Spotlight: Dr. Lye-Yeng Wong

Lye-Yeng Wong is a general surgery resident from Oregon Health Sciences University currently in her professional development years working in the Department of Cardiothoracic Surgery. She has been involved in prior global surgery activities and joined the ENTRUST team about 18 months ago under Drs. Cara Liebert and Dana Lin.

Tell us about how you first became involved in global health work.

I have participated in global health activities since college, but more meaningfully in medical school when I spent a year in Cape Town, South Africa running a pilot cardiomyopathy study as a Doris Duke scholar.  

Since residency, apart from my involvement in the ENTRUST program, I also lead the International Standards and Guidelines working group within the G4 alliance and have been working on best practice recommendations for safe and high-quality surgical care in low- and middle-income countries with projects all over the world.

Tell us about working on site with the first class of medical students to graduate from UGHE (happening this spring, 2025)?

I spent two and a half weeks in Rwanda, of which one week was spent at the main UGHE campus in Butaro and the remaining time at one of the rural hospitals in Kibogora which is at the border of Rwanda and Congo.

The main purpose of the trip was to roll out the 16 ENTRUST cases that we co-developed between the Stanford and UGHE teams. I was with Dr. Martin Bronk, who also helped develop the cases. The ENTRUST cases were piloted in the senior student surgery clerkship for the first time with the batch of students who will be the first class to graduate from UGHE next year in 2025. It was the first time that UGHE students actually used the platform as part of their curriculum.

What was your daily routine at UGHE?

Every day we began with morning report where students who were on-call the night before gave patient presentations of interesting cases. After that we would round on the inpatients then go to the operating room. My role was teaching both in and out of the operating room.

During the day, I helped with hands-on technical teaching in the operating room then in the afternoon, we would use ENTRUST to run formalized didactic sessions with a different focus topic each lesson.

Dr. Bronk and I were together for the first few days, then he stayed at the main hospital in Butaro while I went Kibogora so we both taught in the two different settings.

“Both the UGHE students and faculty love using this digital platform

Tell us about how the UGHE surgical clerkship students worked with ENTRUST.

The UGHE students were dedicated and bright. As young learners, they showed so much maturity. Their drive and gratitude to be in a resource-rich school like UGHE was palpable.

They were very excited to use the ENTRUST platform and have it as part of their curriculum, as it was something new and different from what they had been doing before. Prior to integrating ENTRUST into their didactics, the students engaged in typical lecture-style learning or flipped classroom set-ups where students created presentations and taught each other about specific topics.

While I was there, we also used ENTRUST as a part of their mid-clerkship exams, so we employed it in both teaching and testing mechanisms which worked equally well.

As students completed their clerkship, we asked for formal feedback about ENTRUST and had overwhelmingly positive responses indicating that they would want to continue using and expanding it in surgery. The students also stated that they would love to use it in their other core specialties like internal medicine, pediatrics, and OBGYN.

Is there a need to expand ENTRUST?

As the first step, we created 16 original surgical cases in the pilot stage to test the usability of the ENTRUST platform. Now that we are seeing sustained success with the platform, the UGHE surgery clerkship director, Dr. Anteneh Gadisa Belachew, is very excited about using real patient cases seen in Rwanda to develop additional ENTRUST cases that are even more realistic and representative of patients in this setting. The ENTRUST case library definitely needs to and will be expanded, which will only make the students’ experience more robust.

There will undoubtedly be growing interest in using ENTRUST outside of the UGHE sphere as it is a novel and interactive platform that can be tailored to various classroom and examination settings, and reflect the types of patients seen in different settings.

In addition to the use in surgery clerkship curriculums, we have validated the use of ENTRUST on a bigger scale as a portion of the College of Surgeons of East, Central, and Southern Africa (COSECSA) membership certifying assessments, which ensures that surgical  trainees are ready for independent practice.

Future directions could involve using ENTRUST as a way to earn continuing medical education credits, which can be logistically and financially difficult to access in the African region.

What were the challenges you observed?

As someone who was travelling to Rwanda for the first time, it was helpful for me to ask a lot of questions about how the healthcare system runs, what the patient experience is typically like and  what the access and barriers to care are.

Although English is widely spoken in Rwanda, Kinyarwanda is often the preferred language, especially in rural places. For a foreign physician, this language barrier can be challenging and highlights the importance of working side-by-side with our Rwandan counterparts.  

As expected, resources were sometimes limited as we ran out of gloves, masks, and certain instruments. But in the process, we learned how to improvise and be more resourceful in the operating room.

Working in an LMIC setting is an experience of teaching and learning simultaneously. The students were teaching us as much as we were teaching them, especially regarding culture and traditions which helped us be present in the hospitals with the appropriate respect and humility. Despite the challenges, it’s truly inspirational to see the quality of patient care that was provided in rural hospitals with only the resources available to them.

A funny anecdote: while traveling the five hours on unpaved roads from Kigali (the capital) to Kibogora, we had not just one, but two flat tires on the way. Thankfully, Rwandan resourcefulness is found not only in the hospitals but also on the roadside! Although the unforeseen delays made for a very long day, it was a fun memory that I will never forget.

What suggestions do you have to promote this institutional partnership?

I think that Stanford and UGHE currently have a great partnership in which both sides acknowledge the inherent power dynamics that are common in cross-continent collaborations. By openly discussing the best means to mitigate these differences, the Stanford-UGHE partnership will continue to strive for bidirectionality that ultimately breeds longevity and symbiosis.

I believe that inviting trainees and faculty from Rwanda to Stanford would provide additional exposure to a different way of thinking and operating, in the same way that I gained so much perspective on my trip to Rwanda. I also think that it’s important to share resources that would enable medical students to participate in research projects and get a head start in academia if that is their desired career path. Creating opportunities for our Rwandan partners to attend and present at conferences would continue to generate much needed international discussions on the next frontier for global surgery. The work is certainly not done, and we on the ENTRUST team are excited to be a part of the development of the iconic institution that is UGHE.