Bolivia

The context: Building sustainable, locally driven emergency medicine from the ground up

Autumn M. Brogan, M.D., M.P.H., has supported emergency medicine in Bolivia since 2010. Throughout her work there, local healthcare leaders have expressed a strong interest in building sustainable emergency medicine education in their own institutions. They were particularly interested in building sustainable simulation education for residents within Bolivian institutions — training that gives residents safe, hands-on learning opportunities in clinical care.

In response to this need, Dr. Brogan and her team launched the CERTAIN program with local leaders in 2025. This program has expanded into a structured train-the-trainer didactic program.

The challenges: Curriculum, technology, language, workload

Healthcare professionals in Bolivia face a challenging context. The country is experiencing economic strain — including inflation and fuel shortages — alongside ongoing political tensions. These factors contribute to logistical challenges in providing emergency care for patients and in training emergency medicine professionals.

  • Development of a new field. Emergency medicine in Bolivia is relatively new as a recognized medical specialty. Few healthcare professionals have formal emergency medicine training, and emergency care is often provided by clinicians with backgrounds in general practice or other areas of care.
  • Lack of critical care curriculum. Bolivia lacks a well-designed, standardized residency curriculum. Training that uses simulation-based education is especially scarce, although simulations can be an important learning method for clinicians and nurses.
  • Poor access to technology. Bolivian healthcare teams often have limited access to or familiarity with new technology, both for training and to use in other areas such as communication.
  • Language barriers. "Many Bolivian physicians have limited English proficiency. This makes it difficult to utilize English-based educational modules," explains Marco Bracamante, M.D. Dr. Bracamonte, a physician from Bolivia, completed a research fellowship in emergency medicine at Mayo Clinic during which he focused on the intersection of emergency medicine, psychiatry and global health initiatives. "To address language barriers, CERTAIN is prioritizing Spanish-speaking faculty to deliver lectures and facilitate discussions."
  • Lack of time for training. High clinical workloads and a difficult economic environment also pose significant obstacles to training. "Many attending physicians work two or even three jobs, which makes it difficult to secure protected time for training sessions together," says Dr. Bracamonte.

Our advisory approach: Simulations, conferences and coaching

Dr. Brogan designed an advisory approach to strengthen emergency medicine education in Bolivia. Her goal was to help structure and standardize emergency medicine residency training nationwide. "Our strategic vision is to create a sustainable, locally driven emergency medicine curriculum," she explains.

Dr. Brogan and her Bolivian colleagues launched a simulation instructor development course for emergency medicine across 11 residency programs across Bolivia, the first of its kind in the country. The course focuses on foundational simulation concepts, with an emphasis on psychological safety and structured debriefing. After completing the simulations, residents talk through the care decisions they made and discuss how real-life patient care is impacted by their choices.

Dr. Brogan also organized annual emergency medicine conferences and medical student and resident workshops on emergency medicine topics. She also helped the CERTAIN Program reduce barriers around technology by using tools that participants were more familiar with, such as WhatsApp, for communication and coordination.

Building on these initial successes, Dr. Brogan assessed more advanced needs and learning objectives to launch a CERTAIN coaching program in Bolivia in 2026. She also introduced a quality improvement program to ensure lasting impact. This began with train-the-trainer simulation instructor workshops for emergency medicine faculty.

What changed: A grassroots shift from entering the field toward leading it

The CERTAIN Program's adaptive, collaborative advisory approach has strengthened emergency medicine capacity and training levels in Bolivia. Program activities are culturally and situationally relevant and offer scalable, long-term sustainability.

"These clinical care teams are extraordinarily motivated. We believe Bolivia will soon rival the most advanced emergency medicine programs in Brazil and Chile and emerge as a leader in emergency medicine education in Latin America," Dr. Brogan says.

What we learned: Safe roots and dynamic evolution

"Psychological safety is a topic I am particularly passionate about and actively advocated for in the Bolivian context. It has been deeply fulfilling to contribute to a paradigm shift in medical education in my home country," says Dr. Bracamonte. "I also learned a great deal about how projects evolve from ideas into reality: through sustained effort, adaptation and close collaboration with exceptional teams. This experience has strengthened my commitment to educational innovation and global health work."

What comes next: Expansion and advancement

The CERTAIN Program partnered with Bolivian emergency medicine teams to build a strong foundation for innovative, impactful education, says Dr. Brogan. "Now, we are working even more closely with four of the 11 emergency medicine residencies from our initial partnership. We are recruiting, enrolling and training more participants as trust, familiarity and logistical capacity grow."

Future plans include:

  • Launching a one-year residency training program.
  • Transitioning to case-based discussions led by Bolivian education leaders.
  • Shifting focus to faculty development to support Bolivian educators and administrators.