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Objective A vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are recognised methods to show where efficiencies can be made. We aimed to understand the process and information flows used by the prehospital emergency service in transporting community emergencies in Rwanda in order to identify areas for improvement.Design Two facilitated process/information mapping workshops were conducted. Process maps were produced in real time during discussions and shared with participants for their agreement. They were further validated by field observations.Setting The study took place in two prehospital care settings serving predominantly rural and predominantly urban patients.Participants 24 healthcare professionals from various cadres. Field observations were done on 49 emergencies across both sites.Results Two maps were produced, and four main process stages were described: (1) call triage by the dispatch/call centre team, (2) scene triage by the ambulance team, (3) patient monitoring by the ambulance team on the way to the health facility and (4) handover process at the health facility. The first key finding was that the rural site had multiple points of entry into the system for emergency patients, whereas the urban system had one point of entry (the national emergency number); processes were otherwise similar between sites. The second was that although large amounts of information were collected to inform decision-making about which health facility to transfer patients to, participants found it challenging to articulate the intellectual process by which they used this to make decisions; guidelines were not used for decision-making.Discussion We have identified several areas of the prehospital care processes where there can be efficiencies. To make efficiencies in the decision-making process and produce a standard approach for all patients will require protocolising care pathways.

Background: An international and global medical education programme can help to develop health professionals' skillsets and can be a career-defining factor during the progression from student to practising physician. Our aim is to analyse migration patterns of medical students for elective exchanges and identify intentions for continued migration. Specifically, our objectives were to determine the most popular countries and specialty types that students in the medical and health professions intend to go for elective exchanges; to assess the different factors that contribute to a student's choice to migrate for an elective; and to assess factors leading to the intent of permanent migration after completion of study at the home institution. Methods: Our research deals with experiential learning in a global health setting through analysis of the trends and patterns of medical students pursuing medical electives worldwide. We used a multilingual online questionnaire, completed by students from 15 different countries across a timeframe of 1 month (April 2018). American, European, Asian, and African universities who are part of the Global Educational Exchange in the Medical and Health professions (GEMx) sent an email with the link to the questionnaire to their medical students. The questionnaire was conducted electronically and participants, who were selected via the school's respective student databases, were asked to complete the survey after their electives had been completed. Findings: We analysed responses from 363 students from 15 countries (15 from Kenya; 116 Italy; 20 Nigeria; 16 Rwanda; 5 Ireland; 74 India; 53 Egypt; 47 Indonesia; 11 Mexico; and one response each from Israel, Germany, the Democratic Republic of the Congo, Qatar, Algeria, and Canada). Country mean ages ranged between 21 years and 25 years; 224 respondents (61·7%) were women. The most popular destination country for an elective was the USA (72 students from 10 countries). The most popular specialty types were surgery (74, 20·4%) and internal medicine (56, 15·4%). Students cited expanded medical training (26 [42·6%]) an enhanced CV (18 [29·5%]), and broadened research opportunities (5 [8·2%]) as the most important motivations for choosing an elective exchange to another country. Of those who intended permanent migration (101 [27·8%]), the most frequently cited reason for this migration was the expansion of opportunities in a desired specialty (41 [40·6%]) while the main factor deterring students from permanent migration was the desire to disseminate the acquired learning to native home country health-care providers and systems (159, 60·4%). Interpretation: Students' elective experiences abroad not only significant steer the course of their careers as medical professionals, but are also crucial in creating a more holistic educational experience when combined with their home institution's curriculum. Global electives are an initiative that all schools should dedicate resources to pursuing. The elective process is vastly scalable and can be applied at medical schools in all regions of the world. Funding: None.