The goal of GHC’s emergency medicine residency is to train compassionate and skilled emergency physicians, equipped with evidence-based practices, who can contribute to the specialty’s landscape in the country, fostering its growth and recognition for its significance. Graduates from our residency program work in prominent emergency departments across Brazil, both in public and private hospitals, such as Hospital Cristo Redentor, Hospital Nossa Senhora da Conceição, Hospital São Lucas, and even in leadership roles like coordinating the emergency medicine residency at Hospital Municipal Souza Aguiar Municipal in Niterói, Rio de Janeiro – the state’s first program of its kind. In Brazil, we lack native Portuguese textbooks for Emergency Medicine; we rely on translated manuals. Therefore, we use Tintinalli’s and Rosen’s as our fundamental references. As previously mentioned, we employ the Foundations of Emergency Medicine guide for clinical case discussions – which does have limitations due to the differing epidemiology of Brazilian diseases compared to developed countries. Manuals like Walls also constitute a theoretical cornerstone of our program. In addition, the use of Rosh Review will aid in our residents’ individual development and help diagnose our residency program’s strengths and weaknesses. By comparing our residents’ knowledge areas’ results with those from other programs on the platform, we can identify potential teaching gaps and refine our teaching and learning processes, thereby nurturing increasingly skilled emergency physicians. Undoubtedly, Rosh Review’s rich illustrations and detailed explanations will serve not only as motivation but also as an unparalleled source of knowledge, enhancing our technical and professional growth, while also contributing to the expansion and advancement of Emergency Medicine in Brazil.

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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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We do not have a child psychiatrist in the province. Unfortunately, for this rotation, we have to travel to Gauteng province which is 300km away from Limpopo province. The rotation is for 3 months and unfortunately we have to fund ourselves starting with travel costs, accommodation etc. Mankweng and Pietersburg hospital also have a child psychiatry outpatient clinic every Wednesday, and this is usually done by registrars preferably those who have completed their child psychiatry training in Gauteng province. We do not have a child psychiatry unit in the province and this result in challenges with regard to management of difficult children or those who do not respond to outpatient treatment. We also have few facilities that can help with the care of these children leading to frustration in the family and difficulty with management.
As part of our training, we are also expected to observe and do Electroconvulsive therapies on patients. Our province does not offer this therapy both in the private and public sector. As a result, we have to travel again to Gauteng province to do these therapies which is more than 300 km meters from Limpopo province and this is not covered by the institution. We travel at our own costs and pay for our accommodation.

We are registered with the University of Limpopo which recently established a medical school about 7 years ago and has no resources for postgraduate students. We are also expected to do research as part of our training with the University in order to obtain our Masters degree in psychiatry, where we also don’t have support. We don’t receive teachings or tutorials regarding research, instead we do it ourselves with help from those colleagues who are ahead of us. In addition, the registrar is also expected to teach 4th,5th,and 6th year undergraduate medical students when they come for their clinical rotations in the psychiatry department.
Objective:

The registrar training program is for 4 years. In this period of training, the registrar is expected to write 2 sets of exams from college of medicine South Africa. This include part 1 exams which can be obtained at anytime, ideally at the beginning of registrar ship and part 2 exams, which are exit exams. Both exams are internationally recognized.

There is no formal teaching for these exams, it is mostly self-study with presentation of topics and clinical cases to the psychiatrists. We have academic meetings every Friday of the month, where these presentations are done however, this is not enough to cover most of the required learning objectives. As a result, being awarded the Rosh scholarship will be beneficial to the trainees with theoretical knowledge and practical ability to manage patients effectively. In addition, having access to the Question banks will give the trainees invaluable material to help prepare for exams. Access to this Questions will further help us among others to identify the knowledge gaps.
Rosh came highly recommended by both recently qualified psychiatrist and those preparing for exams and fellowship certificates. One of the newly qualified psychiatrist from our institution relied and used your resources and we can testify that they were really helpful. Rosh is also reported to be user-friendly as compared to its competitors. Among the question banks available, seemingly those from Rosh is the most relevant and applicable to our setting. Unlike the rest of the world which uses mainly ICD 10, South Africa uses Diagnostic and Statistical Manual (DSM5) of which we noticed its part of your references. Our University libraries cater mostly for ICD 10 based Textbooks which are not suitable for our exam preparations .
The college of medicine psychiatry exams previously used to be essay questions until recently where the format was changed to single best answer. Previously people used to rely on past papers, however the college does not have any question banks examples of the single best answer questions. This makes it difficult to study as we have limited resources. Therefore, awarding us the scholarship would be of great assistance.

