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Karydi KI, Kabaghe S, Blamey H, Mohamed M, Shamambo N, Edgcombe H. Non-physician anaesthesia providers' perspectives on task sharing practices in Zambia and Somaliland: a qualitative study. BMJ Open 2024; 14:e078939. [PMID: 38719296 PMCID: PMC11086413 DOI: 10.1136/bmjopen-2023-078939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The 68th World Health Assembly, in 2015, called for surgical and anaesthesia services strengthening. Acknowledging the healthcare staff shortages, they referred to task sharing, among others, as a more effective use of the healthcare workforce. While task sharing has been increasingly proposed as an important strategy to increase the reach and safety of anaesthesia as well as a means of supporting the workforce in low-resource settings, most data on task sharing relate to non-anaesthetic healthcare contexts. The aim of this study was to understand anaesthetic task sharing as currently experienced and/or envisaged by non-physician anaesthesia providers in Zambia and Somaliland. METHODS An exploratory qualitative research methodology was used. Participants were recruited initially via contacts of the research team, then through snowballing using a purposive sampling strategy. There were 13 participants: 7 from Somaliland and 6 from Zambia. Semistructured interviews took place synchronously, then were recorded, anonymised, transcribed and analysed thematically. Triangulation and respondents' validation were used to maximise data validity. RESULTS Four major themes were identified in relation to task sharing practices: (1) participants recognised variable components of task sharing in their practice; (2) access to task sharing depends both on sources and resources; (3) implicit barriers may inhibit task sharing practices; (4) there is an appetite among participants for amelioration of current task sharing practices. CONCLUSIONS Empowering task sharing practices can be achieved only by understanding how these practices work, by identifying gaps and areas of improvement, and by addressing them. The findings from this exploratory study could help the global community understand how anaesthetic task sharing in low-resource settings works and inspire further research on the field. This could inform future modelling of workforce planning strategies in low-resource settings to maximise the effectiveness and professional well-being of the workforce.
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Affiliation(s)
- Konstantina Ilia Karydi
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Helen Blamey
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Naomi Shamambo
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Hilary Edgcombe
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Shahbaz S, Howard N. Anaesthesia delivery systems in low and lower-middle-income Asian countries: A scoping review of capacity and effectiveness. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001953. [PMID: 38498415 PMCID: PMC10947636 DOI: 10.1371/journal.pgph.0001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 02/18/2024] [Indexed: 03/20/2024]
Abstract
Literature on anaesthesia systems in low and lower middle-income countries is limited, focused on the Africa region, and provides minimal data on anaesthesia or associated disciplines within intensive care, pain management and emergency medicine. We thus conducted a scoping review of primary and secondary research literature on capacity and effectiveness of anaesthesia delivery in low and lower middle-income countries in the Asia region from 2000-2021, to clarify existing knowledge, important gaps, and possible subsequent steps. We applied Arksey and O'Malley's scoping literature review method to search five databases (i.e. EMBASE, CINAHL, Medline, Scopus, Web of Science), screen, extract, and synthesise data under three themes: (i) availability and type of anaesthesia workforce; (ii) anaesthesia system infrastructure, equipment, and supplies; and (iii) effectiveness of anaesthesia provision. We included 25 eligible sources of 603 identified. Only ten (40%) were published in the last 5 years and Asian lower-income countries were primarily represented in 15 multi-country sources. Fifteen (60%) sources used quantitative methods and provided limited information on data collection, e.g. sampling criteria or geographic areas included. No sources included countrywide data, despite anaesthesia delivery and resources differing significantly sub-nationally (e.g. central versus rural/remote, or insecure areas). Data on anaesthesiology delivery were limited, with findings including insufficiencies in workforce, supplies, training, and skills-building of anaesthesia personnel, along with the lack of consistent strategies for overcoming maldistribution of resources and improving anaesthesia delivery systems in the region. This review, a first attempt to synthesise existing data on anaesthesia delivery systems in low and lower-middle-income Asian countries, shows the anaesthesia literature is still limited. Findings highlight the urgent need for additional research and collaboration nationally and regionally to strengthen anaesthesia delivery and surgical facilities in resource-constrained settings.
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Affiliation(s)
- Sumbal Shahbaz
- Department of Health Professional Technologies, The University of Lahore, Lahore, Pakistan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Shahbaz S, Zakar R, Howard N. Anaesthesia provision challenges in public hospitals of Pakistan's Punjab province: a qualitative study of expert perspectives. BMJ Open 2023; 13:e075108. [PMID: 38135328 DOI: 10.1136/bmjopen-2023-075108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Anaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of the WHO-World Federation of Societies of Anaesthesiologists' (WHO-WFSA) 'highly recommended' standards of quality anaesthesia services for surgical support in Pakistan's Punjab province. STUDY DESIGN AND SETTING This single-method qualitative study included 22 semistructured interviews with purposively selected anaesthesia system experts in Punjab province, including heads of teaching hospital anaesthesia departments, healthcare commission (HCC) representatives and health department officials. We analysed data thematically, using deductive and inductive coding. PARTICIPANTS 10 participants worked as anaesthesia department heads of teaching hospitals across Punjab, 5 worked for the HCC and 7 worked for the health department. All were selected purposively and had at least 5 years of experience working as head of department or serving in legislative departments. RESULTS We identified three themes experienced as major challenges within the specialty, namely anaesthetist recruitment and retention, quality of care and in-service training, and discrepancies between specialities. Findings indicated that workforce shortages and maldistribution, insufficient in-service training and standards, inadequate equipment maintenance and lack of anaesthesia representation in decision-making compromised anaesthesia provision quality and safety. CONCLUSIONS Improving anaesthesia provision in Punjab would require increasing physician and non-physician anaesthetist numbers and rotation to peripheral postings, strengthening training quality and ensuring availability of WFSA-specified essential equipment and supplies. To achieve essential anaesthesia provision standards, policy interventions are needed to, for example, balance anaesthesiologist and surgeon/obstetrician-gynaecologist numbers, require that anaesthesiology postgraduates work a few years in-country (eg, scholarship bonds), ensure in-service training attendance for skills updates and implement quality assurance standards for equipment and supplies.
