In June 2020, Bernardo Lombo, MD, assistant professor of clinical medicine and Frank Minja, MD, associate professor of radiology and biomedical imaging, became the inaugural recipients of the Yale School of Medicine (YSM) Global Health Education Innovation Award.
Funded by YSM’s Office of Global Health Education (OGHE), two awards of $10,000 each have been created to promote faculty research programs in global health education at Yale and provide opportunities for medical students to learn methods relevant to research in medical education.
Robert Rohrbaugh, MD, associate dean for global health education, stated that “all applications received for this first year of the award addressed important issues in global health education,” adding that Lombo’s and Minja’s projects, “stood out for us as ones which addressed an important need in global health education, and which we believe will build and sustain larger institutional program collaborations.”
Rohrbaugh emphasizes that medical students “are integral to each project and will be learning about how to conduct global health education implementation and outcomes research.”
Lombo and Minja will submit annual reports on their progress to the OGHE and disseminate their work at Yale and beyond.
Tablet Echocardiography For Rheumatic Heart Disease Screening in Indonesia
Rheumatic heart disease (RHD) is a leading cause of cardiovascular disease in developing countries. Although RHD is a preventable condition, if untreated it may lead to premature death. The World Health Organization recommends cardiac ultrasound devices as a cost-effective method for early detection.
Lombo and several faculty colleagues from the section of cardiovascular medicine at YSM co-founded International Team of Educators to Advance Cardiovascular Health (ITEACH). ITEACH provides educational opportunities in low-and middle-income countries, and aims to optimize medical training and cardiovascular research worldwide. Lombo’s Innovation Award project is focused on a portable tablet to detect RHD in rural Indonesia, where ITEACH has been engaged since 2017, thanks to Lissa Sugeng, MD, MPH, associate professor of medicine.
Specifically, this project will provide hands-on training in point-of-care echocardiography for the screening process and will assist with ensuring appropriate follow up for those patients suspected of having RHD, as well as develop an evaluation of the program for quality improvement. ITEACH also will develop an educational exchange with the ASRI community health clinic in Kayong Utara, Borneo, and the medical faculties at Udayana University in Denpasar, Bali and at Tanjungpura University in Pontianak, Borneo, to provide education in cardiology, cardiovascular health research, and echocardiography.
To adapt to COVID-19, the ITEACH team has developed a virtual curriculum in portable tablet echocardiography for their partners in Indonesia.
Second-year YSM medical student Alysha Rose is actively involved with the Innovation Award project. Rose, who met Lombo during the fall of her first year of medical school at a OGHE event, explains she attended her first ITEACH meeting and a seminar on the ASRI community health clinic in the same week, and “this inspired my idea to integrate our rheumatic heart disease screening project with ASRI’s clinics.”
Since that time, Rose has been working with ASRI to develop ITEACH’s partnership and to bring another Indonesian institution, Tanjungpura University, on board for the screening project initiative. “From being encouraged to write proposals, to meeting independently with our partners overseas, the opportunity to work with ITEACH has taken my education and skills in collaborative global health research to a whole new level.” Rose adds, “I am forever grateful to Dr. Lombo and ITEACH for allowing me to contribute to the leadership and direction of this project.”
VR for IR: Virtual Reality Applications in Global Interventional Radiology
Interventional radiology (IR) can provide a broad range of minimally invasive, image-guided diagnostic and therapeutic procedures for many indications including cancer, infection, and vascular disease.
Minja and his team in the Department of Radiology and Biomedical Imaging conducted an on-the-ground assessment at Tanzania’s largest tertiary care center in 2017, which demonstrated a complete lack of IR training opportunities and an urgent need for IR procedures country-wide. The team responded by designing a training model for implementation in the resource-limited setting, by deploying teaching teams of US-based IR physicians, technologists, and nurses for two-week teaching rotations on a monthly basis. From October 2018 until February 2020, a total of 14 teams traveled to Tanzania.
Then the COVID-19 pandemic interrupted this effort and all future trips had to be cancelled until international travel is considered safe and feasible again. The Innovation Award will allow Minja and his team to continue and expand their work in IR training of residents in Tanzania, by using Virtual Reality (VR) technology to provide immersive experiences for students when they cannot conduct in-person training.
As Minja described in his application to the OGHE, “the purpose of this project is to establish VR infrastructure to help advance global IR training in an immediately impactful, immersive, cost-effective, and sustainable way.” The project is two-pronged: (1) the creation of a VR teaching library of common IR procedures for trainees to learn from and review immersively; and (2) live-streaming VR mentoring to allow IR faculty at Yale New Haven Hospital (YNHH) to provide real-time remote assistance to IR trainees at Muhimbili National Hospital.
Second-year YSM student Shin Mei Chan has been working closely with Minja’s team, including with IR Chief Resident Fabian Laage Gaupp, MD, to develop the VR teaching library. The hope is that the VR teaching library will address acute learning needs during the COVID-19 pandemic, which has curtailed international travel to provide in-person training, and also augment future in-person training sessions through immersive review experiences for the trainees.
More specifically, Chan will help to film the procedures with Laage Gaupp in YNHH’s IR suites this summer, using a video camera capable of filming in three dimensions and recording voice. These videos can then be viewed on any commercially available VR headset. The plan is to record VR videos of the most common IR procedures, so that trainees can have these immersive learning resources at their disposal.
Chan explains “I've gotten to contribute to the overall mission of this program, while also spending time in the IR suite and learning about these procedures, learning about global health, and working closely with an incredible set of mentors.” While disappointed that the COVID-19 pandemic prevented her planned travel to Tanzania this summer, Chan says the Innovation Award project “has allowed me to continue to contribute to this very important mission,” adding that it has been “an incredible experience” working closely with Laage Gaupp and Minja, “who are really changing the landscape of global IR and bringing sorely needed procedures to so many in East Africa.”