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A Responsibly-Minded Approach to Virtual Echocardiography Training of Non-Specialists in Haiti and Beyond
Megan Blaustein1, Michel Ibrahim2, Veauthyelau Saint-Joy3
1Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States.
Insights
Remote echocardiography training in Haiti improved resident skills in cardiac imaging and interpretation. This technology-driven approach offers a sustainable solution for cardiovascular care in resource-limited settings.
Area of Science:
- Cardiology
- Medical Education
- Telemedicine
Background:
- Cardiovascular disease is a significant public health concern in Haiti, with a severe shortage of cardiologists.
- General practitioners manage complex cardiac cases, highlighting the need for advanced diagnostic training.
- In-person echocardiography training is currently unfeasible due to geopolitical challenges in Haiti.
Purpose of the Study:
- To assess the effectiveness of a novel remote echocardiography curriculum for internal medicine residents in Haiti.
- To address the need for practical echocardiography skills and low-cost imaging tools in a resource-limited setting.
- To develop a sustainable and context-sensitive training model for echocardiography.
Main Methods:
- A 12-week remote echocardiography training program (FETIP) was implemented for 16 internal medicine residents.
- Training involved live didactic sessions, hands-on image acquisition using portable ultrasound and telemedicine robots, and image interpretation.
- A Training Advisory Board provided oversight and guidance for curriculum refinement.
Main Results:
- Residents showed significant improvements in echocardiography knowledge, image acquisition, and interpretation skills.
- Trained residents successfully applied echocardiography in clinical practice, identifying previously undiagnosed heart failure cases.
- The remote training model proved effective in enhancing diagnostic capabilities for cardiovascular conditions.
Conclusions:
- Technology-driven training models like FETIP can effectively support physicians in resource-limited settings like Haiti.
- The program fosters greater self-sufficiency in echocardiography, improving cardiovascular care.
- The FETIP framework offers a scalable model for global echocardiography training in underserved regions.
Problem:
Cardiovascular disease in Haiti is a major public health issue, yet fewer than 17 cardiologists are present nationwide. Consequently, general practitioners assume a substantial portion of demand for complex disease management. Following their experience of the 2019 International Cardiology Curriculum Accessible by Remote Distance Learning (ICARDs), the authors identified a desire for practical instruction in echocardiography and a low-cost, effective imaging tool to screen for pertinent heart conditions. Current geopolitical challenges in Haiti render in-person echocardiography training unfeasible. A novel remote echocardiology curriculum for internal medicine residents could meet this challenge in a manner that is effective, sustainable, and sensitive to the Haitian context.
Approach:
University Hospital of La Paix served as the pilot intervention site for the Focused Echocardiography Training Intervention Package (FETIP). Portable ultrasound devices and a telemedicine-enabled robot were selected to mediate remote training, which was delivered in September of 2023 to 16 internal medicine residents over the course of 12 weeks. The first phase of training included live didactic sessions created and delivered by board-certified cardiologists. In the second phase, residents received hands-on training in image acquisition under direct supervision. The third phase centered on image interpretation skills. A diverse Training Advisory Board oversaw the implementation of FETIP and offered guidance for ongoing refinements.
Outcomes:
Results demonstrate improvement in three primary endpoints: fundamentals of knowledge, image acquisition, and image interpretation. Residents not only improved their technical performance but also applied echocardiography in appropriate clinical contexts, identifying previously unrecognized cases of heart failure.
Next Steps:
The challenges in cardiovascular care in Haiti are ongoing, yet technology-driven training models like FETIP provide meaningful support to Haitian physicians, leading to future self-sufficiency in echocardiography. Further, the authors' experience offers the global medical community a scalable framework for echocardiography training for use in other resource-limited settings.
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