The World Health Organization (WHO) estimates that as much as half the world’s population is at risk from treatable disease but lacks the infrastructure and clinical and diagnostic services to treat these disease processes. While the past decade in Africa has been shaped by investment in ‘brick and mortar plus equipment’, substantially fewer resources have been committed to developing training programs that would equip clinicians to effectively utilize this new technology in a safe and patient-centric manner. Although teleradiology services have been utilized to improve access to radiologic services globally, they are often unsustainable. As Dr. Bhavya Rehani, a previous recipient of the RSNA Medical Education grant stated, “the key is to empower radiologists locally for long-term sustainability rather than short term solutions”.
A potential solution to this problem is to develop a radiology curriculum which can be used to train and equip radiologists from sub-Saharan African countries as they provide clinical care and serve as policy advisors and regional leaders in academic medicine in their home countries.The barriers to effective training of radiologists in sub-Saharan countries are complex. Reports issued by theRad-Aid organization demonstrate that in sub-Saharan Africa there is a dramatic shortage of radiologists. In Zambia, Uganda, Tanzania and Liberia there is roughly one radiologist per 1 million residents; while data is not available for many other African nations, it is safe to assume that their situations are similar. Many of these nations currently have the equipment for advanced Radiology imaging but no formalized training available for local radiologists in the use of advanced imaging modalities. For example, in Tanzania, an MRI machine has been donated to the Kilimanjaro Christian Medical Center Hospital, however, no formal MRI training has been provided so that local physicians can effectively use this technology.
Additional infrastructure barriers are also present, for instance, in Nigeria, frequent power outages limit the number of cases being performed, reducing resident exposure to pathology during training. The fourteen West African nations surrounding Nigeria face even worse circumstances with minimal or no radiology training available whatsoever, leaving overwhelmed practitioners inadequately equipped to diagnose and treat their respective patient populations.
Over the past decade the University of Rochester, under the leadership of Dr. Michael Potchen, Chair of the Department of Neuroradiology, has collaborated with African healthcare organizations, to provide much needed education on a variety of fronts. Some of these have met with mixed success. For instance, attempts to bring Malawian physicians to the US for individualized training have been successful but too resource intensive to scale up and sustain. Though the current program is limited in scope to Zambia, expansion could lead to a formalized training program, digitalized and packaged into a web-based modular curriculum which would be accessible to other programs in African nations that desire to train physicians in an organized and sustainable manner. PRACTERRA team members, who are radiology residents from the United States with a passion for education and global health, will lead this program expansion.
Goals include: 1) collecting and expanding a series of module based radiology cases curated to reflect pathology seen in the developing world and developed nations 2) providing a formalized curriculum and 3) developing metrics to measure progress and learning which can be utilized by physicians in developing nations to ensure program sustainability and commitment to improvement. This curriculum would also address radiology safety education. Zambia is a relatively representative sub-Saharan African nation in terms of both morbidity and infrastructure and a curriculum tailored to this nation will provide a scaffold by which many other sub-Saharan nations will benefit.