In Kenya, there is a need to improve emergency services. The few available emergency departments (EDs) in referral hospitals are generally staffed by clinical officers and recently graduated medical officers with minimal training in the care of acute, critical, or traumatic conditions. These EDs have limited or no specialist coverage. At the county hospital level, EDs are largely absent, and no formal means exist for triaging patients who arrive with potentially life-threatening medical and surgical conditions. Ultimately, Kenyan referral centers and county hospital emergency services should be led by residency-trained emergency providers. However, this process will take time.
The Accident & Emergency (A&E) department at The Aga Khan University Hospital, Nairobi (AKUH, N) is mainly staffed by senior house officers (medical officers with postinternship experience with or without a Diploma in Primary Emergency Care, Dip PEC) and rotating residents from the departments of Medicine, Surgery, and Family Medicine. They all work under the supervision of an emergency physician on a shift system. Family medicine consultants also periodically rotate in the A&E.
The A&E department is the first point of entry for most of the hospital’s patients. It provides initial assessment, treatment, and stabilization to an average of 180–200 patients per day with a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. The department also responds to cardiac arrests across the hospital as part of the hospital resuscitation system (Code Blue). Approximately 5% of patients seen in the A&E are admitted to the hospital daily, with one-third of them to critical care.
The Emergency Medicine (EM) Training Program is an 18-month full-time competency-based training program conducted at AKUH, N. The aim of this program is to train medical officers to better manage the initial triage and stabilization of patients with a wide variety of medical, surgical, and traumatic conditions 24 hours per day, provide supervision and direction for Emergency Medical Services systems, and coordinate disaster and emergency response at the local and national level.
The trainees work on a rotational basis in Adult A&E for 9 months, Pediatrics A&E for 3 months, Intensive Care Unit for 3 months, Anesthesia for 2 months, and Obstetrics & Gynecology for 1 month. Additional time is spent working in the prehospital system.
The A&E department currently has a full-time emergency physician and visiting international EM faculty teaching the program. Because AKUH, N is a university hospital, faculty from the other departments that the trainees rotate through are involved in teaching and supervision. Visiting EM faculty are also welcome to participate in teaching and training.
At the completion of their study, the trainees will be equipped with the theoretical knowledge, practical ability, and interpersonal skills for full-time or independent EM practice and qualification for the College of Emergency Medicine of South Africa Dip PEC examination. Access to the Rosh Review question bank gives the trainees invaluable study materials for their Dip PEC exam.