{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:45:55Z","timestamp":1792241155881,"version":"4.4.0"},"reference-count":21,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["OTO Open"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>In Rwanda, 30 OHNS clinicians serve the country's population of 14 million. With low subspecialist density, primary care providers (PCPs) become the first line of otolaryngologic triage and care. However, it is unclear if Rwandan PCPs are equipped to bridge OHNS care gaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Cross\u2010sectional qualitative survey\u2010based study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Rwandan PCPs were surveyed, and responses were collected between November 2024 and May.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Surveys were co\u2010developed with Rwandan OHNS clinicians and evaluated the diagnostic and management confidence of common head and neck conditions. Responses were analyzed with descriptive statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty\u2010four PCPs completed the survey. PCPs most frequently encountered sinonasal, pediatric, and ear\/hearing diseases (mean of 10.5, 9.7, and 6.7 presentations\/week, respectively). However, confidence in sinonasal skills was low (mean confidence score of 2.9 out of 5). Diagnostic and management confidence scores were stable across disease categories. Eighty\u2010eight percent of PCPs identified limited training\/knowledge as barriers to patient care. Ninety\u2010seven percent of PCPs agreed that further emphasis on otolaryngology training is needed during medical school.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights training gaps and systemic barriers affecting the Rwandan primary care workforce. Targeted hands\u2010on training is needed to improve PCPs\u2019 skills. Furthermore, evaluation of PCP recognition and management confidence did not reveal specific areas of deficit, indicating that training topics should be comprehensive and diverse. Finally, limited training\/knowledge\/skills was a common barrier to care, highlighting the importance of PCP\u2010focused continuing medical education. This survey framework could be utilized in other LMIC settings to identify areas of reduced confidence in otolaryngology provision.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/oto2.70303","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:00:27Z","timestamp":1792238427000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Opportunities to Improve Primary\u2010Level Otolaryngology Care: A Survey of Rwandan General Practitioners"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6536-9639","authenticated-orcid":false,"given":"Kamala","family":"Pullakhandam","sequence":"first","affiliation":[{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kabongo","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahbuba","family":"Tusty","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Nuss","sequence":"additional","affiliation":[{"name":"Massachusetts Eye and Ear Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle","family":"Cahill","sequence":"additional","affiliation":[{"name":"Los Angeles Department of Head and Neck Surgery University of California Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Patel","sequence":"additional","affiliation":[{"name":"Loyola Stritch School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Bukuru","sequence":"additional","affiliation":[{"name":"Rwanda Military Referral and Teaching Hospital Kigali City Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"J.M.V.","given":"Hirwa","family":"Nteyumwete","sequence":"additional","affiliation":[{"name":"Loyola Stritch School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristote","family":"Hakizimana","sequence":"additional","affiliation":[{"name":"Rwanda Military Referral and Teaching Hospital Kigali City Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee","family":"Kamaliza","sequence":"additional","affiliation":[{"name":"Rwanda Military Referral and Teaching Hospital Kigali City Rwanda"},{"name":"King Faisal Hospital Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Shaye","sequence":"additional","affiliation":[{"name":"Harvard Medical School Boston Massachusetts USA"},{"name":"Massachusetts Eye and Ear Boston Massachusetts USA"},{"name":"Rwanda 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