Spotlight: Dr. Martin Bronk

Dr. Martin Bronk recently visited UGHE in Rwanda for three weeks to teach senior medical students during their surgery clerkship.

What is UGHE?

UGHE was founded in 2015 through the vision of Paul Farmer and Partners in Health, together with philanthropic support from the Cummings and Gates Foundations. It envisions developing leaders who will have a global view of health to be able to truly advance care in an effective and equitable manner.  Based on that perspective, UGHE has made the unique decision that all of the medical students will obtain both a medical degree and a public health degree. The campus is set in a remarkably beautiful setting in the mountainous terrain of rural Rwanda. The buildings are architecturally inviting and technologically advanced.  And the people are simply extraordinary.

The students come from Rwanda and some neighboring countries, most of them from backgrounds that are relatively disadvantaged. Generally, they don’t have a long family history of having higher education and many come from rural areas.

They are selected from a large, highly competitive pool of applicants, and they are truly devoted learners. I recognized the strength and commitment of the students even before my visit to the campus. I had the opportunity to participate in some on-line teaching sessions with second-year students during which we discussed various clinical cases. I was truly impressed at these young students’ depth of background knowledge and the thoughtful approaches they took to clinically-focused discussions.

Tell us more about working with the first class of senior surgical clerkship students.

I arranged my recent trip to UGHE to correspond to the time period when the inaugural cohort of medical students would be doing their senior surgical rotation during their fifth year of medical school. This group is particularly special as the first group of medical students at UGHE. The 40 students in this class had the privilege and challenges of being the first to engage a fresh curriculum in a new environment. Of course, during this time, they had come to know each other quite well and really seemed to be closely connected and mutually supportive.

They worked hard to master the fundamentals of medicine, knowing that they soon would be moving into positions of true clinical responsibility. They had roles similar to our students on clinical services and also helped to educate each other through various types of presentations. One of these teaching responsibilities was in leading a weekly seminar on a particular topic of surgical importance. Typically, a group of three students would present a comprehensive review that would cover everything from anatomy to pathology to diagnosis to treatment. They were impressive!

What kinds of challenges do they face at UGHE?

UGHE students face a number of challenges. First, there is the issue of being in a rural environment away from family or activities that would be found in larger centers. The medical school is in a beautiful mountainous region, but it is about three hours from the capital, Kigali, and there is not much to do in the small nearby towns. So, there is a sense of isolation.

Regarding more long-term considerations about their future careers, the students face a dilemma of trying to reconcile the experience they have at UGHE with what they may encounter when they enter practice as clinicians. Their classroom learning is quite robust and they learn about medicine with a broad vision of what may be available for patients in a variety of settings, including well-resourced environments. However, when they enter the hospitals where they do their clinical rotations, they are confronted with significant resource limitations, both in personnel and in materiel. This contrast was readily apparent in the nearby Butaro Hospital where the students did a portion of their surgical rotation. Although it was being developed as a national cancer center, its surgical ward and available resources really were those of a district hospital with the marked limitations that characterize medical care in low-income settings. And after graduation, the students will do mandatory service as general physicians where they will be faced with similar challenges.

Tell us about your daily routine at UGHE.

My day typically would start with the students presenting cases that had come through the emergency department during the night.  Together with one of the two primary surgeons at the hospital, we would review each case in some detail, discussing differential diagnoses and potential therapeutic plans. Following these more formal presentations, we would go to the surgical wards where we would make rounds. These rounds were structured somewhat differently from those we are used to in our system. Typically, the students would not present the patient but the general physician rotating through the surgical ward would give a few brief comments and the attending surgeon would then outline the plan. Occasionally, I would ask a question or offer some thoughts, but the process did not feel as though it was intended to engender much discussion.

After (or sometimes during) rounds, one of the students might go to the OR if there were cases scheduled. This time was a good opportunity for me to review some more of the details of management of the patients on the wards with students, house doctors, or nurses.

My role was not to do any clinical care, but I did make it to the OR to watch a splenectomy on a trauma patient and was impressed at the way the OR functioned and the quality of the surgical care provided.

In the afternoons, there were lectures presented by both faculty and students. These lectures were all presented on Zoom, as the students rotated at several different locations during their surgical clerkships. As I mentioned, the student presentations were particularly impressive. During some of the afternoon sessions, we had the opportunity to try out the ENTRUST platform that had been created by Drs. Liebert and Lin, using cases that a number of us had helped to create specifically for medical students. I found that the platform was easy for the students to use and the cases were valuable tools for exploring a variety of clinical issues. The platform also allows students to work through cases independently or to use them in a flipped-classroom type format. 

What kind of relationship can you envision between Stanford and UGHE?

Stanford has multiple connections with UGHE, and Dr. Brooke Cotter from Internal Medicine has been doing a great job coordinating between Stanford physicians and their counterparts at UGHE to refine the shape of the relationship and help address their actual needs for future programs. UGHE has some truly wonderful and committed full-time faculty such as Dr. Anteneh Belachew, who is the surgeon in charge of the surgical clerkship. However, at the moment, UGHE still relies on the many people from outside institutions who can spend varying periods of time in a voluntary capacity. The folks at UGHE, ranging from students to faculty to support staff, really seem to appreciate the contributions of everyone who can take the time to work with them.

While I was there, one of my internal medicine colleagues, Dr. Lars Osterberg, was visiting for his third time, and a couple of pediatricians from a Canadian medical school also were on a brief visit. Although we clearly come from a very different medical environment, I am convinced that many of us, both faculty and residents, can be useful in a variety of capacities, both in teaching and in helping in certain aspects of clinical care. Given that much of the lecturing is done in hybrid fashion, we also have the opportunity to participate in online teaching. In addition, UGHE has already begun to participate in bidirectional programs that give some of their faculty the opportunity to learn specialized skills at Stanford.

I feel truly fortunate to have been able to initiate a connection with the remarkable institution and people that form UGHE, and I certainly would hope to continue my relationship in the future.