Residents Victoria Nyaiterra, Esther Nakasagga, and Jamilah Nabukenya employ new diagnostic techniques in the OR with Dr. Ramon Franco and Paul Paddle

Residents Victoria Nyaiterra, Esther Nakasagga, and Jamilah Nabukenya employ new diagnostic techniques in the OR with Dr. Ramon Franco and Paul Paddle

In November 2013, Dr. Ramon Franco and his fellow, Dr. Paul Paddle, traveled to Mbarara, Uganda as part of the first subspecialty faculty rotation aimed at augmenting the ENT postgraduate training program of the Faculty of Medicine at Mbarara University of Science and Technology/Mbarara District Regional Referral Hospital.  The second of only two ENT training programs in Uganda, Mbarara is a small program with limited opportunity to obtain the subspecialty training needed to develop the next generation of Ugandan faculty capable of serving their patient population.

[I] have been on several of these trips before, this one was unusual…most trips you get a chance at one really good thing.  [Here], it was like the Himalayas – peak beyond peak.  – Ramon Franco

Focusing on laryngology, Drs. Franco and Paddle worked with the residents in the first week (Drs. Victoria Nyaiterra, Esther Nakasagga, and Jamilah Nabukenya from the Mbarara program and Drs. Angelica Lhima and Kasule Umar from the Makerere University/Mulago National Referral Hospital), giving didactic lectures and leading clinical and surgical instruction.

Dr. Ramon Franco describing different approaches to problems of the vocal cords

Dr. Ramon Franco describing different approaches to problems of the vocal cords

Although the faculty visit was highlighted by the residents’ participation in the first two laryngectomies to be performed in Western Uganda, a more long-lasting impact may have been realized in the clinical practice.  Upon arrival, Franco and Paddle identified previously unutilized donated laryngoscopy diagnostic equipment and aided the residents in adding these new tools to their clinical practice.  Previously confined to mirrors and scopes unsuited for accurate diagnostic work, the residents learned how to scope patients in a clinical setting, allowing for improved diagnoses and reducing the need to use the OR for exploratory procedures.  While wary at first of whether patients would accept the procedure, repeated success by residents with screened patients showed that these clinical skills could become a valuable tool in clinic with repeated use.  During the second week, in which Dr. Paddle remained to be immersed in the normal routine of clinical/surgical practice, he noted that the residents continued to become more skilled and confident in scoping patients in clinic.

In a way, there is this lack of cynicism… [the residents] are not learning because of an exam, or wanting high marks…literally the next patient they see…they will use this technique on…there is an urgency…they are providing care, it matters.  – Paul Paddle

Larygectomy teamedited

Drs. Paul Paddle, Esther Nakasagga, Victoria Nyaiterra, Ramon Franco, Jamilah Nabukenya, Angelica Lhima, and Kasule Umar

At the onset of the intervention and at its end, Dr. Paddle administered a mock oral (a validated clinical practice ability instrument for surgical training aimed at assessing ENT resident progress [1]) and OSAT.  These assessments allowed an objective measure on the effectiveness of short-term clinical/surgical instruction and will act as a guide for future faculty visits on how to improve pedagogy.

Radiology at Mbarara is represented by Dr. Julius Mugisha and resident Dr. Moses Acan, who have recently begun working with Dr. Garry Choy and the MGH Department of Radiology to improve their training program and offer a platform for teleradiology.  While in Mbarara, we worked with Dr. Julius to send CT scans to our Head and Neck Radiology expert at MEEI, Dr. Mary Beth Cunnane, for consultation, serving to both give valuable feedback for the ENT physicians as well as starting a constructive dialogue between MEEI and Mbarara Radiology for future head and neck consultations and educational support on the specialty.

The next scheduled faculty visit will be March 10-14 led by Dr. Eric Holbrook and focusing on Rhinology/Sinus Surgery.

We would like to extend our thanks to Dr. Doreen Nakku, Head of the ENT program at MUST, and Dr. Milanes Pompa for their welcome; the MGH-MUST Research Collaboration for facilitating the beginning of the this collaboration; and Dr. Stephen Ttendo and the entirety of the Anesthesia Department for their excellent support.    

[1] Shin JJ, Page JH, Shapiro J, Gray ST, Cunningham MJ.  Validation of a clinical practice ability instrument for surgical training.  Otolaryngol Head Neck Surg. 2010 Apr; 142(4):493-9.


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