Our five-step approach to transitioning to a virtual space was inspired by Deming’s cycle of change model  and is outlined in Table 1. This was based on a scoping consultation with Addis Ababa University EM colleagues. Each step was conducted through close collaboration between University of Toronto and Addis Ababa University EM physicians.
There have been three continuing professional development sessions (in addition to the pilot sessions discussed in Table 1): one on point of care ultrasound and COVID-19, one on advocacy and hospital administration, and one on bioethics and its application to the pandemic. We also facilitated three wellness sessions for staff.
Once invitations were extended across Ethiopia, attendees from three additional EM sites participated. Based on feedback from Addis Ababa University EM staff, residents will also be invited to most future continuing professional development and wellness sessions, following a grand rounds format.
Postgraduate teaching began 2 weeks after the first pilot continuing professional development session, using a similar format followed by an evaluation. We have held 15 postgraduate teaching sessions. Synchronous attendance varied from 2 to 28 residents (out of a total of 30). The number of recording views ranged from 2 to 54 (median 12) per session. Of 27 responses to post-session evaluations, 56% reported at least 1 connection interruption, reinforcing the importance of access to both live and recorded sessions. Most responses (94% not including two missing responses) indicated that residents felt comfortable participating while being recorded. Instructors noted less interactivity than what would be expected in person due in part to limitations in internet connection (not being able to use the microphone or video reliably and relying on the chat function).
The estimated cost of $10,000 per trip for two faculty members and one resident was avoided. We incurred a small new expense of $226 for a Zoom business account. Instructors were not compensated financially, and all other administrative costs were unchanged; existing internet access routes were utilized so no additional cost were required for internet connection. Funds not spent on teaching trips due to the disruption of the COVID-19 pandemic will be used for future in person teaching and other initiatives.