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Kijabe Hospital/Tenwek Hospital ECCCO Program, Kenya

The Emergency Critical Care Clinical Officer program at Kijabe hospital is a nationally recognized higher degree program available to Clinical Officers (CO) in Kenya. It was started in 2015 to meet the need for emergency medicine clinicians in rural Africa. The program initially was started at Kijabe hospital, a 350-bed Level 5 referral and teaching hospital located just west of the capital city of Nairobi but has since grown to have trainees rotate at Tenwek Hospital for several months during their training. Tenwek Hospital is a 420-bed Level 6b (similar to a US Level 1) trauma center located in rural Kenya. The program has a rigorous 18-month curriculum that focuses on evaluating, diagnosing and managing common and pressing conditions seen in our resource-constrained context. The trainees become proficient in advanced emergency medical procedures, patient resuscitation, airway management, ICU ventilator management, and Point-of Care Ultrasound (POCUS).

ECCCO trainees focus on both clinical skills as well as quality improvement and research initiatives and are often involved in directing national level programs after graduation. Our graduates host a national conference for emergency medicine which is well attended by clinicians in other specialty areas who are interested in topics of emergency medical care. Many of our graduates also work closely with the Emergency Medicine Kenya Foundation (EMFK) as the clinical officer arm supporting emergency medicine advancement within Kenya

During a 1-month training block, trainees in the program spend 2 weeks on rotation, 1 week of didactics (which includes an end of week exam), and 1 week off. Since its inception, the program has trained 48 graduates and takes in 10-14 trainees every 18 months. These graduates then go out within their communities and are often the only clinician in their hospital with advanced clinical skills to be able to take care of critical patients. Faculty for the program include former graduates, visiting critical care clinicians from The United States, hospital consultants, and US board certified Emergency Medicine Physicians at the Kijabe and Tenwek training sites. The training environments involve two 10-bed emergency departments at both Tenwek and Kijabe and are outfitted similarly to a US-based emergency department with an electronic medical record, digital x-ray and CT scan imaging, POCUS (GE Venue Go at Tenwek, SonoSite M-turbo and Butterfly at Kijabe), on-site laboratory, rapid ECG capabilities, and continuous telemetry monitoring for all patients. Both training sites also have access to a blood bank, ICU care, 24/7 surgical capabilities, pediatrics, dialysis, ophthalmology, and obstetric support. Tenwek hospital also offers neurosurgical and cardiothoracic support. The trainees work 12-hour shifts in the emergency department, with direct supervision by either a board-certified emergency medicine attending or an ECCCO graduate. At the end of their 18-month training period, the trainees sit for a comprehensive exam like a US emergency medicine residency in-service exam. Graduates also are certified in American Heart Association (AHA) Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) as well as Advanced Trauma Life Support (ATLS) through the Kenyan College of Surgeons.

We have trialed Rosh Review in the past with our trainees and they state that they really enjoy the low-pressure and individual style of education Rosh provides. We as a program have found that Rosh Review also provides a well-rounded and critical thinking approach to the emergency and critical patient. We have seen that it improves the depth of knowledge of our trainees and helps fill in some of our training gaps. Our trainees enjoy being able to work on Rosh Review in between patients and during slow periods in the department. Rosh also helps bring up topics of discussion between the trainees and instructors and helps maximize the opportunities our trainees have in acquiring critical information and skills during their time with us.

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