Nadia Tagoe KNUST, Rockefeller Oteng UM, Sue Ann Bell UM, Peter Donkor KNUST, Joan Kellenberg UM
Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana received a MEPI Linked Award in 2010 to improve the provision of emergency medical care in Ghana through innovative and sustainable physician, nursing and medical student in-country training programmes. The Ghana Emergency Medicine Collaborative Training Programme is designed to create a cadre of health workers who are specifically trained to provide acute and emergency care. This training is implemented through a multi-institutional partnership between KNUST, Komfo Anokye Teaching Hospital (KATH), the Ghana College of Physicians and Surgeons (GCPS), Ghana’s Ministry of Health (MOH), the Ghana Ambulance Service (GAS), the University of Michigan (UM) and the University of Utah.
Ghanaian traumatology leaders produced a consensus paper describing a significant deficiency in the preparations and management of emergent clinical presentations. To address this recognized need, GCPS approached the UM Department of EM in 2008 to collaborate on Emergency Medicine (EM) development as a specialty in Ghana. As in most developing countries, injury and acute medical illness are significant and growing causes of morbidity and mortality in Ghana. Several mass casualty events, including the Accra Soccer Stadium disaster in 2001, which led to 127 deaths as a result of inadequate emergency medical services, highlighted this need in Ghana. This five-year MEPI Linked Award has as its intent to develop an in-country training programme, which will produce trained emergency care professionals committed to developing the specialty in Ghana. As the pioneer programme for the training of emergency care personnel in West Africa, it is designed to be sustainable and reproducible throughout sub-Saharan Africa.
The specific aims of the collaborative are:
1. Develop and disseminate innovative EM curricula and institute team training for residents, nurses, Emergency Medical Technicians (EMTs) and medical students.
2. Provide research training and mentorship to physicians and nurses as a way of cultivating multidisciplinary, locally driven research in EM.
3. Initiate and expand on educational exchange programmes via clinical rotations for EM residents and nurses with partner institutions who have more developed emergency care settings; as well as via onsite UM EM faculty supervision, including didactic and clinical bedside training throughout the year.
4. Enhance faculty career development and increase provider retention of new EM specialists through enhanced training in leadership, professionalism, administration and emergency department operations.
The emergency medicine residency curriculum was developed as a collaborative effort between the UM MEPI team and GCPS. The curriculum, based on US, UK and other international standards, has been modified to reflect clinical conditions prevalent in Ghana as well as available resources. Using a combination of intensive clinical training and didactic lectures at a well equipped training site (KATH), a train the trainer (ToT) model is being implemented to ensure retention and sustainability of the programme. At the end of the five year grant, the programme anticipates graduating about 40 EM physician specialists, with more than half enrolled in fellowship training towards faculty status.
The emergency nursing curriculum was developed based on a needs assessment specific to the current status of emergency nursing in Ghana. This was done collaboratively by KNUST, KATH nursing leadership, the UM School of Nursing and the UM Department of EM. The curriculum, which takes regional and national context into account, is based on validated South African and U.S. models of emergency nursing education currently in use. A similar ToT model will ensure that local trainers are equipped to sustain the training. The expected outcomes of the emergency nursing training programme include a curriculum that is replicable throughout the region as well as contribute to an increase in the number of specialty trained nurses that are prepared to address the management of injury and acute medical conditions in regional, district and tertiary medical centres. Eighty nurses are expected to graduate with a Diploma in Emergency Nursing at the end of five years.
Medical Student Training:
Pre-clinical and clinical curricula have been developed to introduce medical students to emergency medicine. The pre-clinical experience is a two-hour exposure to the theory and practice of the specialty of emergency medicine. The clinical curriculum involves a mandatory one-week rotation for all 4th year medical students in the Emergency Department. It is envisioned that in addition to the acquisition of the essential clinical skills, more medical students will develop an interest in the practice of emergency medicine through this exposure. There are hopes for the extension of the clinical exposure beyond the current one week.
Emergency Medical Services (EMS) Providers:
As a critical component of the emergency medical system, pre-hospital providers will receive education in areas such as the management of trauma victims, mass casualties and patient transport. This EMS training will be based on a needs assessment and curriculum development which will be collaboratively carried out by the Ghana National Ambulance Service, the UM EM Department and pre-hospital care experts from other well established settings.
In summary, this training programme intends to create a cadre of health workers with specialty training in emergency care to form the foundation of an emergency medical care system in Ghana. These personnel are committed to building the EM specialty in Ghana; thereby improving the provision of team based emergency health care. This training model of creating leaders in all aspects of emergency medicine will contribute to the retention of Ghana's healthcare workforce as well as the sustainability of the training programme.