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Affiliation(s)
- Sumbal Shahbaz
- Department of Health Professional Technologies, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
- Department of Public Health, University of the Punjab, Quaid-i-Azam Campus, Lahore, Pakistan
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Quaid-i-Azam Campus, Lahore, Pakistan
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
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Bognini MS, Oko CI, Kebede MA, Ifeanyichi MI, Singh D, Hargest R, Friebel R. Assessing the impact of anaesthetic and surgical task-shifting globally: a systematic literature review. Health Policy Plan 2023; 38:960-994. [PMID: 37506040 PMCID: PMC10506531 DOI: 10.1093/heapol/czad059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/04/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
The global shortage of skilled anaesthesiologists, surgeons and obstetricians is a leading cause of high unmet surgical need. Although anaesthetic and surgical task-shifting are widely practised to mitigate this barrier, little is known about their safety and efficacy. This systematic review seeks to highlight the existing evidence on the clinical outcomes of patients operated on by non-physicians or non-specialist physicians globally. Relevant articles were identified by searching four databases (MEDLINE, EMBASE, CINAHL and Global Health) in all languages between January 2008 and February 2022. Retrieved documents were screened against pre-specified inclusion and exclusion criteria, and their qualities were appraised critically. Data were extracted by two independent reviewers and findings were synthesized narratively. In total, 40 studies have been included. Thirty-five focus on task-shifting for surgical and obstetric procedures, whereas four studies address anaesthetic task-shifting; one study covers both interventions. The majority are located in sub-Saharan Africa and the USA. Seventy-five per cent present perioperative mortality outcomes and 85% analyse morbidity measures. Evidence from low- and middle-income countries, which primarily concentrates on caesarean sections, hernia repairs and surgical male circumcisions, points to the overall safety of non-surgeons. On the other hand, the literature on surgical task-shifting in high-income countries (HICs) is limited to nine studies analysing tube thoracostomies, neurosurgical procedures, caesarean sections, male circumcisions and basal cell carcinoma excisions. Finally, only five studies pertaining to anaesthetic task-shifting across all country settings answer the research question with conflicting results, making it difficult to draw conclusions on the quality of non-physician anaesthetic care. Overall, it appears that non-specialists can safely perform high-volume, low-complexity operations. Further research is needed to understand the implications of surgical task-shifting in HICs and to better assess the performance of non-specialist anaesthesia providers. Future studies must adopt randomized study designs and include long-term outcome measures to generate high-quality evidence.
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Affiliation(s)
- Maeve S Bognini
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Christian I Oko
- Division of Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, United Kingdom
| | - Meskerem A Kebede
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Martilord I Ifeanyichi
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Darshita Singh
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Rachel Hargest
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
- University Hospital of Wales, Heath Park, Cardiff CF14 4XN, United Kingdom
| | - Rocco Friebel
- Global Surgery Policy Unit, The London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
- Center for Global Development, Abbey Gardens, Great College Street, London SW1P 3SE, United Kingdom
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Asemu YM, Yigzaw T, Ayalew F, Akalu L, Scheele F, van den Akker T. The Ethiopian Anesthetist Licensing Examination and Associated Improvement in in-School Student Performance: A Retrospective Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:741-751. [PMID: 37465374 PMCID: PMC10351591 DOI: 10.2147/amep.s414217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
Background Ethiopia introduced a national licensing examination (NLE) in response to growing concerns about the competence of graduates and the quality of education. This study aimed to assess the associated in-school student performance changes in anesthetist training programs following NLE implementation. Methods Academic records of 1493 graduate anesthetists were retrospectively obtained from eight universities before (n=932) and after (n=561) NLE implementation. Four universities were first-generation (oldest), three were second-generation, and one was third-generation (newest). We compared the yearly (Y1 to Y4) and cumulative grade point averages (GPA) to assess if there were in-school student performance differences between the two periods. The Kruskal-Wallis and Mann-Whitney U-tests were used to compare groups. Results are presented as a median, interquartile range, a 95% confidence interval (CI) for median differences, and Cohen's r effect size. Results Overall, there was a small to moderate improvement in student academic performance following NLE implementation. However, the statistically significant differences were limited to first-generation university students and those entering directly from high school. We found considerable positive differences in all five performance measures in first-generation university students, with Year-1 GPA and cumulative GPA measurements exhibiting large effect sizes (Cohen's r = 0.96 and 0.79, respectively, p <0.005). Those entering from high school demonstrated significant differences in four of five performance measures, with the largest positive gains on the year-1 GPA (median before [n=765] and after [n=480]: 3.11-3.30, 95% CI (0.09, 0.22), r=0.46, p <0.005)). Second- and third-generation university students showed no significant differences, while nurse entrants exhibited a significant difference in their Y2GPA scores only with an actual drop in performance. Conclusion The Ethiopian anesthetist NLE is associated with an overall modest in-school academic performance improvement, supporting its use. The stagnant or declining performance among nurse entrants and the newest (second and third) generation university students deserve further scrutiny.
