Education and Operations Research

Project Team: Cheryl Hunchak, Andrew W. Battison, Taofiq Oyedokun, James Stempien, Megan Landes, Nour Khatib, Kimberly Desouza, Jodie Pritchard, Marko Erak, Shannon Chun, Susan Bartels, Arjun Sithamparapillai, Kirsten Johnson, Kelly Eggink & Amanda Collier

Project Description (Abstract): Global emergency medicine initiatives have substantially expanded at academic institutions across North America in the past decade [1]. Simultaneously, emergency medicine is expanding worldwide as a specialty, increasing demand for expertise in global emergency medicine practice. Compared to other established emergency medicine subspecialties in Canada, institutional support for global emergency medicine practice has lagged. Individual physicians practicing global emergency medicine have typically faced predictable challenges previously referred to as a ‘global health tax’ [2], including costs associated with obtaining postgraduate global health training and engaging in unremunerated work abroad, while attempting to meet the demands of Canadian academic emergency medicine practice. Global emergency medicine engagement has historically been viewed by institutions and emergency medicine departments as independent from academic emergency medicine work, akin to a ‘hobby’, completed in relative isolation, on one’s own time. Additionally, time away from Canadian emergency medicine practice for global emergency medicine work can require significant life disruptions. This often limits global emergency medicine practitioners to engage in shorter, episodic contributions that lack practical and academic value. As a result, many contribute meaningfully to the field for a relatively short period [3]. Those who remain in global emergency medicine practice typically struggle to sustain their work over time. From a Canadian institutional perspective, this has meant losing key educators, scholars and mentors able to respond to the growing global and local demand for global emergency medicine expertise and scholarship.

To address the gap between global demand and available expertise, and the current realities of global emergency medicine practice within Canadian academic institutions, we present two case studies that highlight innovative organizational solutions to support meaningful and sustainable global emergency medicine contributions in Canada.

PUBLICATIONS

1. Hunchak C, Battison AW, Oyedokun T, Stempien J, Landes M, Khatib N, Desouza K, Pritchard J, Erak M, Chun S, Bartels S. Supporting global emergency medicine practice for Canadian physicians: models to foster academic productivity and build collaborative communities of practice. Canadian Journal of Emergency Medicine. 2024 Sep;26(9):612-8.

Project Team: Anna Nowacki, Sofia Kebede, Margaret Thompson, Alexandra McKnight, Aklilu Azazh, Lisa M Puchalski Ritchie

Project Description (Abstract): The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is a bi-institutional partnership between the University of Toronto (UofT) and Addis Ababa University (AAU) focused on addressing the need for emergency medicine (EM) postgraduate training and care in Ethiopia. Toxicology is a key competency in EM. EM physicians are often the first and sole clinicians to identify and treat patients presenting with a wide range of intoxications. The goal of this project was to conduct an educational needs assessment to inform the development of a context-specific toxicology curriculum for the AAU EM training program.

PUBLICATIONS

1. Nowacki A, Kebede S, Thompson M, McKnight A, Azazh A, Ritchie LM. The Addis Ababa toxicology curriculum project: educational needs assessment for the toxicology modules of an emergency medicine training program. International Journal of Emergency Medicine. 2024 Oct 2;17(1):131.

PRESENTATIONS

1. Nowacki A, Kebede S, Thompson M, McKnight A, Azazh A, Puchalski Ritchie LM. An educational needs assessment for the toxicology modules of an emergency medicine training program at Addis Ababa University. Canadian Association of Emergency Physicians (CAEP) Conference. Toronto, Ontario, Canada. May 2023. (Poster Presentation)
2. The Addis Ababa Toxicology Curriculum Project: Educational Needs Assessment for the Toxicology Modules of an Emergency Medicine Training Program. International Conference on Emergency Medicine (ICEM). Melbourne, Australia. June 2022. (Poster Presentation)
3. Nowacki A, Kebede S, Thompson M, McKnight A, Azazh A, Puchalski Ritchie L. The Addis Ababa Toxicology Curriculum Project: Educational needs assessment for the toxicology modules of an Emergency Medicine Training Program. Richard K Reznick Wilson Centre Virtual Research Week. Virtual Presentation. 2020 Oct 28-30 (Poster Presentation)

Project Team: Jennifer M. Bryan, Temesgen Beyene, Sofia Kebede, Adam Kaufman, Tilahun Jiru, James Maskalyk, Megan Landes, Alexandra McKnight, Elayna Fremes, Eileen Cheung, on behalf of the Toronto Addis Ababa Academic Collaboration in Emergency Medicine

Project Description (Abstract): The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is an educational global health partnership established 10 years ago to support the growth of EM in Ethiopia. In-person global health partnership activities were disrupted by the COVID-19 pandemic. We describe our five-step process for transitioning our global health partnership to a virtual space. Each step was conducted in collaboration between the University of Toronto and Addis Ababa University EM physicians: (1) risk identification and needs assessment, (2) discussing mitigation strategies, (3) crafting and piloting an approach, (4) revising based on pilot results, 5) implementation with continuous evaluation and revision. Teaching was modified iteratively in response to feedback. Our experience shows that virtual teaching, while not a replacement for in-person engagement, can be a valuable tool both to supplement partnership activities when travel is not possible, and to enhance global health partnerships long term. This approach can also inform the transition of other forms of medical education to the virtual space.

