The Ghana Emergency Medicine Collaborative

Background

A disproportionate percentage of the 5.8 million annual injury-related deaths occur in low- and middle-income countries due to poor emergency care.^1,2 A deficit in the human resources for health infrastructure needed to address this issue is particularly acute in Sub-Saharan Africa. The authors report a process of introducing emergency medicine training programs in Ghana utilizing funding from the Medical Education Partnership Initiative (MEPI).

Innovation

The Ghana Emergency Medicine Collaborative (GEMC) was established in 2008 to provide sustainable, high-quality, in-country training in emergency care for medical students, nurses, and physicians. The collaborative is composed of six institutions that previously collaborated on human capacity building in Ghana: Kwame Nkrumah University of Science and Technology (KNUST); the Komfo Anokye Teaching Hospital (KATH); Ghana Ministry of Health (MoH); Ghana College of Physicians and Surgeons (GCPS); Ghana’s National Ambulance Service (NAS); and the University of Michigan (UM). A three-year curriculum for physician residency training and a one-year diploma for nursing were developed and implemented at KATH. This is the only center in West Africa offering residency and nursing training in EM. A train-the-trainers model was used, including didactic lectures in open educational resource format, bedside supervision/teaching, and clinical simulations.

Outcomes

Two classes of residents have graduated from the physician-training program for a total of 11 EM specialists. The graduates have been employed and integrated into the MoH’s plan to provide emergency training to doctors in rural practice. Two graduates have left the primary training site (KATH) and are receiving mentorship to start emergency departments (ED) in two other regions of the country. Four other specialists have become instructors in the education program run by the NAS to train emergency medical technicians. Additionally, 24 nurses have completed the diploma program in Emergency Nursing, awarded by KNUST. From this initial cohort, three have received advanced training and are preparing to serve as preceptors for the subsequent classes of trainees. Seventeen nurses remain at KATH, where they are taking on leadership roles in administration, education, and the clinical supervision of rotating nursing students in the ED. The remaining graduates have returned to their home institutions to serve emergency-nursing experts.

Comment

One critical component to the long-term success and sustainability of the program will be the production of qualified trainers and advocates of EM. While the physician graduates of the training program have all been qualified as specialists by GCPS, they must also complete a two-year fellowship to become faculty members in the college Therefore, the next phase for physician development is the creation of a core faculty in the GCPS through these fellowships. The continued progress of nurse training also depends on the creation of full-time in-country faculty. Acquiring the needed nursing human resources and infrastructure requires that graduates are provided master’s-degree level training. The MoH has a plan to create emergency centers in each of Ghana’s 10 regions within 5–7 years, thus providing career opportunities for the graduates. This collaborative training model is one that may be applied to developing health care worker capacity in other low- middle income countries. Through funding from MEPI, the GEMC has developed formal training programs in emergency care for physicians and nurses and is continuing to work at establishing the sustainability of these programs.