An International Virtual Classroom: The Emergency Department Experience at Weill Cornell Medicine and Weill Bugando Medical Center in Tanzania

We created a sustainable, bidirectional partnership using telecommunication technology to enhance emergency medicine education collaboration. Telemedicine is a practical and innovative methodology to expand training in emergency medicine and establish bidirectional partnerships between academic departments in high-income and low- and middle-income countries. Key Messages Specialty graduate medical education and training typically follows an apprenticeship model that requires in-person teaching and instruction, which because of the COVID-19 pandemic, can be challenging in regions with travel restrictions and strict lockdown guidelines. In areas that have few specialty-trained local providers, it presents a circular conundrum: creating training programs requires faculty; having faculty requires creating training programs. The bidirectional partnership established between the emergency medicine departments of Weill Cornell Medicine and Bugando Medical Center demonstrates a collaborative approach to telemedicine and e-learning that is sustainable and encourages long-term engagement. Our approach of incorporating telecommunications into academic collaborations may remediate problems that have reduced the effectiveness of other traditional forms of educational connection between high-income countries and low- and middle-income countries, including lack of sustainability and reduced engagement over time. Although this technology was used in the context of emergency medicine graduate education, the benefits of this approach can easily be extrapolated to strengthen a wide variety of international collaborations. ABSTRACT Emergency medicine (EM) is rapidly being recognized as a specialty around the globe. This has particular promise for low- and middle-income countries (LMICs) that experience the largest burden of disease for emergency conditions. Specialty education and training in EM remain essentially an apprenticeship model. Finding the required expertise to educate graduate learners can be challenging in regions where there are low densities of specialty providers. We describe an initiative to implement a sustainable, bidirectional partnership between the Emergency Medicine Departments of Weill Cornell Medicine (WCM) in New York, NY, USA, and Bugando Medical Center (BMC) in Mwanza, Tanzania. We used synchronous and asynchronous telecommunication technology to enhance an ongoing emergency medicine education collaboration. The Internet infrastructure for this collaboration was created by bolstering 4G services available in Mwanza, Tanzania. By maximizing the 4G signal, sufficient bandwidth could be created to allow for live 2-way audio/video communication. Using synchronous and asynchronous applications such as Zoom and WhatsApp, providers at WCM and BMC can attend real-time didactic lectures, participate in discussion forums on clinical topics, and collaborate on the development of clinical protocols. Proof of concept exercises demonstrated that this system can be used for real-time mentoring in EKG interpretation and ultrasound technique, for example. This system was also used to share information and develop operations flows during the COVID-19 pandemic. The use of telecommunication technology and e-learning in a format that promotes long-term, sustainable interaction is practical and innovative, provides benefit to all partners, and should be considered as a mechanism by which global partnerships can assist with training in emergency medicine in LMICs.