Hip hip hooray for medical education

(by Ted John)

A few months ago, I wrote a post on medical education and my experience organizing a 2-week dental course for the medical students, which you can read more about here. It was the first time teaching such a course at our hospital and the first time for me to coordinate/organize a course. Since we don’t have any dentists on site, teaching was done exclusively through audio/video recordings and live video conferencing.

Fast forward a few months, and I have now finished coordinating a new course on orthopedics and trauma. Here’s a table to give you an idea of how they were similar and different, at a glance.

	Dental	Ortho/Trauma
Number of students enrolled	46	52
Duration of course	2 weeks	5 weeks
Number of instructors	3	6
Number of (different) lectures	9	29
% of lectures taught in English (PPT slides in French)	78%	26%
Method of instruction	tele-education	in-person (some distance learning)

Of course, there are a number of other differences. For example, the scope of the ortho/trauma course was broader, but more related to general surgery (at least as it pertains to trauma). Thus, while it would be ideal for orthopedic surgeons to teach the more strictly ortho topics, we did the best with what we had in terms of available expertise. In what other context could you imagine an ortho/trauma course taught by a motley of 4 general surgeons, an ER doctor, and a visiting orthopedic surgeon? 😄

Lecturing in our newly renovated classroom

Another big difference was that not all students were present for the in-person instruction at Kibuye. At any given point in time during the course, there were 8-16 students doing clinical rotations off-site in Bujumbura. As a result, it required more effort and coordination to ensure that these students could have timely access to recorded lectures and corresponding slides. The usual routine was that as soon as an instructor finished giving their lecture, they would send me their recorded audio file, which I would then upload to Dropbox (along with their slides). Then there’s the logistics of administering quizzes and exams in two locations simultaneously, getting scanned copies of the completed off-site quizzes, and grading and reporting all students’ results in a timely manner. Doing this in the US with high-speed internet and ubiquitous Wi-Fi would be challenging in and of itself, so accomplishing this in our context is nothing short of incredible.

Medical students taking one of their weekly quizzes

Here’s a condensed list of the content we covered:

• ATLS/Burns
• Trauma of the spine and chest
• Trauma/fractures of the upper extremities (shoulder, humerus, elbow, forearm/wrist, hand)
• Trauma/fractures of the lower extremities (hips, femur, knee, ankle)
• Musculoskeletal infections and tumors
• Differences in the pediatric population (plus congenital abnormalities)

Skeleton models of bones and joints were available for students throughout the course 

Much of the content goes well beyond the expertise of a typical general surgeon, so we are thankful for a French textbook that we used as the foundation for our instruction. In reading through this book and preparing slides, I’m certain that each instructor learned something in the process, whether deepening their own medical/surgical knowledge or perhaps learning additional French words for specific terms. For instance, I learned that the commonly used English abbreviation ORIF (open reduction, internal fixation) does not translate exactly into French as with other terms and is probably closest to réduction sanglante avec contention interne (which is literally “bloody reduction with internal compression/immobilization”). One can only wonder if this is actually what is colloquially used in France. In this sense, it felt like I was earning continuing medical education (CME) credits.

We’re also thankful for Joel Post, an orthopedic surgeon who visited for 2 weeks during the middle of the course. We intentionally planned the course to correspond with when he was around so that we and the students could benefit from his expertise. With Dr. Post’s fellowship training in orthopedic oncology as well as traumatology, he was the perfect person to give the lectures on osseous tumors and ankle fractures (which I view as generally more complex both in terms of injury patterns and management). As I sat in the back of the room listening to him, with stories of patients from his own current clinical practice, I couldn’t help but think, “Wow, this is so interesting. I wish Joel could teach all the ortho lectures!”

My family with Joel just before his return to the US

Overall, though, I’m quite pleased with how the course turned out, and I think the students learned a lot. As with the dental course, I recognized the top performing students, but this time with little bags of calcium supplements (tums) for fun. I even trialed an electronic post-course survey through google forms to solicit feedback, the template for which others can continue using in future courses going forward. In response to the question of what was the best part of the course, a good number of students said “everything”. Yet, I know there’s room for improvement, and will take to heart the students’ suggestions for the next time this course is taught again in a couple years. For now, I can redirect my attention elsewhere, perhaps in helping with the start of a surgery residency training program in the coming months. Tibia continued...

Group photo with the Kibuye cohort of students at the end of the course