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Affiliation(s)
- Yohannes Molla Asemu
- Health Workforce Improvement Program, Jhpiego, an Affiliate of Johns Hopkins University, Ethiopia Country Office, Addis Ababa, Ethiopia
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Tegbar Yigzaw
- Health Workforce Improvement Program, Jhpiego, an Affiliate of Johns Hopkins University, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Firew Ayalew
- Health Workforce Improvement Program, Jhpiego, an Affiliate of Johns Hopkins University, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Leulayehu Akalu
- Ethiopian Association of Anesthetists (EAA), Addis Ababa, Ethiopia
- School of Anesthesia, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fedde Scheele
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Obstetrics and Gynecology, OLVG Teaching Hospital, Amsterdam, the Netherlands
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands
| | - Thomas van den Akker
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
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Ross O, Shakya R, Shrestha R, Shah S, Pradhan A, Shrestha R, Bhandari P, Paris B, Shah K, Shrestha A, Zimmerman M, Henrikson H, Tamang S, Rajbhandari R. Pathways to effective surgical coverage in a lower-middle-income country: A multiple methods study of the family physician-led generalist surgical team in rural Nepal. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001510. [PMID: 36963001 PMCID: PMC10021892 DOI: 10.1371/journal.pgph.0001510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/24/2023] [Indexed: 03/04/2023]
Abstract
The Lancet Commission on Global Surgery (LCoGS) recommends using specialist surgical workforce density as one of 6 core indicators for monitoring universal access to safe, affordable surgical and anaesthesia care. Using Nepal as a case study, we explored the capacity of a generalist workforce (led by a family physician or MD general practitioner and non-physician anaesthetist) to enable effective surgical delivery through task-shifting. Using a multiple-methods approach, we retrospectively mapped essential surgical care and the enabling environment for surgery in 39 hospitals in 25 remote districts in Nepal and compared it with LCoGS indicators. All 25 districts performed surgery, 21 performed Caesarean section (CS), and 5 met at least 50% of district CS needs. Generalist surgical teams performed CS, the essential major operation at the district level, and very few laparotomies, but no operative orthopaedics. The density of specialist Surgeon/Anaesthesiologist/Obstetrician (SAO) was 0·4/100,000; that of Generalist teams (gSAO) led by a family physician (MD General Practitioners-MDGP) supported by non-physician anaesthetists was eight times higher at 3·1/100,000. gSAO presence was positively associated with a two-fold increase in CS availability. All surgical rates were well below LCoGS targets. 46% of hospitals had adequate enabling environments for surgery, 28% had functioning anaesthesia machines, and 75% had blood transfusion services. Despite very low SAO density, and often inadequate enabling environment, surgery can be done in remote districts. gSAO teams led by family physicians are providing essential surgery, with CS the commonest major operation. gSAO density is eight times higher than specialists and they can undertake more complex operations than just CS alone. These family physician-led functional teams are providing a pathway to effective surgical coverage in remote Nepal.
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Affiliation(s)
- Ollie Ross
- Nick Simons Institute, Lalitpur, Nepal
- University Hospital Southampton, Southampton, United Kingdom
| | | | | | - Shristi Shah
- Galangoor Duwalami Primary Health Care Centre, Maryborough, Australia
| | - Amita Pradhan
- Nick Simons Institute, Lalitpur, Nepal
- KIST Medical College, Lalitpur, Nepal
| | | | | | - Becky Paris
- Hereford County Hospital, Hereford, United Kingdom
| | | | | | | | - Hannah Henrikson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | | | - Ruma Rajbhandari
- Nick Simons Institute, Lalitpur, Nepal
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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Shahbaz S, Zakar R, Fischer F, Howard N. Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13427. [PMID: 36294008 PMCID: PMC9603508 DOI: 10.3390/ijerph192013427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/04/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Limitations in the global anaesthesia workforce contribute to the emigration of skilled anaesthesiologists from lower-income to higher-income countries, jeopardizing workforce balance and patient outcomes in Pakistan. This study aimed to explore the challenges experienced by anaesthesiologists in Punjab, Pakistan's most populous province, and the potential changes to encourage their retention. We conducted a qualitative study, conducting semi-structured interviews with 25 purposively sampled consultant anaesthesiologists working in Punjab and analysing data thematically. Reported professional challenges and reasons consultant anaesthesiologists chose to work abroad differed between public and private sectors, each sector providing distinct challenges that compromised anaesthesia workforce numbers and quality. Key concerns were security, promotion/incentive structures, and gender inequalities in public hospitals versus inadequate salary and facilities, surgeon dependency, and the lack of out-of-theatre practice in private hospitals that minimized the scope and earnings of anaesthesiologists within Pakistan. Our findings help contextualise Pakistan's anaesthesia workforce crisis, indicating public-sector improvements could include increasing security in hospital premises, performance-based incentives, and qualification-dependent promotion, while private-sector improvements could include decreasing surgeon dependency, fixing salary percentages by surgical case, and encouraging direct patient-anaesthesiologist relationships. National and subnational interventions to promote anaesthesiology, along with public awareness campaigns, could additionally raise its profile and encourage retention.
