Teaching Ultrasound in Lower-Resource Areas

Stanford’s Department of Emergency Medicine launched an ultrasound training program for emergency medicine residents at the University Teaching Hospital of Kigali in Rwanda.

Patients in Rwanda emergency departments (EDs) tend to be high acuity; ultrasounds can change the course of a patient’s treatment even more so than in the United States. And bedside ultrasound can substitute for expensive imaging diagnostics in lower-resourced areas.

The Rwanda emergency medicine training program does not consistently offer an ultrasound curriculum. Physicians learn through bedside teaching, which can be sporadic, inconsistent, and incomplete. A hospital might have just one ultrasound machine, which may be hard to repair.

Thanks to a seed grant from Stanford’s Center for Innovation in Global Health, Stanford emergency medicine fellows and physicians developed an ultrasound “boot camp” for second and third-year residents consisting of lectures and hands-on training. The project was created by Patrick Lanter, MD, global emergency medicine/ultrasound fellow, and Enoch Obeng, MD, former global emergency medicine fellow and current faculty member, in collaboration with Michelle Feltes, MD, assistant professor of emergency medicine.

While much of the curriculum is similar to that used in the United States, several differences reflect the targeted Rwandan needs. Focused assessment with sonography for HIV-associated tuberculosis (FASH) is taught because tuberculosis rates in Rwanda are high. There is a bigger emphasis on treating trauma from vehicular accidents in Rwanda where patients are often in more advanced distress because of delays in getting to the hospital.

After the boot camp concludes, images captured in Rwanda are sent to Stanford, where Lanter and Timothy Batchelor, MD, global emergency medicine/ultrasound fellow, review both quality and diagnosis and send constructive feedback to Rwandan residents to increase in-country knowledge.

Sustainability and long-term impact are key considerations. Three Rwandan boot camp participants volunteered to join Stanford’s image review process to become what are called “super users.” The goal is to have super users assist in teaching subsequent training sessions as well as implement their own image review process, growing the number of local emergency medicine ultrasound experts in Rwanda.

Additionally, the team hopes to use the data collected on ultrasound use and impact to illustrate the need for more equipment and training for the Rwanda Ministry of Health and other funders.

Spring 2024