PUBLICATIONS

1. Bryan JM, Beyene T, Kebede S, Kaufman A, Jiru T, Maskalyk J, Landes M, McKnight A, Fremes E, Cheung E. Maintaining a global health partnership during the COVID-19 pandemic: a road map from the Toronto Addis Ababa Academic Collaboration in Emergency Medicine. Canadian Journal of Emergency Medicine. 2021 Mar;23(2):242-4.

Project Team: Nazanin Meshkat, Elayna Fremes, Joanna Burke-Bajaj, Sofia Kebede, Cheryl Hunchak

Project Description (Abstract): A bi-institutional partnership between physicians at Addis Ababa University, Ethiopia and the University of Toronto, Canada led the development and implementation of a novel emergency medicine (EM) postgraduate training program at Addis Ababa University (AAU). Subsequently, the first three cohorts of trainees were invited to participate in the evaluation of the curricular components devised and delivered by Toronto EM physicians as part of the Toronto Addis Ababa Academic Collaboration in EM (TAAAC-EM). We sought to characterise the strengths and weaknesses of the curriculum to improve it for future trainee cohorts.

PUBLICATIONS

1. Meshkat N, Fremes E, Burke-Bajaj J, Kebede S, Hunchak C. Perceptions and reflections of early graduates of the first emergency medicine residency program in Ethiopia: a qualitative study. African Journal of Emergency Medicine. 2022 Mar 1;12(1):7-11.

Project Team: Arjun Sithamparapillai (Medical Student PI), Elayna Fremes, James Maskalyk, Megan Landes

Project Description (Abstract): Global health partnerships (GHPs) between high income and low income countries are a means of capacity building in education. Literature often focuses on the GHP structure and output, along with retention and experience of local trainees, but neglects the experience of involved faculty. Here, we survey Canadian teaching faculty participating in the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) to describe characteristics of participants and their  experience in the program.

PRESENTATIONS

1. Sithamparapillai A, Fremes E, Maskalyk J, Landes M. Canadian faculty experience of participating in a global health partnership working to build emergency medicine capacity in Ethiopia. Canadian Association of Emergency Physicians (CAEP) Conference. Halifax, Nova Scotia, Canada. May 2019. (Poster Presentation)

Project Team: Michelle Tubman (Resident PI), James Maskalyk, David MacKinnon, Raghu Venugopal, Elayna Fremes, Lisa Puchalski Ritchie, Aklilu Azazh, Megan Landes

Project Description (Abstract): The Toronto-Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) deploys teaching teams of Canadian EM faculty to Addis Ababa to deliver a longitudinal residency curriculum. Canadian trainees participate in these teams as a formally structured and supervised elective in global health (GH) and EM, which has been designed to enhance the strength of GH electives and address key challenges highlighted in the literature. The purpose of this qualitative study was to identify, describe, and evaluate strengths and weaknesses of this elective in relation to its purposeful structure. Residents who completed the elective were invited to participate in face-to-face interviews to discuss their experiences.

PUBLICATIONS

1. Tubman M, Maskalyk J, Mackinnon D, Venugopal R, Fremes E, Ritchie LM, Azazh A, Landes M. Tackling challenges of global health electives: resident experiences of a structured and supervised medicine elective within an existing global health partnership. Canadian Medical Education Journal. 2017 Apr 20;8(2):e4.

Project Team: Meredith Jane Kuipers, Amira Eapen (Masters Student PI), Joel Lockwood, Sara Berman, Samuel Vaillancourt, James Maskalyk, Aklilu Azazh, Megan Landes

Project Description (Abstract): In Ethiopia, improvement and innovation of the emergency care system is hindered by lack of specialist doctors trained in emergency medicine, underdeveloped emergency care infrastructure, and consumable resource limitations. Our aim was to examine the critical factors affecting retention of graduates from the Addis Ababa University (AAU) post-graduate emergency medicine (EM) training program within the Ethiopian health care system.

