…”

“…In many cases, the goal is for the resource-limited settings partner to administer the program independently. One successful example of such a horizontally integrated program is the East African Training Initiative, a pulmonary/critical care fellowship training program in Addis Ababa, Ethiopia [29]. In partnership with the Ethiopian Ministry of Health, international professional societies, nongovernmental organizations, and a consortium of universities in Europe and North America, a growing cadre of domestically trained intensive care physicians is now assuming leadership roles in ICU education and clinical care in the country, where only a few years ago no such opportunities existed.…”