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Affiliation(s)
- Sumbal Shahbaz
- Department of Public Health, University of the Punjab, Lahore 54590, Pakistan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119077, Singapore
- Department of Allied Health Sciences, Superior University, Lahore 54000, Pakistan
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore 54590, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, 87437 Kempten, Germany
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119077, Singapore
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London 400706, UK
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Holmaas G, Abate A, Woldetsadik A, Hevrøy O. Establishing a sustainable training programme in anaesthesia in Ethiopia. Acta Anaesthesiol Scand 2022; 66:1016-1023. [PMID: 35749233 PMCID: PMC9541354 DOI: 10.1111/aas.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
Background Lack of qualified staff is a major hindrance for quality and safety improvements in anaesthesia and critical care in many low‐income countries. Support in specialist training may enhance perioperative treatment and have a positive downstream impact on other hospital services, which may improve the overall standard of care. Methods Between 2011 and 2019, consultant anaesthetists from Haukeland University Hospital in Norway supported a postgraduate anaesthesia‐training programme at Addis Ababa University/Tikur Anbessa Specialised Hospital in Ethiopia. The aim of the programme was to build a self‐sustainable work force of anaesthetists across the country who could perform high quality anaesthesia within the confinement of limited local resources. Over the course of 10 years, an almost continuous rotation of experienced anaesthetists and intensivists assisted training of Ethiopian residents in anaesthesia and critical care. Local specialists organised the programme; however, external support was necessary during this period to establish a sustainable training programme. Results Since the programme's commencement at Addis Ababa University in 2011, 159 residents have entered the programme and 71 have graduated. As the number of qualified anaesthetists increased, Ethiopian specialists gradually obtained responsibility for the programme. Candidates are recruited from various regions and from neighbouring countries. Five other Ethiopian training sites have been established. To date (May 2022), 112 residents have completed their training in Ethiopia, and 195 residents expect to graduate within 3 years. Conclusion Nearly 11 years after establishment of the programme, locally trained highly qualified anaesthetists work in Ethiopia's major hospitals throughout the country.
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Affiliation(s)
- Gunhild Holmaas
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
| | - Ananya Abate
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | | | - Olav Hevrøy
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
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Priorities for content for a short-course on postoperative care relevant for low- and middle-income countries: an e-Delphi process with training facilitators. Anaesthesia 2022; 77:570-579. [PMID: 35319098 PMCID: PMC9315034 DOI: 10.1111/anae.15675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
Most surgical and anaesthetic mortality and morbidity occurs postoperatively, disproportionately affecting low- and middle-income countries. Various short courses have been developed to improve patient outcomes in low- and middle-income countries, but none specifically to address postoperative care and complications. We aimed to identify key features of a proposed short-course addressing this topic using a Delphi process with low- and middle-income country anaesthesia providers trained as short-course facilitators. An initial questionnaire was co-developed from literature review and exploratory workshops to include 108 potential course features. Features included content; teaching method; appropriate participants; and appropriate faculty. Over three Delphi rounds (panellists numbered 86, 64 and 35 in successive cycles), panellists indicated which features they considered most important. Responses were analysed by geographical regions: Africa, the Americas, south-east Asia and Western Pacific. Ultimately, panellists identified 60, 40 and 54 core features for the proposed course in each region, respectively. There were high levels of consensus within regions on what constituted core course content, but not between regions. All panellists preferred the small group workshop teaching method irrespective of region. All regions considered anaesthetists to be key facilitators, while all agreed that both anaesthetists and operating theatre nurses were key participants. The African and Americas regional panels recommended more multidisciplinary healthcare professionals for participant roles. Faculty from high-income countries were not considered high priority. Our study highlights variability between geographical regions as to which course features were perceived as most locally relevant, supporting regional adaptation of short-course design rather than a one-size-fits-all model.
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Aboobacker S, Ahmed S, Kumar N, Al Khal A. Post-Graduation Anesthesiology Program in Qatar, Viewpoints and Future Challenges. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.18965.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Qatar is a country located on the east shores of the Arabian Peninsula. In the past three decades, Qatar has experienced significant changes in its educational and healthcare systems. At the time of writing this paper, there are two accredited Faculties of Medicine, which offer students from all over the world the possibility of becoming doctors. Residency Programs are taught in English and are accredited by Accreditation Council for Graduate Medical Education-International (ACGME-I). In this paper, we outline the organisation of Qatar medical education at undergraduate and postgraduate levels, with particular emphasis on the postgraduate anaesthesiology residency program. We outline the opportunities for curriculum development and its future challenges.
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Asemu YM, Yigzaw T, Desta FA, Scheele F, van den Akker T. Evaluating the effect of interventions for strengthening non-physician anesthetists' education in Ethiopia: a pre- and post-evaluation study. BMC MEDICAL EDUCATION 2021; 21:421. [PMID: 34364373 PMCID: PMC8349499 DOI: 10.1186/s12909-021-02851-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Access to safe surgery has been recognized as an indispensable component of universal health coverage. A competent anesthesia workforce is a prerequisite for safe surgical care. In Ethiopia, non-physician anesthetists are the main anesthesia service providers. The Government of Ethiopia implemented a program intervention to improve the quality of non-physician anesthetists' education, which included faculty development, curricula strengthening, student support, educational resources, improved infrastructure and upgraded regulations. This study aimed to assess changes following the implementation of this program. METHODS A pre-and post-evaluation design was employed to evaluate improvement in the quality of non-physician anesthetists' education. A 10-station objective structured clinical examination (OSCE) was administered to graduating class anesthetists of 2016 (n = 104) to assess changes in competence from a baseline study performed in 2013 (n = 122). Moreover, a self-administered questionnaire was used to collect data on students' perceptions of the learning environment. RESULTS The overall competence score of 2016 graduates was significantly higher than the 2013 class (65.7% vs. 61.5%, mean score difference = 4.2, 95% CI = 1.24-7.22, p < 0.05). Although we found increases in competence scores for 6 out of 10 stations, the improvement was statistically significant for three tasks only (pre-operative assessment, postoperative complication, and anesthesia machine check). Moreover, the competence score in neonatal resuscitation declined significantly from baseline (from 74.4 to 68.9%, mean score difference = - 5.5, 95% CI = -10.5 to - 0.5, p < 0.05). Initial gender-based performance differences disappeared (66.3% vs. 65.3%, mean score difference = - 1.0, 95% CI = - 6.11-3.9, p > 0.05 in favor of females), and female students scored better in some stations. Student perceptions of the learning environment improved significantly for almost all items, with the largest percentage point increase in the availability of instructors from 38.5 to 70.2% (OR = 3.76, 95% CI = 2.15-6.55, p < 0.05). CONCLUSION The results suggest that the quality of non-physician anesthetists' education has improved. Stagnation in competence scores of some stations and student perceptions of the simulated learning environment require specific attention.