In addition, world economy took a knock recently following the Covid-19 pandemic. This caused an unrest in some parts of the countries. South Africa was not spared, the inflation went through the roof where we are forced to balance between spending money on daily needs versus buying study materials. With the current Rand/Dollar(R18,19/1$) exchange, it has become almost impossible to afford anything that gets imported from outside the continent. In that context, the scholarship would really be of benefit to us.

Due to financial constraints, our University, being rural university, also opted to put a cap on the number of Journal accesses, especially the international Journals which made things even difficult for us to prepare for exams. We can only access some of these journals only when your on the university premises. This makes our training difficult as the college of psychiatry uses mainly international Journals for which our access is limited by both the University and lack of finances, so having access to your Question Bank will help bridge some of these deficits.
Apart from completing our training, the knowledge acquired from using Rosh review, will be beneficial not only to the communities that we will be serving but will also come in handy to the medical officers and registrars, enrolling in the same program. We will in the future recommend the use of this application such as Rosh review not only for psychiatry but for all other medical discipline.

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The residency program, run by the UB, is supported by the Cameroon Arizona Partnership, a collaboration of physicians and educators from both Cameroonian and Arizona institutions. The goal of CAP is to reduce maternal mortality by training and retaining skilled women’s health specialists in Cameroon. We believe in training excellent professionals in Cameroon, rather than
removing them from their home country. This model has been shown to be much more effective in
providing professionals who stay and practice where they are most needed. Our program is new — the first class of four residents has just begun this academic year! The long term goal will be four classes of 4-5 residents each, with the graduates pursuing certification by the West African College of Surgeons.

Dr. Brady, having been a residency director for 17 years in Arizona, has seen the benefits of the Rosh Review Program for his American residents, and would love to extend this tool to help the Cameroonian residents pursue their goals. As we are rather early in the process, we don’t have specific “testimonials” yet, but we expect that will come with time.

Let us describe a bit about the challenge we seek to address, our model, and why it will work.

The Problem:
A woman in Sub-Saharan Africa is almost 100 times more likely to die from pregnancy or childbirth related complications than a woman in a developed country; a 1 in 39 lifetime risk compared to 1 in 3,800. In Cameroon, there are 596 maternal deaths per 100,000 live births (WHO, 2015). This is characteristic of sub-Saharan Africa, where most of the worst maternal mortality ratios, and the majority of maternal deaths, are found. Leading causes of maternal death are hemorrhage, hypertension, infections, and complications of preexisting conditions such as malaria (Filippi et al.,2016). Huge disparities in the level of neonatal mortality persist across countries. The first 28 days of life-the neonatal period-are the most vulnerable time for a child’s survival. In 2016, the number of newborn deaths per 1,000 live births was 3.7 in the U.S and 23.9 in Cameroon ( World Bank, 2016). Most deaths are caused by diseases that are easily preventable or treatable with proven, cost–effective interventions. Lack of resources drives these disparities. The key resource is medical expertise and leadership. Cameroon has a shortage of medical professionals, with fewer than two doctors for every 10,000 people. Much of the medical care is often provided by incompletely trained hospital staff. While poverty, AIDS, Ebola, malaria, and violence in Africa have rightly captured the world’s attention, the lack
of access to critical obstetric care has quietly devastated Sub-Saharan communities in a direct and personal way. These deaths, as well as early neonatal deaths and complications such as obstetric fistula, are almost all preventable with skilled obstetric care.