PUBLICATIONS

1. Kuipers M, Eapen A, Lockwood J, Berman S, Vaillancourt S, Maskalyk J, Azazh A, Landes M. Examining critical factors affecting graduate retention from an emergency training program in Addis Ababa, Ethiopia: a qualitative study of stakeholder perspectives. Canadian Medical Education Journal. 2017 Apr 20;8(2):e61.

Project Team: Joel R. Lockwood (Resident PI), Megan Landes, Sara Berman, James Maskalyk, Aklilu Azazh

Project Description (Abstract): Despite a significant burden of acute illness, infrastructure for emergency medical care remains underdeveloped in Ethiopia.  The Toronto-Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is a collaborative effort tasked to address the design and implementation of the first Ethiopian Emergency Medicine (EM) training program. This developing system represents a complex health care milieu that will require support from many stakeholders including governmental organizations, hospital administration, and the current residents in order to build an efficient and equitable system.   Graduate retention within this specialty and within Ethiopia will depend on the outcomes of this ongoing development.  The objective of this study was to improve understanding the health care and human resources issues that new graduates will be encountering as Ethiopia’s first emergency medicine physicians.  Furthermore we wished to explore emergency medicine residents’ perceptions around factors affecting retention post graduation. 

PRESENTATIONS

1. ​​Examining the current health care milieu of the new Ethiopian emergency medicine system: A qualitative analysis of Ethiopian Emergency Medicine Residents. African Conference on Emergency Medicine (AfCEM). Addis Ababa, Ethiopia. November 2014. (Oral Presentation)
2. Lockwood J, Azaj A, Maskalyk J, Berman S, Vaillancourt S, Landes M. Examining graduate retention within the new Ethiopian emergency medicine system: A qualitative analysis of Ethiopian Emergency Medicine trainees. Canadian Association of Emergency Physicians (CAEP) Conference. Ottawa, Ontario, Canada. June 2014. (Poster Presentation)
3. Lockwood J, Azaj A, Maskalyk J, Berman S, Vaillancourt S, Landes M. Examining graduate retention within the new Ethiopian emergency medicine system: A qualitative analysis of Ethiopian Emergency Medicine trainees. University of Toronto Division of Emergency Medicine Resident Day. Toronto, Ontario, Canada. May 2014. (Poster Presentation)
4. Lockwood J, Azaj A, Maskalyk J, Berman S, Vaillancourt S, Landes M. Examining graduate retention within the new Ethiopian emergency medicine system: A qualitative analysis of Ethiopian Emergency Medicine trainees. DFCM Annual Conference. Toronto, Ontario, Canada. May 2013. (Poster Presentation)

Project Team: Emily Austin (Resident PI), Megan Landes, Nazanin Meshkat, Phil Miller, James Maskalyk, Allan Okrainec, Aklilu Azazh

Project Description (Abstract): Simulation is a prevalent training tool for the acquisition of technical skills in emergency medicine.   In resource-limited settings the challenges to using simulation include the lack of equipment and the lack of trained health providers to provide teaching and feedback in simulation settings.  ‘Telesimulation’ is a low-cost, validated, and reliable education tool which remotely connects teachers with trainees using the internet and webcams, re-creating a similar environment to one in which the teacher and trainees are in the same room. 

PRESENTATIONS

1. Austin E, Landes M, Meshkat N, Miller P, Maskalyk J, Okrainec A, Azazh A. ‘Telesimulation’ in Emergency Medicine: connecting Canadian faculty to Ethiopian residents to provide procedural teaching. African Conference on Emergency Medicine (AfCEM). Addis Ababa, Ethiopia. November 2014. (Oral Presentation)
2. Austin E, Landes M, Miller P, Meshkat N, Okrainec A, Azazh A. Telesimulation: Connecting Canadian Faculty to Ethiopian residents to train emergency procedures. Canadian Association of Emergency Physicians (CAEP) Conference. Ottawa, Ontario, Canada. June 2014. (Poster Presentation)
3. Austin E, Landes M, Meshkat N, Maskalyk J, Okrainec A, Miller P, Azazh A. ‘Telesimulation’ in Emergency Medicine: connecting Canadian faculty to Ethiopian residents to provide procedural teaching. DFCM Conference 2014. Toronto, Ontario, Canada. May 2014. (Poster Presentation)
4. Austin E, Miller P, Meshkat N, Okrainec A, Azazh A, Landes M. Telesimulation: Connecting University of Toronto Faculty to Ethiopian Residents to teach emergency procedures. University of Toronto Division of Emergency Medicine Resident Day. Toronto, Ontario, Canada. May 2014. (Poster Presentation)

