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We created a sustainable, bidirectional partnership using telecommunication technology to enhance emergency medicine education collaboration. Telemedicine is a practical and innovative methodology to expand training in emergency medicine and establish bidirectional partnerships between academic departments in high-income and low- and middle-income countries.

Introduction while physician burnout has been studied in high-income countries, more research is necessary on burnout in lesser-income regions such as Tanzania. This study aimed to determine levels of burnout in Tanzanian physicians and to understand the contributing risk factors for burnout in this region. Methods the Maslach Burnout Inventory (MBI-HSS) was adapted to assess burnout in Tanzanian physicians. Utilizing a cross-sectional design, we studied two distinct cohorts: 1) Emergency Medicine (EM) trained physicians in Tanzania and; 2) specialists at Bugando Medical Centre. We surveyed demographic, personal, and workplace data to identify risk factors for burnout. Results seventy-seven percent (30/39) of Tanzanian EM providers and 39% (37/94) of Bugando specialists completed the survey. We identified burnout in 67% of Tanzanian EM providers and in 70% of specialists at Bugando. Burnout risk factors in EM physicians included dissatisfaction with career choice, considering switching institutions, working in an urban setting, inadequate coverage for emergencies/leave, and financial housing responsibilities. In Bugando specialists, risk factors were unnecessary administrative paperwork, working overnight shifts, pressure to achieve patient satisfaction or decrease length of stay, meaningful mentorship, and not having a close friend/family member die. Conclusion this study reports a high prevalence of burnout in Tanzanian physicians. Risk factors for burnout were multifactorial but mainly related to institutional and workplace constituents. Targeting these risk factors provides opportunities to boost physician wellness and guides important areas for future research in this African region.

Objective:The World Health Organization aims to reduce worldwide under-five mortality rates (U5MR), with a focus on resource-limited settings (RLS). Tanzania reports a mean U5MR of 54 per 1000 live births, largely due to treatable infectious diseases that may lead to sepsis, accounting for 40% of the under-five deaths. Bugando Medical Centre in Mwanza, Tanzania represents a resource-limited setting in Sub-Saharan Africa and estimates a 14% pediatric mortality rate. We sought to better understand provider experience in recognizing and managing pediatric sepsis in the emergency department (ED) at Bugando Medical Centre in Mwanza, Tanzania. Methods:We conducted a qualitative study with a purposive sampling of 14 Bugando Medical Centre ED providers from January to February 2019, via minimally structured interviews, to identify factors influencing the recognition and management of children presenting to the ED with concern for sepsis. Interviews were conducted in English, audio recorded, and transcribed. Data saturation determined the sample size. Three primary coders independently coded all transcripts and developed an initial coding list. Consensus among all authors generated a final coding scheme. A grounded theory approach guided data analysis. Results:We achieved thematic saturation after 13 interviews. Responses identified patient-, provider-, and health care system-related factors influencing sepsis recognition and management in children presenting to the ED. Patient-related factors include the use of traditional healers, limited parent health literacy, and geographic factors impacting access to medical care. Provider-related factors include limited knowledge of pediatric sepsis, lack of a standard communication process among providers, and insufficient experience with procedural skills on children. Health care systemrelated factors include limited personnel and resources, delayed transfers from referral hospitals, and lack of standard antibiotic-use guidelines.Conclusions: This qualitative study identified patient, provider, and health care system-related factors that influence the emergency care of children with suspected sepsis in a quaternary hospital in Mwanza, Tanzania. These factors may serve as a framework for educational opportunities to improve the early recognition and management of pediatric sepsis in a resource-limited setting.