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Affiliation(s)
- Yohannes Molla Asemu
- Jhpiego, An affiliate of Johns Hopkins University, Ethiopia country office, Addis Ababa, Ethiopia
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tegbar Yigzaw
- Jhpiego, An affiliate of Johns Hopkins University, Ethiopia country office, Addis Ababa, Ethiopia
| | - Firew Ayalew Desta
- Jhpiego, An affiliate of Johns Hopkins University, Ethiopia country office, Addis Ababa, Ethiopia
| | - Fedde Scheele
- Athena Institute for Transdisciplinary Research, Amsterdam, The Netherlands
- OLVG Teaching Hospital, Amsterdam, The Netherlands
- Amsterdam UMC, Amsterdam, the Netherlands
- Dutch Royal Medical Council, Chair Legislative College for Accreditation of Residency Training 2016–2019, Utrecht, The Netherlands
| | - Thomas van den Akker
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
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12
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Fentie Y, Simegnew T. Awareness and its associated factors towards anesthesia and anesthetists' among elective surgical patients in Debre Tabor Comprehensive Specialized Hospital, North Central Ethiopia 2021: Cross-sectional study. Ann Med Surg (Lond) 2021; 68:102640. [PMID: 34401128 PMCID: PMC8347818 DOI: 10.1016/j.amsu.2021.102640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background Patient awareness level of anesthesia and anesthetist is not well known in the study area which makes patients blind about the risk and benefits of anesthesia and the role of anesthetists'. This study aimed to assess elective surgical patients' awareness and its associated factors of anesthesia and anesthetists’ in Debre tabor comprehensive specialized Hospital, north-central Ethiopia, 2021. Method Institutional based cross-sectional study was conducted on 367 patients who underwent for elective general surgery in Debre Tabor Comprehensive Specialized Hospital from December 15, 2020, up to May 15, 2021. Data were collected with a structured questionnaire of 13 items after translating the English version to the local language (Amharic). Descriptive statistics were expressed in percentage and presented with tables. Bivariable and multivariable logistic analysis were done to identify factors associated with the awareness level of patients on anesthesia and anesthetists. Statistical significance level was set at P < 0.05 with 95 % CI. Results In this study, 25.1 % [95 % CI= (20.7–29.6)] of patients were adequately aware of anesthesia and anesthetist. Multivariable logistic analyses showed that male patients [AOR = 1.90; 95 % CI= (1.03–3.52)], level of education of secondary school [AOR = 3.20; 95 % CI= (1.07–9.61)] and collage and above [AOR = 4.75; 95 % CI= (1.73–13.06)], patients from Urban [AOR = 6.34; 95 % CI= (3.01–13.39)], and patients with previous anesthesia exposure [AOR = 3.43; 95 % CI= (1.76–6.69)] were more aware of anesthesia and anesthetist than their counterparts. Conclusion The awareness level of patients about anesthesia and anesthetists in this study was poor. Sex, residency, educational level, and previous anesthesia exposure were factors associated with patients’ awareness level of anesthesia and anesthetists. Awareness of patients about anesthesia improves clinical service. Awareness of patients about anesthesia was poor in DCSH. Sex, residency, and previous anesthesia exposure are associated with awareness. Awareness creation strategies are required to improve awareness levels.
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Affiliation(s)
- Yewlsew Fentie
- Department of Anesthesia, College of Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tadelech Simegnew
- Department of Anesthesia, College of Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
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Igaga EN, Sendagire C, Ayebale ET. Task Sharing in Global Anesthesia and Surgery: Workforce Concerns. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-020-00433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Lonnée HA, Taule K, Knoph Sandvand J, Koroma MM, Dumbuya A, Jusu KS, Shour MA, Duinen AJ. A survey of anaesthesia practices at all hospitals performing caesarean sections in Sierra Leone. Acta Anaesthesiol Scand 2021; 65:404-419. [PMID: 33169383 DOI: 10.1111/aas.13736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/07/2020] [Accepted: 10/19/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Providing safe anaesthesia is essential when performing caesarean sections, one of the most commonly performed types of surgery. Anaesthesia-related causes of maternal mortality are generally considered preventable. The primary aim of our study was to assess the type of anaesthesia used for caesarean sections in Sierra Leone. Secondary aims were to identify the type and training of anaesthesia providers, availability of equipment and drugs and use of perioperative routines. METHODS All hospitals in Sierra Leone performing caesarean sections were included. In each facility, one randomly selected anaesthesia provider was interviewed face-to-face using a predefined questionnaire. RESULTS In 2016, 36 hospitals performed caesarean sections in Sierra Leone. The most commonly used anaesthesia method for caesarean section was spinal anaesthesia (63%), followed by intravenous ketamine without intubation; however, there was a wide variety between hospitals. Of all anaesthesia providers, 33% were not qualified to provide anaesthesia independently, as stipulated by local regulations. Of those, 50% expressed high confidence in their skills to handle obstetric emergencies. There were discrepancies among hospitals in the availability of essential drugs, the use of post-operative recovery and the presence of a functioning blood bank. CONCLUSION Anaesthesia for caesarean sections in Sierra Leone showed a predominance for spinal anaesthesia. The workforce consisted mainly of non-physicians, of which a third was not trained to provide anaesthesia independently. Both the type of anaesthesia and the presence of qualified anaesthetic providers was widely variable between hospitals. Significant gaps were identified in the availability of equipment, essential drugs and perioperative routines.
