“Strengthening Emergency Care in Belize” is a collaborative effort by Karl Heusner Memorial Hospital (KHMH), Belize Ministry of Health, and the Medical College of Wisconsin (MCW). The original memo of understanding was executed in December 2013 after over three years of dialogue with the principals involved. This program involves training emergency medicine providers (doctors and nurses) from the Accident and Emergency Department (A&E) at KHMH with didactics, bedside teaching, skill labs, and immersive experiences at the MCW campus.
Resources & Environment
KHMH is the only trauma center in Belize. It is the only government-sponsored hospital in the country with access to subspecialists, and it is the main referral hospital for the country. The A&E sees approximately 30,000 patients per year, two-thirds of whom are adults. In the A&E there are 2 critical care rooms, 10 monitored beds, and distinct observation and pediatric sections for a total of approximately 30 beds in the department. The hospital has a medical and surgical intensive care unit, pediatric intensive care unit, and operating rooms in addition to medical, surgical, pediatric, and obstetric wards. Emergency ancillary services include a stat laboratory and radiology department (computed tomography, ultrasound, and plain films).
In 2010, the medical leadership of Belize (including the Belize Medical and Dental Association, Belize Ministry of Health, and KHMH administration) contacted Dr. Mark Bruce, American College of Emergency Physicians Lead Ambassador – Belize. This leadership recognized that a high-census, high-acuity emergency medicine practice had been developed at KHMH A&E without trained specialists in emergency medicine (EM); in fact, there was no recognition of the specialty of EM in Belize. The KHMH A&E was largely staffed by physicians who were in transition to other specialty training programs outside of Belize, resulting in poor outcomes for KHMH A&E patients.
After a brief assessment, Dr. Bruce contacted his colleagues at MCW to become an academic partner in a Belize EM training program. Along with Dr. Stephen Hargarten, then chairperson of EM at MCW and Froedtert Memorial Lutheran Hospital (Milwaukee’s trauma center) and MCW Assistant Dean for Global Health, Dr. Bruce participated in the 2010 Belize Medical and Dental Association congress and began designing the program with the Belize partners.
The active training began in January 2014 and still continues, so far resulting in a core group of nine KHMH A&E physicians completing the EM curriculum. This has been accomplished with significant help from EM faculty of State University of New York – Stony Brook, Brown University, MCW, Baylor College of Medicine/Texas Children’s Hospital, University of California – Davis, University of British Columbia, and Dalhousie University. In January 2019, Dr. Bruce requested permission from the Belize Medical Council to administer a qualifying EM examination to the core group and to grant them EM specialty recognition upon successful completion of the written and oral examinations. The Belize Medical Council approved this request, and a comprehensive EM board review course will be taught September 30–October 11, 2019, with the first sitting of the written and oral examinations November 14–15, 2019. This core group of nine physicians will be the first graduates of the program, and they plan to continue working at KHMH A&E and serve as faculty for new trainees.
There is tangible improvement in KHMH A&E patient outcomes as a result of this program. The advancement of a systems-based approach to emergency care across Belize is being realized, aided by the completion of an Emergency Medicine System Fellowship by Dr. Rigo Montejo (one of the core group physicians and director of the Belize Emergency Response Team) at MCW in June 2018. The training model for the “Strengthening Emergency Care in Belize” program has been to train trainers, with the ultimate goal of establishing an emergency medicine residency training program at KHMH, being a center of excellence in emergency care and a resource for not just Belize, but also Central America and the Caribbean.
Using Rosh Review
The Rosh Review question bank will provide an invaluable resource for the core physician group to prepare for the written boards exam this fall. They have no other access to online training materials, so this will be critical to their success in passing the written exam as well as in their ongoing learning.