Assessing the Quality and Effectiveness of Teaching Clinical Officers in Uganda Using a Dermatology ECHO program
Authors: Brown Todd , Lewis Bethany K. H. 
Published: July 2024

Background/Purpose Extension for Community Healthcare Outcomes (ECHO) started in 2003 with the mission to improve healthcare in rural and underserved areas. Often, individuals living in rural or underserved areas have a lack of access to specialty care. With more than one-third of all primary care patients seeking care for at least one skin problem, establishing a Dermatology ECHO program is essential in providing comprehensive specialty care to rural and underserved areas. Using telemedicine technology, our institutions’ Dermatology department has established an ECHO model to train and teach clinical officers located in Uganda. While research studies are showing the benefits of dermatology telemedicine in addressing rural needs, few studies look at the benefits of dermatologists training community healthcare workers to improve care in rural and underserved areas. Accordingly, this study aims to assess the effectiveness of a Dermatology ECHO program in training clinical officers in Uganda. Methods We partnered with the WORLD AMTC Network in Uganda to recruit clinical officers interested in dermatology care. Before the training sessions, a 9 question Likert scale survey (not at all confident, slightly confident, somewhat confident, very confident) was conducted to determine the participants confidence in identifying and treating skin conditions. The same survey was conducted after the sessions. Results In the first ECHO session, 8 participants responded to the pre-session survey and 7 participants responded to the post-session survey. In the second session, 10 participants responded to the pre-session survey and 9 participants responded to the post-session survey. The confidence responses were associated with a numerical score (1-not at all confident, 2-slightly confident, 3-somewhat confident, 4-very confident). The average rating for ‘appropriately addressing patients’ concerns with respect to this skin condition’ was 2.4 before the sessions and 3.75 after the sessions which represented the largest improvement in confidence (1.3). The next largest improvement (1.17) came from ‘prescribing the appropriate medication for this skin condition’ which had an average rating of 2.39 before the sessions and 3.56 after the session. The third largest improvement (1.16) came from the question ‘suggesting evidence-based ways to care for this skin condition’ which had an average rating of 2.3 before the sessions and 3.5 after the sessions. Discussion While telemedicine has improved dermatology care in rural areas, there is a lack of research on the effectiveness of Dermatology ECHO programs in teaching community healthcare workers that practice in rural/underserved areas. With dermatology care being an important part of primary care, the effectiveness in using ECHO to train and teach dermatology care is important to examine. The results of this study suggest that the largest confidence increases for providers come in the form of addressing patients’ concerns, prescribing appropriate medications, and caring for skin conditions using evidence-based methods. Additionally, all 9 questions asked showed an improvement in confidence from before the session to after the session suggesting that Dermatology ECHO session may improve participants confidents. Future surveys administered to this same group of participants will help determine how ECHO sessions effectiveness change over time and how participants confidence change over time for different skin conditions.While telemedicine has improved dermatology care in rural areas, there is a lack of research on the effectiveness of Dermatology ECHO programs in teaching community healthcare workers that practice in rural/underserved areas. With dermatology care being an important part of primary care, the effectiveness in using ECHO to train and teach dermatology care is important to examine. The results of this study suggest that the largest confidence increases for providers come in the form of addressing patients’ concerns, prescribing appropriate medications, and caring for skin conditions using evidence-based methods. Additionally, all 9 questions asked showed an improvement in confidence from before the session to after the session suggesting that Dermatology ECHO session may improve participants confidents. Future surveys administered to this same group of participants will help determine how ECHO sessions effectiveness change over time and how participants confidence change over time for different skin conditions. Background/Purpose Extension for Community Healthcare Outcomes (ECHO) started in 2003 with the mission to improve healthcare in rural and underserved areas. Often, individuals living in rural or underserved areas have a lack of access to specialty care. With more than one-third of all primary care patients seeking care for at least one skin problem, establishing a Dermatology ECHO program is essential in providing comprehensive specialty care to rural and underserved areas. Using telemedicine technology, our institutions’ Dermatology department has established an ECHO model to train and teach clinical officers located in Uganda. While research studies are showing the benefits of dermatology telemedicine in addressing rural needs, few studies look at the benefits of dermatologists training community healthcare workers to improve care in rural and underserved areas. Accordingly, this study aims to assess the effectiveness of a Dermatology ECHO program in training clinical officers in Uganda. Methods We partnered with the WORLD AMTC Network in Uganda to recruit clinical officers interested in dermatology care. Before the training sessions, a 9 question Likert scale survey (not at all confident, slightly confident, somewhat confident, very confident) was conducted to determine the participants confidence in identifying and treating skin conditions. The same survey was conducted after the sessions. Results In the first ECHO session, 8 participants responded to the pre-session survey and 7 participants responded to the post-session survey. In the second session, 10 participants responded to the pre-session survey and 9 participants responded to the post-session survey. The confidence responses were associated with a numerical score (1-not at all confident, 2-slightly confident, 3-somewhat confident, 4-very confident). The average rating for ‘appropriately addressing patients’ concerns with respect to this skin condition’ was 2.4 before the sessions and 3.75 after the sessions which represented the largest improvement in confidence (1.3). The next largest improvement (1.17) came from ‘prescribing the appropriate medication for this skin condition’ which had an average rating of 2.39 before the sessions and 3.56 after the session. The third largest improvement (1.16) came from the question ‘suggesting evidence-based ways to care for this skin condition’ which had an average rating of 2.3 before the sessions and 3.5 after the sessions. Discussion While telemedicine has improved dermatology care in rural areas, there is a lack of research on the effectiveness of Dermatology ECHO programs in teaching community healthcare workers that practice in rural/underserved areas. With dermatology care being an important part of primary care, the effectiveness in using ECHO to train and teach dermatology care is important to examine. The results of this study suggest that the largest confidence increases for providers come in the form of addressing patients’ concerns, prescribing appropriate medications, and caring for skin conditions using evidence-based methods. Additionally, all 9 questions asked showed an improvement in confidence from before the session to after the session suggesting that Dermatology ECHO session may improve participants confidents. Future surveys administered to this same group of participants will help determine how ECHO sessions effectiveness change over time and how participants confidence change over time for different skin conditions.While telemedicine has improved dermatology care in rural areas, there is a lack of research on the effectiveness of Dermatology ECHO programs in teaching community healthcare workers that practice in rural/underserved areas. With dermatology care being an important part of primary care, the effectiveness in using ECHO to train and teach dermatology care is important to examine. The results of this study suggest that the largest confidence increases for providers come in the form of addressing patients’ concerns, prescribing appropriate medications, and caring for skin conditions using evidence-based methods. Additionally, all 9 questions asked showed an improvement in confidence from before the session to after the session suggesting that Dermatology ECHO session may improve participants confidents. Future surveys administered to this same group of participants will help determine how ECHO sessions effectiveness change over time and how participants confidence change over time for different skin conditions.