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Novel online course for emergency medicine in Africa and the U.S.

May 05, 2014
Matthew Strehlow

In 2013, the Office of International Affairs (OIA), in collaboration with the Office of the Vice Provost for Online Learning (VPOL), granted funding to develop innovative online and blended courses in collaboration with international non-Stanford faculty. OIA met with Professor Matthew Strehlow, one of the winners of the OIA-VPOL Faculty Seed Grants for Online International Learning, to hear about his course that has launched in mid-April. Managing Emergencies: What Every Doctor Must Know is one of the world’s first online courses focused on emergency care that simultaneously trains medical students at Stanford and Makerere University in Uganda.

Q. Why is it important to train medical students in emergency medicine in developing countries?

MS: The majority of low-middle income countries (LMICs) have no concept of emergency medicine. For instance, they do not stratify, or categorize patients based on the time-dependent nature of one’s condition. In most places in Uganda, they don’t even triage patients, meaning they don’t sort the patients based on the severity of their condition. And very few people are trained to provide emergency care in a hospital. In these countries, it is very common that all the patients wait in line to be treated, first-come-first-serve, no matter how critical one’s medical condition is. Thus, it is imperative to teach medical students and practitioners the concepts of emergency care and the principles for triaging patients and resuscitation.

Q. How did you come up with an idea of launching Introduction to Essential Emergency Care?

MS: Dr. Mahadevan, who jointly created the course, and I have been working together on international emergency medicine for more than a decade. We recognize the same gaps in training medical students in the field, especially in developing countries. Conventional approaches for training medical students in these countries is to offer short-term seminars taught by invited speakers from other countries. Unfortunately, this does not always guarantee a change in medical practice. We’ve tried different methodologies, such as training the trainers of medical students and creating facilitator courses that enable the facilitators to coordinate videotaped courses and teaching materials for their students. Each methodology has its own limits.  We have continued to come up with better approaches that are sustainable and impactful.

Managing Emergencies: What Every Doctor Must Know is a carefully designed course with interactive online training followed by a live seminar. The course starts off with five weeks of online classes offered simultaneously at Makerere University and Stanford University. This will be followed by supplemental on-site procedural training that will be taught in one-day seminars at both schools.

Q. How will you be evaluating the impact of the course?

MS: In August, we will offer a live lecture to a separate small group of students at Makerere University during which we will utilize the same topics and slides that we used for the online training. Then, we will compare and evaluate the immediate knowledge gains, as well as retention, for both groups at the university.

"This is what Stanford is about - taking ideas, fostering them, and putting them into an action."

Q. Tell me more about the online course and how it has unfolded so far.

MS: We have 109 medical students enrolled in the course - 77 from Makerere University and 32 from Stanford. Due to limited space, we had to turn down students at Makerere who were interested in taking the online course, which was difficult for us.

There are twenty modules each containing multiple five-to-fifteen minute videos. Each video is comprised of a core lecture followed by a case presented using video clips from the television program, ER. All the materials are offered with closed captions so that students in non-English-speaking countries can easily follow along. Then, the video instructor throws out several key questions. Once they answer the instructor’s questions, they are able to see of the page. Finally, experts in each field will answer the question and lead further discussion.

We are fortunate to have a great group of students from both countries. It is exciting to see student feedback and interest in the course given that medical students tend to have intense class schedules and this is an elective course. One of our students left a comment on the discussion space in response to the session taught by Dr. Stevens, one of the experts who participated in the course:

"Oh Dr. Stevens, I am really impressed by how you address radiological concerns on CXR [Chest X-Rays]. YOU KNOW CHEST X-RAYS GET CONFUSING AT TIMES…”

Q. Which offices have you been collaborating with to develop the course?

MS: We’ve worked with VPOL in developing the course materials, and their support has been outstanding. Both VPOL and OIA have helped us form the partnership with Makerere University. We will also evaluate the effectiveness of the course through the grant we received from them.

Q. Do you have any plans to expand the course to other low-middle income countries?

Yes, this is a trial course. Makerere University has already mentioned that they are interested in making the course required for their medical students in the future. At the same time, we’ve talked with universities in Tanzania, Kenya, Rwanda, Pakistan, and Cambodia about the possibilities of introducing the course. Our plan is to expand the course at the university level starting this fall. We will use the same platform and let it run based on each university’s individual schedule, not based on Stanford’s. One of the great things about the course is that we can customize the modules and contents. For instance, we can add specific topics to the course based on each country’s unique needs and circumstances, such as tuberculosis or malaria training.

Q. How do you anticipate the course will change people’s thoughts on Stanford’s School of Medicine?

MS: The “Stanford” brand is known throughout the world. On the other hand, in some more remote places, we often get referred as coming from “Standard” University, which may sound shocking to some at Stanford, but these people have never heard of Stanford. They do now. We are aiming to fill a gap in the global health arena by offering the online course to countries where it is very much needed. We are looking to become contributors to global health and development. I believe our efforts will come back with new partnerships, higher recognition of the university, and new opportunities and ideas. This is what Stanford is about - taking ideas, fostering them, and putting them into an action.

Q. I would like to know how you were personally motivated to develop the emergency medicine course for developing countries. Can you share what inspired you?

MS: I initially made my decision to go to medical school while I was working as a teacher in Tanzania. During my time there, I worked with a physician where I saw the challenging plight of the people living there. I confirmed my interest in emergency medicine and critical care while volunteering in West Africa as a medical student. A little girl came to the hospital, waiting in line for hours with hundreds of other people. When she came in, she started to have a seizure. When the seizure stopped after we initiated some care, we had to move on to another patient, which I didn’t feel comfortable with. When she started to have another seizure we didn’t know what to do. She died shortly after.

I was very frustrated about what happened and talked to a physician about it. I was saying “Why didn’t someone do anything to help her? I was just a student.” She just looked at me and said, “Why didn’t you know what to do?” At that point, I decided I needed to find a way to train people so that they are armed with skills in emergency medicine. I have had the good fortune to be trained at this fantastic university, and I would like to give back what I’ve learned here to those who are in much need of emergency and critical care.

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