The University of Rochester employs about 80 radiologists; the country of Zambia has one. A collaboration between Michael Potchen, M.D., professor in the Department of Imaging Sciences, URMC Imaging residents, and the Zambian Ministry of Health aims to address this disparity by training Zambian medical school graduates in radiology. This endeavor is unique in that, while Potchen is the attending physician overseeing the project, URMC Imaging residents are actually running the program.
The goal is to create a complete radiology training program that will be freely available to teaching hospitals not just in Zambia, but other countries, too. It will include all the necessary materials for training and evaluating new radiologists, as well as the educational content they need to successfully provide imaging services to patients.
“We’re trying to develop a training guide that could be used in any resource-limited country,” says Simone Montoya, M.D., a fourth-year Imaging Sciences resident who is leading the effort. “We’re working off the framework Dr. Potchen developed and using technology to make the program more accessible to the world. We’re adapting it and changing it when we learn what works and what doesn’t.”
In 2008, Zambia obtained two 1.5 Tesla MRI machines, but only had one trained radiologist to run them. If anyone has the credentials to launch a program, it’s Potchen, who has spent part of every year in Africa since 2005 training international neuroradiology fellows – especially those in resource-poor tropical regions. He began his work in Malawi, and moved his research and training programs to Zambia after it acquired the MRI machines. He obtained a NIH grant to help fund his training program aimed at remedying the shortage of experts in the country.
The Zambian government was so pleased with Potchen’s training program that it increased the number of trainees beyond what was in his original grant proposal. “We have NIH funding to train one Zambian resident, but the Zambian Ministry of Health wanted us to train six. Next year they’ve asked us to train 12,” explained Potchen.
Providing Tools for Empowerment
The training is conducted by URMC Imaging Sciences residents through a program called PRACTERRA. PRACTERRA, or A Portable Radiology Curriculum for Training, Evaluating, and Retaining Radiologists in Africa, is spearheaded by Montoya and another fourth-year resident, Sarah Mohajeri Moghaddam, M.D. Potchen asked them to help with the initiative and they eagerly accepted the opportunity, presiding as co-principle investigators for the grant-funded project. Montoya has an interest in educational development and Mohajeri Moghaddam has a background in public health.
Together, they are developing a web-based, modular curriculum that includes lectures on how to read CT and MRI scans; case studies that show different conditions; lectures that they deliver over web chat; examinations; and teacher training guides. They are also trying to include concepts like “how to be a radiologist,” lectures on how to write up a report that is useful to other clinicians, an overview of daily tasks, and other aspects of the job that are hard to learn from a book.
Importantly, they recognize that PRACTERRA will work best as a partnership. “We aren’t trying to go to Zambia and say, ‘we are Americans, our way is right.’ We are trying to provide the tools for them to empower themselves,” says Montoya.
Although there is no language barrier between the Rochester radiologists and the Zambian radiologists in training, the method of teaching is drastically different. “Their method of teaching is more didactic- lecture style and no questions,” explains Potchen. “We are more Socratic and encourage discussion, so it has been a challenge to meet in the middle in a way that works for both groups.”
Fortunately, the URMC team recently initiated collaborations with groups performing similar outreach and training projects at other universities. For example, at the most recent Radiological Society of North America (RSNA) meeting, Potchen and Montoya were able to connect with clinicians at other sites (nationally and internationally) with similar endeavors. The different perspectives of these other groups are helping the URMC team make their program more generalizable to the developing world.
The residents also get to see their program in action. In January 2019, Montoya, Mohajeri Moghaddam and others traveled to Zambia to witness the impact of their work and to learn more about how radiology is applied in the country. In order to cover the considerable expenses required to get halfway around the world, the residents applied for financial support and, so far, they have all successfully obtained their own funding. Funding has come from several sources, including the RSNA Derek Harwood-Nash Education Scholar Grant, the ACR Reeder-Goldberg Resident Travel Grant, and the Harry W. Fischer Fund Award.
In addition to the NIH, PRACTERRA is funded by a 2018 Derek Harwood-Nash International Education Scholar Grant through the RSNA, as well as a Harry W. Fischer Fund Award from the University of Rochester. The group is looking to expand their program at the training hospital in Zambia by recruiting residents and attendings outside the University of Rochester. “We’d like to have someone there every month. It’s such a valuable, bi-directional learning experience,” notes Potchen.
The program is earning praise at URMC as well. David Waldman, M.D., Ph.D., chair of Imaging Sciences remarked, “This is an exciting and important opportunity for us to bring our educational techniques and technology to the rest of the world. It has been a great learning experience for the medical system in Zambia along with our own residents. We look forward to expanding this program.”