Putting an end to preventable maternal, perinatal and early neonatal mortality will only be realized when the most severe maternal complications can be comprehensively addressed with known obstetric interventions. Newborn lives can be saved when an at-risk fetus is identified and delivered before it is too late. To provide the high-impact interventions of modern obstetric care, and to provide leadership in women’s health, skilled professional obstetricians/ gynecologists are required as part of the healthcare team. Currently, the ability to train this level of practitioner is severely lacking in most countries of sub-Saharan Africa. However, many universities and tertiary hospitals are potential training sites for physicians who wish to become OB/GYN physicians. The Ghana-Michigan success has shown us that it can be done; that long-term partnerships can be sustainably create new capacity, and that trained
OBGYNs will stay in their country. The investment in training OBGYNs also reinforces institutions for certification and professionalism, building an engaged and global network of OBGYNs — ultimately strengthening the broader public health infrastructure.

The long-term goal is to serve maternal health across the country and the region, thus creating
significant public health gains and eliminating preventable maternal and neonatal morbidity and
mortality. It is important to note that the trainees themselves will also be providing care to the
community in hospitals as they train; those gains will begin to be realized almost immediately. The project’s success will be demonstrated by increased access to maternal and infant health interventions and reductions in maternal and early neonatal morbidity and mortality.

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We currently have 25 registrars in the program at WITS. Our responsibilities as registrars include teaching the medical students Basic Life Support skills and Advanced Airway skills. We also offer courses in BLS and Emergency Care to all first year paramedical students. Once a year we receive Cuban medical students who we teach Emergency Medicine skills during a two day course. We moreover volunteer to offer emergency care at large sporting events, including the Comrades marathon.

Our work environment at the public hospitals is typical for any developing country. The community desperately needs the services we offer and this leads to us seeing a vast variety of pathologies. When compared to developed countries, our public health system struggles with extreme resource constraints. This includes a shortage of staff, a shortage of hospital beds and access to technology. There is often a shortage of equipment, including consumables, blood products and medications. There is; however, also access to some very specialised treatment options. This is never enough to offer superior care to all our patients, as the needs far outweighs the access. It is often difficult to access cath-labs, theatres and even CT scanners. When taking in consideration our resource constraints, I think that we still succeed in offering superior care to our patients.

Most of our graduates remain involved in training and work in the public health system. We do not have enough graduates to run all the emergency departments at district level and this is something that the department is trying to correct. I am one of the candidates who received a bursary from the private sector to complete my studies. In return I will be working in one of the more resource limited government hospitals in South Africa. In this way we can continue educating more doctors and nurses to offer the best possible care and to practice evidence based medicine.

Several of my colleagues who have completed their degrees have made use of Roche Review and have shared their very positive experiences with the program. It has been recommended to us as a great resource to help us prepare for our final examinations. Every candidate who has purchased your programme in the past 18 months has passed their exams and are now qualified Emergency Physicians.

I have used the free trial offered and feel that it is invaluable to practice the correct format of answering multiple choice questions. I also enjoy the review and information available with each of the questions. It is an excellent way to prepare. We do not have anything similar available to us. Many of our candidates cannot afford the expense of the subscription as our remuneration is not very high and the value of the South African rand does not compare well to overseas currencies.
I am proud to be studying Emergency Medicine and to be able to give back to the community. I am very positive that Emergency Medicine in South Africa will continue to grow and that we will continue to contribute to the global community with cutting edge research and new innovations.

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The EM Residency Program provides a challenging working environment for trainees. The KUTH Emergency Department faces many of the obstacles commonly seen in emergency medicine among LMIC countries, including underfunding and limited resources. Residents are given experience working in a high-stress large hospital system. As the largest referral hospital, the KUTH ED receives critical patients from district hospitals across the country. For this reason, EM Residents are forced to provide care to critical patients at a high volume with limited staff and beds.

The program has limited resources to support clinical training. All training materials, including textbooks and question banks, are provided through free open-access resources. The program also has limited trainers, relying heavily on visiting faculty and former program alumni who volunteer their time weekly to provide didactic training.

Despite restricted funding and resources, the EM Residency Program has transformed emergency medicine in Rwanda. In a study conducted by Brown University to evaluate the efficacy of the program, results found an association between the implementation of EM training with formalized EM care systems and a reduced overall hospital mortality, driven predominately by improved EC survival (Aluisio, et al., 2019).

