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Global Health Partnership

Queen’s University Department of Diagnostic Radiology & University of Nairobi Department of Diagnostic Imaging and Radiation Medicine

The Department of Diagnostic Radiology has created a Global Health Program, to provide outreach Radiology expertise to various parts of the developing world. This will also serve to establish professional and personal linkages between Queen’s University Faculty of Health Sciences and select universities and hospitals around the world.

The Department of Diagnostic Imaging and Radiation Medicine at the University of Nairobi is currently under-resourced and understaffed with a current faculty of 8 radiologists and 1 medical physicist. The current number of radiology residents is 58 making it challenging to effectively train and mentor trainees.

Given their limited residency training capacity, the Queen’s University Department of Diagnostic Radiology will enter into a partnership with the Department of Diagnostic Imaging and Radiation Medicine at the University of Nairobi, Kenya to create a Global Health Program with two main focuses: Education and Mentorship.

The purpose of this partnership is to establish a permanent international linkage to improve medical education and practice in Radiology programs and build capacity in specialty medical education and professional development.

Background:

Due to the universal shortage of radiologists, medical officers may perform certain radiological tasks including the responsibility for reporting acute trauma radiographs (Plessis & Pitcher, 2015). However, in sub-Saharan Africa which accounts for 24% of the world's disease burden (WHO, 2013), both radiologists and medical officers are acutely limited in supply (Kawooya, 2012), making the delivery of radiology services including imaging and diagnostics a challenge. In Kenya, access to basic imaging and laboratory services remains a major challenge in rural areas, which account for 74% of the population and is serviced by health outposts that lack basic radiology equipment, trained radiologists and laboratory tests (World Bank, 2017). Meanwhile, 90% of Kenya’s radiologists are estimated to be working in urban settings, with 76% (141 of 185) of radiologists in Kenya concentrated in just three major cities (Kawooya, 2012). More than 50% (26/47) of the 47 counties in Kenya are without a radiologist. These counties either refer patients for imaging or use tele radiology where available.

Access to radiology services in resource-constrained settings such as Kenya is particularly critical when one considers the unmeasured burden of tuberculosis (TB) and the major role of chest radiography in TB detection and control (Dhoot et al., 2018; WHO, 2016a). Currently, Kenya is among 30 countries with the world’s highest country-level burdens of TB (WHO, 2016b). For instance, the 2016 Kenya TB Prevalence Survey reported a national TB prevalence of 558 cases per 100 000 people, and this more than twice that of previous estimates by the WHO (Dhoot et al., 2018; WHO, 2016b). Chest radiography is, for example, recommended by the WHO as a screening tool for TB given its high sensitivity (WHO, 2016a) but the lack of adequate radiographic imaging capacity in Kenya, particularly in rural areas makes it difficult to implement this recommendation (Dhoot et al., 2018).

The Partnership:

This will be carried out in two parallel components:

1.    The International Education Exchange (IEE), which will be through the creation of a permanent electronic (videoconference) linkage between the partner institutions, allowing for the establishment of a permanent international collaborative professional and personal linkage between Queen’s University Faculty of Health Sciences and the University of Nairobi.

2.    The Visiting Professorship Program, attuned to the CanMEDS roles of Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional. Some of the present needs at the host site are the delivery of MRI physics, research methods, and leadership and governance modules.

International Education Exchange (IEE):

The IEE is a vital component of the Global Health Program. This will allow for continuous communication on educational aspects of the program throughout the years. This will serve to strengthen student-teacher and student-student relationships outside of the two-week period of the Visiting Professorship component. Through this communication link, the Faculty and radiology residents in Nairobi will have an opportunity to participate in and contribute to several educational events held throughout the year run by the Department of Diagnostic Radiology.  

The IEE includes (see attached Table):

 a.    Monthly Department of Diagnostic Radiology Grand Rounds. These are Royal College Accredited Rounds, with formal presentations by Radiologists and Radiology residents

b.    Q3 months Radiology-Emergency Collaboration (REC) Rounds. These are Royal CollegeAccredited educational sessions with the following objectives:
    a.   Present the clinical presentation and imaging of interesting cases presenting to the Emergency      department
    b.   Review the literature and using case examples discuss vis-à-vis practice changes, diagnostic criteria, communication pathways, and management techniques in an effort to positively affect patient care
    c.   Identify at least one area of successful collaborative pathway or potential improvement and refer to appropriate process mechanisms in the Departments of Diagnostic Radiology and Emergency Medicine

c.    Monthly Department of Diagnostic Radiology Case of the Month Rounds. These are interactive case presentation and discussion rounds, with open participation by Radiologists and Radiology residents

d.    Q6 monthly Artificial Intelligence Lecture Series. These are Royal College Accredited Lectures, held in collaboration with the School of Computing at Queen’s University and the Department of Diagnostic Radiology. Lectures are given by invited guest speakers, with interest in Artificial Intelligence and Healthcare, specifically imaging

e.    Others, including Queen’s Annual Radiology Imaging Symposiums

Table. International Education Exchange (IEE) Activities

Event Description                                                                          Occurrence

