Remote Teaching in a Rwandan Emergency Medicine Residency: A Viable Option with Limited In-person Staff

Low and middle-income countries (LMIC) in Africa face challenges in medical education. Eleven countries have no medical school, 24 countries share one medical school, and few have residency programs. This shortage means that Africa has only 1.7% of the world's physicians, yet bears 27% of the global disease burden. COVID-19 created further educational constraints, especially in emergency medicine (EM). Student and resident education opportunities were limited. Rwanda faced a shortage of available in-person EM residency instructors during the pandemic, and to support learning needs, we designed and implemented a remote teaching model to substitute in-person instruction. The objective of this study was to evaluate whether remote and pre-recorded teaching is positively received by EM learners and if it is a viable supplement in resource limited settings. Pre-recorded lectures were presented to residents, with lecturers remotely available. We evaluated the program using the first-level Kirkpatrick framework (suitability/satisfaction) via a quantitative and qualitative post-lecture survey. The survey was completed by residents in attendance. Responses were analyzed using descriptive statistics. Outcome measures included learner satisfaction, lecture quality, technological quality, and situational suitability. Qualitative and free-response data was An average of 11 Rwandan EM residents attended 18 lectures. Using a Likert scale, the composite learner satisfaction score was 4.25 (σ = 0.1), the lecture quality score was 4.2 (σ = 0.1), the technological quality score was 4.0 (σ = 0.36), and the situational suitability score was 4.25 (σ = 0.07). These results indicated overall satisfaction with the lectures. Lower scores were given regarding lecturer accents and speech rates. Qualitative feedback did not demonstrate significant dissatisfaction with quality or suitability. When in-person lecturers are unavailable, pre-recorded, remote instructional methods may be an appropriate substitute. Future directions may include piloting the project with a larger, multinational cohort or in LMICs with greater technological or resource limitations.