CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 AFRICA 155 Impact of the COVID-19 pandemic on cardiology fellowship training in a sub-Saharan African training centre: an African perspective E Amendezo, M Ngunga, AH Ahmed, MH Varwani, B Karau, R Kimeu, M Jeilan Abstract Aim: The impact of the COVID-19 pandemic on cardiology fellowship training in sub-Saharan Africa (SSA) is not known. This study aimed to determine the impact of the COVID-19 pandemic on fellowship training, and reviewed the adaptiveness of the existing training systems. Methods: We conducted a three-month data survey related to the cardiology fellows’ clinical exposure at the Aga Khan University Hospital, Kenya, before the COVID-19 pandemic and compared it with a three-month period during the pandemic. Hospital data volumes for patients’ contacts, ambulatory and catheterisation laboratory procedures recorded during the periods of March to May 2019 (three months pre-COVID-19) and March to May 2020 (three months during the COVID-19 pandemic) were analysed. A comparative fellows’ logbook evaluation of recorded cases was also conducted for the two study time periods. In addition, fellows answered a survey questionnaire related to their roles and responsibilities in the hospital, their views on cardiology training during the COVID-19 pandemic and the pandemic’s impact on their training. Results: There was a significant reduction in the volume of patients and cardiac procedures during the COVID-19 period compared to the pre-COVID-19 period. In the same line, the number of fellows’ training episodes reduced significantly during the COVID-19 pandemic compared to their performances before the pandemic. Fellows felt that the COVID-19 crisis has had a moderate to severe impact on their fellowship training. They however noted an increase in the provision of virtual local and international meetings and conferences, which supported the training positively. Conclusions: This study showed that the COVID-19 crisis resulted in a significant reduction in the total volume of patients and cardiac procedures and, in turn, the number of training episodes. This may have limited the fellows from achieving a great amount of skills base in highly technical skills by the end of their training. Opportunities for post-fellowship training in the form of continued mentorship and proctorship would be a valuable option for the trainees if there is a similar pandemic in the future. Keywords: COVID-19, cardiology fellowship training, Africa Submitted 17/8/20; accepted 24/4/23 Published online 19/6/23 Cardiovasc J Afr 2024; 35: 155–159 www.cvja.co.za DOI: 10.5830/CVJA-2023-023 The shortage of cardiologists in sub-Saharan Africa (SSA) has partly been attributed to disturbed training opportunities and a lack of fellowship programmes.1,2 Because of a shortage of specialists, fellowship programmes in SSA are delivered by a relatively small faculty base. This may leave them vulnerable to system stresses and less flexible or adaptive. The first curriculum-based fellowship programme to cover both invasive and non-invasive adult cardiology in East Africa was launched by the Aga Khan University Hospital, Nairobi (AKUHN) in 2017. This three-year programme was designed to provide sufficient exposure to out-patient care, ambulatory cardiovascular diagnostics, acute cardiac care, including in-patient cardiology, cardiovascular research and to both invasive and interventional cardiac procedures.3 The programme was envisioned to train physicians through a combination of didactic lectures, hands-on procedure skills, simulator sessions, research electives and presentation skills development across all disciplines in cardiovascular care. The reduction in clinical case volumes has necessitated adaptive changes to allow fellowship learning opportunities to continue. The coronavirus 19 (COVID-19) pandemic provoked multiple deliberate and inadvertent responses, many of which disrupted the platform for healthcare delivery and training.4 Some countries noticed a reduction in visits to healthcare facilities, particularly for non-COVID-19-related care.5 In Kenya, the government introduced measures to contain rates of transmission in March 2020,6 and these included restricted travel across countries, closure of country borders, a curfew that kept people in their homes for many hours per day, and social distancing. Coupled with fear, anxiety and misinformation about the risks of exposure in healthcareproviding institutions, propagated by various media, and the knock-on effect on the economy, access to healthcare became extremely difficult.7 With the reduced volume of patients accessing healthcare, a reduced number of elective cases as mandated by guidelines,8 and a deliberate move to limit unnecessary clinician exposure due to limited access to personal protective equipment, and with hospital systems adapting through a redeployment of doctors, including trainees, an impact on training opportunities was inevitable.9 Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya E Amendezo, MD M Ngunga, MD, mzeengunga@yahoo.com AH Ahmed, MD MH Varwani, MD B Karau, MD R Kimeu, MD M Jeilan, MD, Jeilan.mohamed@aku.edu
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