My project is with Health Volunteers Overseas, associated with the medical school in Kabale, Uganda. There is an existing relationship between HVO and the Kabale University school of medicine to help train and implement a problem-based learning curriculum. My role would include the training of medical students in the use, implementation and technique of point-of-care ultrasonography for the care of pulmonary and intensive care unit patients, evaluation and management of pulmonary conditions, physical examination, and clinical decision making. My project is anticipated to last a duration of four weeks during which time I will work closely with faculty at the Kabale SOM to help provide specialty expertise and consultative mentorship to the student body. At present, the access to specialists/consultant services at the Kabale SOM is limited to general internal medicine and pediatrics at the present time.
The population benefiting from this existing relationship between HVO and Kabale SOM includes the people of the 50 acre area surrounding the Kabale medical school campus along with the medical officers and student body at this clinical location. This clinical location does not yet have a medical residency program but the university is looking to expand its clinical program in the coming years. Our efforts with expanding the use of point of care sonography and offering education in internal medical subspecialty training will help to train local students who will likely return in the coming years to continue to practice in this region thereby benefiting future students and residents of Kabale. The sustainable and long-lasting efforts of this initiative are the biggest draw for me as a physician for wanting to be involved in this particular project. One of the concerns I have with international volunteer efforts is the potential for harm being effected locally after foreign volunteers leave. The nature of this particular program being focused on education and a longstanding existing partnership with this medical school both speak to a positive and sustainable relationship likely to benefit the trainees and local population over the long term.
I hope that I can teach students how to use point of care ultrasound to help take care of hospitalized patients - this particular bedside technology is something that the faculty are hoping students can be trained to use more frequently. There are numerous applications from identification of pneumothorax, pulmonary edema, pleural effusion characterization and management, pneumonia, trauma (FAST examination), sepsis (echocardiography, renal sonography, hepatic sonography) which can be employed quickly to help triage and manage patients in resource-limited settings.
I was teaching M3 and M5 level students at the Kabale school of medicine in Uganda. In the course of my rotations I specifically taught students the basics in chest x-ray interpretation, spirometry and lung function testing, point-of-care ultrasonography, ward emergencies and advanced cardiac life support. We also rounded in the wards at the regional referral hospital with the interns and the medical students. During our ward rounds I supervised and taught the residents and students how to perform basic point-of-care sonography and echocardiography for patients admitted to the hospital. We also used our skills reviewing chest roentography and EKG interpretation.
From a clinical standpoint, there were several extreme limitations in care and efficacy. In the first, the regional poverty is extraordinary. As a result, patients often cannot afford the costs of medical testing such as x-rays, sonograms or blood work for diagnostic evaluation. More commonly, diagnostic biopsies or therapeutic interventions are very limited due to the cost. As clinicians we often use our patients' response to our treatments as a diagnostic tool to help refine and hone our skill set. We see if our patients improve or deteriorate then re-evaluate our diagnosis and whether we have made an error or could have performed better in the next iteration. In the absence of this kind of feedback it is extremely challenging to provide coaching to the medical students on how to proceed in care delivery. It is harder still for the students themselves to develop confidence in decision making or feedback on how we provide care.
One of the things that I think we can bring to the table is resources for education and how to approach clinical uncertainty. In the intensive care unit, we are often in uncertain situations where decisions have to be made quickly due to rapid clinical changes. The approach of making decisions in the face of uncertainty has to be guided by awareness of that uncertainty. That became an important part of my philosophy of teaching students and residents. What do we wish we could know? And what is the risk of not treating or missing this diagnosis? Can we use a less invasive tool such as sonography to help clarify whether this patient has primary pulmonary hypertension or secondary owing to left heart failure? What clinical signs point toward acute pulmonary embolism and what clinical signs suggest chronicity of this diagnosis?
I am continuing teaching my students via tele-lectures with a continued focus on bedside sonography skills which is something they have ready access to at the facility. I hope to return in the future and continue teaching students and residents. I learned so much on this trip and made wonderful relationships with staff and students I hope will serve me in the years to come. Thank you to Doximity for helping to support this journey for all of us.