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Affiliation(s)
- Herman A. Lonnée
- Department of Anaesthesia and Intensive Care St. Olav’s Hospital Trondheim Norway
| | - Katinka Taule
- Faculty of Medicine Norwegian University of Science and Technology Trondheim Norway
| | | | - Michael M. Koroma
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
- Department of Anaesthesia Princess Christian Maternity Hospital (PCMH) Freetown Sierra Leone
| | | | - Kakpama S.K. Jusu
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
| | - Mohamed A. Shour
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
| | - Alex J. Duinen
- Department of Cancer Research and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
- Department of Surgery St. Olav’s HospitalTrondheim University Hospital Trondheim Norway
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15
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Gray RM, Evans FM. Well-being of the global anesthesiologist. Paediatr Anaesth 2021; 31:13-15. [PMID: 33378131 DOI: 10.1111/pan.14093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Rebecca M Gray
- The Division of Paediatric Anaesthesia, Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.,Division of Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Faye M Evans
- The Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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16
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Lilaonitkul M, Mishra S, Pritchard N, Andhoga J, Olang' P, Kibet EB, Walker IA, Hart J, Byrne-Davis L. Mixed methods analysis of factors influencing change in clinical behaviours of non-physician anaesthetists in Kenya following obstetric anaesthesia training. Anaesthesia 2020; 75:1331-1339. [PMID: 32436211 DOI: 10.1111/anae.15091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Abstract
Maternal mortality rates in low-middle income countries remain high, with sub-Saharan Africa accounting for two-thirds of global maternal deaths. Inadequate staff training is one of the main contributors to anaesthesia-related deaths and the Association of Anaesthetists developed the Safe Anaesthesia from Education course in collaboration with the World Federation of Societies of Anaesthesiologists to address this training gap. We aimed to evaluate the impact of this course among Kenyan participants. Mixed methodologies and secondary analyses of anonymised data were used to study translation of learning into practice. In total, 103 participants from 66 facilities who attended courses between 2016 and 2017 were analysed. Ninety (87%) participants who were followed up completed knowledge tests. Baseline median (IQR [range]) knowledge test score was 41 (37-43 [21-46]). There was a significant improvement in median (IQR [range]) knowledge test score immediately post-course (43 (41-45 [33-48]); p < 0.001) which was sustained at 3-6 month follow-up (43 (41-45 [32-50]); p < 0.001 compared with baseline). Eighty-four of the 103 participants were observed in their workplace and capability, opportunity and motivation-behaviour framework was used to study the barriers and facilitators to practice change. Psychological capability and reflective motivation were the main factors enabling positive behaviour change such as team communication and pre-operative assessment, whereas physical and social opportunity accounted for the main barriers to behaviours such as performing the surgical safety checklist. Our study demonstrates that the Safe Anaesthesia from Education obstetric course is relevant in the low-resource setting and may lead to knowledge translation in clinical practice.
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Affiliation(s)
- M Lilaonitkul
- Department of Anesthesia and Peri-operative Care, University of California San Francisco, San Francisco, CA, USA
| | - S Mishra
- Department of Internal Medicine, Lincoln Medicine Center, New York, NY, USA
| | - N Pritchard
- Department of Anaesthesia, St George's University Hospitals NHS Foundation Trust, London, UK
| | - J Andhoga
- Department of Anaesthesia, Jomo Kenyatta University of Agriculture and Technology, Kiambu, Kenya
| | - P Olang'
- Department of Anaesthesia, University of Nairobi, Nairobi, Kenya
| | - E B Kibet
- Department of Anaesthesia, Kenyatta National Hospital, Nairobi, Kenya
| | - I A Walker
- University College London Institute of Child Health, London, UK
| | - J Hart
- Division of Medical Education, University of Manchester, Manchester, UK
| | - L Byrne-Davis
- Division of Medical Education, University of Manchester, UK
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17
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Milenovic MS, Matejic BR, Simic DM, Luedi MM. Burnout in Anesthesiology Providers: Shedding Light on a Global Problem. Anesth Analg 2020; 130:307-309. [PMID: 31934905 DOI: 10.1213/ane.0000000000004542] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Miodrag S Milenovic
- From the Department of Anaesthesiology and Resuscitation, Emergency Center, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bojana R Matejic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dusica M Simic
- Department of Anesthesiology, University Children's Hospital, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Markus M Luedi
- Department of Anaesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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18
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Mumbwe MC, McIsaac D, Jarman A, Bould MD. A Cross-Sectional Survey to Determine the Prevalence of Burnout Syndrome Among Anesthesia Providers in Zambian Hospitals. Anesth Analg 2020; 130:310-317. [PMID: 31725020 DOI: 10.1213/ane.0000000000004464] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Burnout is a psychological syndrome that results from chronic exposure to job stress. It is defined by a triad of emotional exhaustion, depersonalization, and reduced personal accomplishment. In research, mostly from high-income countries, burnout is common in health care professionals, especially in anesthesiologists. Burnout can negatively impact patient safety, the physical and mental health of the anesthetist, and institutional efficiency. However, data on burnout for anesthesia providers in low- and middle-income countries are poorly described. This study sought to determine the prevalence of burnout syndrome among all anesthesia providers (physician and nonphysician) working in Zambian hospitals and to determine which sociodemographic and occupational factors were associated with burnout. METHODS A questionnaire was sent to all Zambian anesthesia providers working in private and public hospitals. The questionnaire assessed burnout using the Maslach Burnout Inventory Human Services Survey, a validated 22-item survey widely used to measure burnout among health professionals. Sociodemographic and occupational factors postulated to be associated with burnout were also assessed. RESULTS Surveys were distributed to all 184 anesthesia providers in Zambia; 160 were returned. This resulted in a response rate representing 87% of all anesthesia providers in the country. Eighty-six percentage of respondents were nonphysician anesthesia providers. Burnout was present in 51.3% (95% confidence interval [CI], 43.2-59.2) of participants. Logistic regression analysis revealed that "not having the right team to carry out work to an appropriate standard" (odds ratio, 2.91, 95% CI, 1.33-6.39; P = .008), and "being a nonphysician" (odds ratio, 3.4, 95% CI, 1.25-12.34; P = .019) were significantly associated with burnout in this population. CONCLUSIONS In a cross-sectional survey of anesthesia providers in Zambia, >50% of the respondents met the criteria for burnout. The risk was particularly high among nonphysician providers who typically work in isolated rural practice. Efforts to decrease burnout rates through policy and educational initiatives to increase the quantity and quality of training for anesthesia providers should be considered.