Department of Diagnostic Radiology Grand Rounds                        Monthly
Radiology-Emergency Collaboration (REC) Rounds                        Every 3 months
Department of Diagnostic Radiology Case of the Month Rounds     Monthly
Artificial Intelligence Lecture Series                                                  Every 6 months
Queen’s Annual Radiology Imaging Symposiums                            Yearly

The impact of the IEE component on international residents will be measured by the evidence of:  

a) Improved resident test scores on professional activities.
b) Increase in resident university/ national/international board examination pass rates
c) Increase in resident assessment scores (completed by staff supervisors)

All assessments will be reviewed on an annual basis jointly by the Department Head of Diagnostic Radiology, Queen's University and the Chair for the Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi. Recommendations for improving the program will be distributed to all staff and students at each site.  A summary of the recommendations will be posted on each Department’s website.

The Visiting Professorship Program:

The Department of Diagnostic Radiology at Queen’s University will sponsor one Visiting Professor for the Global Health Program each calendar year. The position will be open to all Radiologists within the Department.

Overview:

  1. Applications will open every year for professorships that are to be held the following year. The application form will emphasize the applicant’s teaching skills and educational experience, with a focus on how the potential professor integrates the CanMEDS roles into their responsibilities. Preference will be given to applicants who have not been a Global Health Program Visiting Professor within the past three years;
  2. All applications will be reviewed by the PGME Director and Faculty Research Director, who will recommend a Radiologist to the Department Head for approval. The host country/organization will be notified of the selection, and will participate in the final decision;
  3. The duration of the professorship is two weeks. A longer stay may be arranged if agreed upon by both the Queen’s Department of Diagnostic Radiology and the host site, the University of Nairobi Department of Diagnostic Imaging and Radiation Medicine. The Department will provide 1 week (5 days) of Academic Leave to each successful applicant;
  4. Upon completion of the program, the Global Health professor will be asked to write a one-page report summarizing his/her experience to be published in the Department of Diagnostic Radiology and Queen’s University Faculty of Health Sciences websites and publications. A Grand Rounds presentation to the Queen’s University Faculty of Medicine and/or a Health Sciences Education Rounds presentation describing their educational experience will also be expected.

Department of Diagnostic Radiology:

The Department of Radiology at Queen’s University is aligned with the vision of the Royal College with multiple faculty member volunteers on Royal College Committees including the Diagnostic Radiology Specialty Committee, CBD Diagnostic Radiology Committee, Royal College Surveyor program and Royal College Diagnostic Radiology examination. This provides a wealth of experience on the multiple aspects of the Royal College and will be helpful for providing a collaborative program which aligns with the mission of the Royal College.

The Department of Diagnostic Radiology at Queen’s University is an innovator in education. It established the first competency based medical education (CBME) program in Diagnostic Radiology residency in Canada with the Royal College FIRE initiative and is a leader in CBME. We will leverage this experience, and take it international, to improve and optimize the residency experience in Nairobi and help improve education.

Objectives of Partnership:

  1. Promote medical education and scholarship at the partner institution through participation in the various Department of Diagnostic Radiology educational events;
  2. Provide opportunities for lifelong education for Faculty and radiology students in Nairobi, Kenya, with a focus on professional learning and development and maintenance of competence and certification;
  3. Assist with enhancement of Radiology student assessment and examination processes. This will include helping to design and integrate a structured resident training program and provide tools to analyze the functionality of the implementation process.  We will share our experience of adopting and implementing a CBME residency program in the Department of Diagnostic Radiology at Queen’s University with the partner institution;
  4. Support the partner institution to achieve their long-term educational objectives of establishing a core curriculum, standard assessment tools, improving clinical skills, organizational skills and assessment. Provide templates for deliverance of annual Radiology resident mock oral and OSCE examinations, which can be performed in conjunction with similar testing of Queen’s Radiology residents on an annual basis;
  5. Provide an opportunity for mentorship in medical education via access to faculty, students, and resources at Queen’s University.

Forecasted Outcomes/Deliverables:

  1. Increase in learner satisfaction through improvements in quality of care;
  2. Increased learner confidence in the delivery of appropriate care;
  3. Knowledge transfer: new diagnostic and therapeutic techniques;
  4. Improvement in resident test scores;
  5. Increase in resident university/national/international board examination pass rates;
  6. Increase in resident assessment scores (completed by staff supervisors);
  7. Personal and Professional growth of Visiting Professors through fulfillment of CanMEDS roles of Medical Expert, Communicator, Collaborator, Leader, Health Advocate, Scholar and Professional.