To date, a total of four cohorts have completed the EM residency-training program with a total of 18 graduates. These graduates have gone on to work in hospital systems across Rwanda, including King Faisal Hospital, the University Teaching Hospital of Butare, and the Rwanda Military Hospital. The program has built a strong alumni community with several graduates staying in the KUTH ED after the program, going on to become leaders in the department and mentors to future cohorts.

The Rosh Review will be a transformative asset to the program. As a whole, Rosh Review will elevate and enrich the clinical training provided, allowing Residents for the first time to have access to a dynamic question bank. Rosh Review will be essential in filling the program’s current gap in education due to limited trainers. Faculty will be able to lead clinical trainings in- person and then direct residents to Rosh Review to expand on that knowledge, a component that the program has never had before. With Rosh Review, the EM residency-training program will ensure its residents are receiving the highest quality education.

On a personal level, Rosh Review will provide residents with the resources to study efficiently and effectively. This will be crucial, as extensive studying alongside high-stress days in the ED, has led to feelings of burnout among residents. However, with a systematic means of studying with Rosh Review, this stress will be reduced. Residents currently only utilize open public access study tools. With Rosh Review, for the first time, residents will have an individualized study experience with personal analytics and online support.

As a program operating in an LMIC, Rosh Review will be imperative to providing equitable opportunities for education and in turn, improving emergency medicine in Rwanda.

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There are many challenges to attracting physicians to the specialty of EM in Vietnam, including salary, schedule, and reputation. However, there are efforts to attract and retain EM specialists. In addition, the Ministry of Health has recognized the importance of developing EM capacity, reflecting the World Health Organization’s resolutions 60.22 and 72.31, which highlight the importance of developing emergency and trauma care systems. While the long-term goal of creating an actual EM residency at Cho Ray exists, after multiple conversations with hospital leadership, plans were made to develop an EM diploma program. The diploma program is an 18-month EM curriculum that includes both didactic and clinical skills elements. It is modeled after similar programs that have been successful in South Africa, Kenya, Singapore, Myanmar, and other countries. 

The inaugural class faces many challenges: not only a new concept and training paradigm, but amid an ongoing pandemic. The original design had many visiting professors from the University of Utah and UC Davis to guide in-person and skills teaching, but this is not currently possible, so the majority of the teaching will be online. Local critical care instructors from the critical care residency will help teach skills. Thus, the leadership at Cho Ray Hospital has opted to start with just 2 learners, who are physicians already working in the ED at Cho Ray. The curriculum will include asynchronous assignments, interactive online lectures and teaching modules, and virtual SIM. The curriculum will be supported by the active retrieval involved with weekly assigned Rosh Review questions.

Rosh Review is honored to be a part of this program.

*2013: “Emergency Medicine Conference”; 2014: “Updates on Emergency and Critical Care”; 2015: “Updates on Emergency Medicine and Critical Care Conference”; 2016: “Sepsis and Trauma Management Conference”

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The college has more than 2,800 clinical, academic, and administrative and support staff members who provide medical specialty services to patients referred from all over the country, teach medical and nursing students, and do basic and applied research. While the inpatient capacity is more than 700 beds, the college sees an average of 1,200 emergency and outpatient clients daily.

In 2015, AaBET was inaugurated as a public hospital under SPHMMC, and it is one of the first health sectors with an entire trauma and burn unit. The hospital has more than 200 beds and around 800 staff. It includes departments in EMCC, Neurosurgery, and Orthopedics and Traumatology, and an academic program in Plastic and Reconstructive Surgery. The EMCC department was established with the purpose of providing patient-centered quality care, running innovative training programs, and performing problem-solving research in the areas of emergency, trauma, and related fields to transform the care and training provided to a higher level. It became recognized as a fully fledged academic department in 2015.

Since the EMCC department was established, it has produced the first batch of 8 EM specialists, who are currently working at SPHMMC, AaBEF, and other emergency centers. The program’s intake capacity originally ranged from 9 residents per year, and it grew to 22 residents in 2019, including 2 residents from Sudan. Currently, there are more than 52 residents specializing in the field. 

All of the graduates from the EMCC department are involved in setting up new programs, research, and leadership, and Rosh Review will be an invaluable tool to further improve evidence-based medical training. It will benefit the program as a tool for free open access medical education as well as for residents’ CME.

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