Background

The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) was established 10 years ago as an educational partnership between the University of Toronto and Addis Ababa University [1] designed to support the development of a community of emergency medicine (EM) specialists in Ethiopia. Here we discuss the impact of the COVID-19 pandemic on our global health partnership and the innovations that have allowed it to remain effective.

Our partnership is built on a curriculum designed collaboratively by University of Toronto and Addis Ababa University faculty. While Addis Ababa University staff lead key parts of the curriculum, many teaching requirements are met by visiting University of Toronto staff and senior residents during 1-month teaching trips in Addis Ababa three times per year. The COVID-19 pandemic resulted in the first ever cancellations of teaching trips. We needed to quickly identify ways of engaging from a distance. Until now there had been no clear pathway identified in the literature for transitioning an in-person global health education partnership to a virtual space.

Rationale

The pandemic threatened the solidarity and trust we had built over a decade of collaboration. We were motivated to find strategies for synchronous sessions to maintain the interactive nature of our sessions and promote ongoing relationship building. This led to a rapid pivot to virtual education.

Description of innovation

Our five-step approach to transitioning to a virtual space was inspired by Deming’s cycle of change model [2] 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.

Table 1 Five step approach to transitioning to a virtual space
Full size table

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.

Discussion

Global health partnerships can continue to grow despite the COVID-19 pandemic. TAAAC-EM’s five step approach to transitioning to virtual education emphasizes iterative improvement to maintain consistency with the needs of staff and residents. This approach can inform the transition of other forms of medical education to the virtual space. Through virtual education we have reaffirmed our commitment to the TAAAC-EM partnership. We recognize, however, that virtual education is limited for hands-on learning and cannot fully replace in person teaching [3]. Our next steps are to explore options for procedure and simulation teaching. Once travel to Ethiopia for teaching is possible again, we will use what we have learned to incorporate virtual teaching where it is most effective, allowing us to maximize the value of teaching trips.

Summary

In-person teaching trips have been central to the success of TAAAC-EM; the cancellation of the first teaching trips in our history due to the COVID-19 pandemic has inspired us to find new ways to support local training of EM physicians in Ethiopia. We offer our experience as a roadmap to other global health partnerships that have been similarly impacted by COVID-19. While not a replacement for in-person engagement, virtual education can be a valuable tool both to supplement partnership activities when travel is not possible, and to enhance global health partnerships long term.