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Affiliation(s)
- Mbangu C Mumbwe
- From the Department of Anesthesia, University Teaching Hospital, Lusaka, Ministry of Health, Zambia
| | - Dan McIsaac
- Department of Anesthesiology & Pain Medicine and Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alison Jarman
- Department of Anaesthesia, Austin Hospital, Melbourne, Australia
| | - M Dylan Bould
- Department of Anesthesia and Pain Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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Mossenson AI, Tuyishime E, Rawson D, Mukwesi C, Whynot S, Mackinnon SP, Livingston P. Promoting anaesthesia providers' non-technical skills through the Vital Anaesthesia Simulation Training (VAST) course in a low-resource setting. Br J Anaesth 2020; 124:206-213. [DOI: 10.1016/j.bja.2019.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/05/2019] [Accepted: 10/18/2019] [Indexed: 11/27/2022] Open
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Burton ZA, Ayele Y, McDonald P. Establishing a sustainable anaesthetic education programme at Jimma University Medical Centre, Ethiopia. Anaesth Intensive Care 2019; 47:334-342. [PMID: 31390882 DOI: 10.1177/0310057x19860984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lack of continuing education and physician anaesthetist support are commonly cited problems amongst Ethiopian anaesthetic providers. Whilst operating at Jimma University Medical Centre (JUMC), Operation Smile volunteers identified a clear need for improvement in anaesthetic care delivery at JUMC. JUMC is a 450-bed university teaching hospital 350 km southwest of Addis Ababa. At the start of this programme it had two physician anaesthetists, with the majority of anaesthesia historically having been provided by non-physician anaesthesia providers. A visiting lecturer programme was established at JUMC in 2012 following collaboration between two consultant anaesthetists, working for Operation Smile and JUMC respectively. UK trainee anaesthetists in their final years of anaesthetic training volunteered at JUMC for periods of two to six months, providing sustainable education and consistent physician anaesthetist presence to support service provision and training. Over its six-year history, nine visiting lecturers have volunteered at JUMC. They have helped establish a postgraduate training programme in anaesthesia, assisting in the provision of a future physician anaesthetist workforce. Four different training courses designed for low- and middle-income countries (LMICs) have been delivered and visiting lecturers have trained local anaesthetists in subsequent course delivery. Patient safety and quality improvement projects have included introducing the World Health Organization Surgical Safety Checklist, Lifebox pulse oximeters, obstetric spinal anaesthesia packs, improving critical care delivery and establishing two post-anaesthetic care units. Development of partnerships on local, national and global platforms were key to the effective delivery of relevant sustainable education and support. Instilling local ownership proved fundamental to implementing change in the local safety culture at JUMC. Sound mentorship from anaesthetic consultant supervisors both in the UK and in Jimma was crucial to support the UK trainee anaesthetists working in a challenging global setting. This model of sustainable capacity building in an LMIC with a significant deficit in its physician workforce could be replicated in a similar LMIC setting.
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Affiliation(s)
- Zoë A Burton
- Anaesthesia and Critical Care, Queen Alexandra Hospital, Portsmouth, UK
| | - Yemane Ayele
- Department of Anaesthesiology, Jimma University Medical Centre, Jimma, Ethiopia
| | - Philip McDonald
- Department of Anaesthesia and Critical Care, St Richard's Hospital, Chichester, UK.,Operation Smile, UK
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21
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Edgcombe H, Baxter LS, Kudsk-Iversen S, Thwaites V, Bulamba F. Training non-physician anaesthetists in sub-Saharan Africa: a qualitative investigation of providers' perspectives. BMJ Open 2019; 9:e026218. [PMID: 30850414 PMCID: PMC6429866 DOI: 10.1136/bmjopen-2018-026218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To explore the views of non-physician anaesthesia providers (NPAPs) and their colleagues regarding the effectiveness of NPAP training programmes in three contrasting sub-Saharan African countries. DESIGN This was a qualitative exploratory descriptive study. Semistructured interviews were conducted online, recorded, transcribed and analysed thematically using NVivo. SETTING Participants' homes or workplaces in Sierra Leone, Somaliland and Uganda. PARTICIPANTS 15 NPAPs, physician anaesthetists and surgeons working in the countries concerned. RESULTS Three major themes were identified: (1) discrepancy between urban training and rural practice, (2) prominent development of attitudes outside the curricular set during training, including approaches to learning and clinical responsibility and (3) the importance of interprofessional relationships developed during training for later practice. CONCLUSIONS Anaesthesia providers in different cadres and very different country contexts in sub-Saharan Africa describe common themes in training which appear to be significant for their later practice. Not all these issues are explicitly planned for in current training programmes, although they are important in the view of providers. Subsequent programme development should consider these themes with a view to enhancing the safety and quality of anaesthesia practice in this context.