PRESENTATIONS

1. Hunchak C. Introduction of a Resident-Faculty Mentorship Program: The Toronto-Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) Experience. AfCEM 2014, Addis Ababa, Ethiopia. (Poster Presentation)

Project Team: Nazanin Meshkat, Sisay Teklu, Cheryl Hunchak, on behalf of TAAAC-EM and the Global Health Emergency Medicine (GHEM) organization at the Division of Emergency Medicine, University of Toronto

Project Description (Abstract): In response to the Ethiopian Federal Ministry of Health mandate to develop EM services in Ethiopia, University of Toronto EM faculty were invited to develop and deliver EM content and expertise for the first EM postgraduate residency training program at AAU. The Toronto Addis Ababa Academic Collaboration-EM (TAAAC-EM) used five steps of a six-step approach to guide curriculum development and implementation: 1. Problem identification and general needs assessment, 2. Targeted needs assessment using indirect methods (interviews and site visits of the learners and learning environment), 3. Defining goals and objectives, 4. Choosing educational strategies and curriculum map development and 5. Implementation.

PUBLICATIONS

1. Meshkat N, Teklu S, Hunchak C, TAAAC-EM and the Global Health Emergency Medicine (GHEM) organization at the Division of Emergency Medicine, University of Toronto. Design and Implementation of a postgraduate curriculum to support Ethiopia's first emergency medicine residency training program: the Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). BMC medical education. 2018 Dec;18:1-8.

PRESENTATIONS

1. ​​Hunchak C, Landes M, Maskalyk J, MacKinnon D, Puchalski Ritchie LM, Venugopal R, Azaj A, Waji S, Meshkat N. Development & Implementation of an Emergency Medicine Residency Training Curriculum: The Toronto-Addis Ababa Academic Collaboration in Emergency Medicine. Canadian Association of Emergency Physicians (CAEP) Conference. Edmonton, Alberta, Canada. June 2015. (Poster Presentation)
2. Hunchak C. Development and Implementation of an Emergency Medicine Residency Training Curriculum: The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). International Conference on Residency Education (ICRE). Toronto, Ontario, Canada. September 2014. (Oral Presentation)
3. Hunchak C, Landes M, Maskalyk J, MacKinnon D, Puchalski Ritchie LM, Venugopal R, Azaj A, Teklu S, Meshkat N. Partnering to Develop and Implement an Emergency Medicine Residency Training Program Curriculum: The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM). DFCM Conference 2014, Toronto, Ontario, Canada. May 2014.(Poster Presentation)

PUBLICATIONS

1. Teklu S, Azazh A, Seyoum N, Woldetsadik A, Tupesis JP, Wubben R, Hunchak C, Meshkat N, Tefera G, Maskalyk J. Development and implementation of an emergency medicine graduate training program at Addis Ababa University School of Medicine: challenges and successes. Ethiopian medical journal. 2014 Jul 1:13-9.
2. Azazh A, Teklu S, Woldetsadi A, Seyoum N, Geremew H, Busse H, Tefera G, Wubben R, Rankin P, Tupesis JP, Maskalyk J. Emergency medicine and its development in Ethiopia with emphasis on the role of Addis Ababa University, School of Medicine, Emergency Medicine Department. Ethiopian Medical Journal. 2014 Jul 1:1-2.
3. Maskalyk J, Landes M. The Toronto-Addis Ababa academic collaboration: emergency medicine. Ethiopian Medical Journal. 2014 Jul 1:45-8.
4. Nowacki AK, Landes M, Azazh A, Ritchie LM. A review of published literature on emergency medicine training programs in low-and middle-income countries. International Journal of Emergency Medicine. 2013 Dec;6:1-0.
5. Maskalyk J, Landes M, Azaj A, Teklu S, Letovsky E, Schull MJ. Development of emergency medicine in Ethiopia. CJEM: Journal of the Canadian Association of Emergency Physicians. 2012;14(4):211.

OTHER REPORT

1. Landes M, Maskalyk J, Hunchak C, Fremes E. Partnering to establish emergency medicine in Ethiopia: development, implementation and evaluation of a postgraduate residency training program at Addis Ababa University. Final Technical Report. International Development Research Centre (IDRC). March 2014.

PRESENTATIONS

1. Ben Yakov M, Hunchak C, Landes M. Use of personal PDA for medical information for emergency medicine residents at Addis Ababa University. Canadian Association of Emergency Physicians (CAEP) Conference. Vancouver, British Columbia, Canada. June 2013. (Poster Presentation)
2. Landes M, Nowacki A, Puchalski-Ritchie L, Azaj A. A systematic review of emergency medicine training programmes in low to middle income countries. Emergency Medicine in Developing Countries Conference. Capetown, South Africa. November 2011. (Oral Presentation)