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Affiliation(s)
- Hilary Edgcombe
- Nuffield Department of Clinical Neurosciences (NDA), University of Oxford, Oxford, UK
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Linden S Baxter
- Department of Anaesthetics, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - Soren Kudsk-Iversen
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Victoria Thwaites
- Department of Anaesthetics, Inverclyde Royal Hospital, Greenock, Inverclyde, UK
| | - Fred Bulamba
- Department of Anaesthesia, Faculty of Health Sciences, Busitema University, Mbale, Uganda
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Bashford T, Myint PPN, Win S, Thu M, Naing MM, Burnstein R, Hlaing TT, Brealey E, Hutchinson PJ, Clarkson J. A systems approach to trauma care in Myanmar: from health partnership to academic collaboration. Future Healthc J 2018; 5:171-175. [PMID: 31098561 PMCID: PMC6502594 DOI: 10.7861/futurehosp.5-3-171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Experience from a variety of disciplines suggests that improving healthcare, particularly in resource-poor environments, can benefit from a systems approach. However, putting this into practice is challenging, especially in the context of an international institutional health partnership. In this article, we outline how a systems approach to the improvement of trauma care has informed both clinical improvement and academic collaboration as part of an ongoing partnership involving Cambridge University Hospitals NHS Foundation Trust, the University of Cambridge, and Cambridge Global Health Partnerships in the UK, and Yangon General Hospital, University of Medicine 1, and the Tropical Health and Education Trust (THET) in Myanmar. Improving and researching trauma care is an exemplar of a systems problem, requiring an understanding of the relevant people, equipment, processes, institutions, and power structures that result in the delivery of care at all points of the patient's journey from injury to rehabilitation. Exploring this in the explicit context of traumatic brain injury is one of the research themes of the NIHR Global Health Research Group on Neurotrauma, allowing systems research to directly inform efforts at practical improvement.
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Affiliation(s)
- Tom Bashford
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, UK
| | - Phyu Phyu Nwe Myint
- NIHR Global Health Research Group on Neurotrauma, University of Medicine 1, Myanmar
| | - Sein Win
- NIHR Global Health Research Group on Neurotrauma, University of Medicine 1, Myanmar
| | - Myat Thu
- NIHR Global Health Research Group on Neurotrauma, University of Medicine 1, Myanmar
| | - Mu Mu Naing
- NIHR Global Health Research Group on Neurotrauma, University of Medicine 1, Myanmar
| | - Rowan Burnstein
- Cambridge-Yangon Trauma Intervention Partnership, Cambridge University Hospitals NHS Trust, UK
| | | | - Evelyn Brealey
- Cambridge Global Health Partnerships, Cambridge University Hospitals NHS Trust, UK
| | - Peter J Hutchinson
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, UK
| | - John Clarkson
- Engineering Design Centre, University of Cambridge, UK
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Sanfilippo F, Noto A, Palumbo GJ, Ippolito M, Gagliardone M, Scarlata M, Bignami E, Sangalli F, Cattaneo S, Blangetti I, Scolletta S, Locatelli A, Tritapepe L, Lorini FL, Arcadipane A. Burnout in Cardiac Anesthesiologists: Results From a National Survey in Italy. J Cardiothorac Vasc Anesth 2018; 32:2459-2466. [PMID: 29929893 DOI: 10.1053/j.jvca.2018.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE There is increasing burnout incidence among medical disciplines, and physicians working in emergency settings seem at higher risk. Cardiac anesthesiology is a stressful anesthesiology subspecialty dealing with high-risk patients. The authors hypothesized a high risk of burnout in cardiac anesthesiologists. DESIGN National survey conducted on burnout. SETTING Italian cardiac centers. PARTICIPANTS Cardiac anesthesiologists. INTERVENTIONS The authors administered via email an anonymous questionnaire divided into 3 parts. The first 2 parts evaluated workload and private life. The third part consisted of the Maslach Burnout Inventory test with its 3 constituents: high emotional exhaustion, high depersonalization, and low personal accomplishment. MEASUREMENTS AND MAIN RESULTS The authors measured the prevalence and risk of burnout through the Maslach Burnout Inventory questionnaire and analyzed factors influencing burnout. Among 670 contacts from 71 centers, 382 cardiac anesthesiologists completed the survey (57%). The authors found the following mean Maslach Burnout Inventory values: 14.5 ± 9.7 (emotional exhaustion), 9.1 ± 7.1 (depersonalization), and 33.7 ± 8.9 (personal accomplishment). A rate of 34%, 54%, and 66% of respondents scored in "high" or "moderate-high" risk of burnout (emotional exhaustion, depersonalization, and personal accomplishment, respectively). The authors found that, if offered to change subspecialty, 76% of respondents would prefer to remain in cardiac anesthesiology. This preference and parenthood were the only 2 investigated factors with a protective effect against all components of burnout. Significantly lower burnout scores were found in more experienced anesthesiologists. CONCLUSION A relatively high incidence of burnout was found in cardiac anesthesiologists, especially regarding high depersonalization and low personal accomplishment. Nonetheless, most of the respondents would choose to remain in cardiac anesthesiology.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
| | - Alberto Noto
- Department of Anaesthesia and Intensive Care, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Gaetano J Palumbo
- School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Mariachiara Ippolito
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency. Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Mariapia Gagliardone
- Cardiothoracic Anesthesiology Unit, Transplant Center and De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Maria Scarlata
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Sangalli
- Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy
| | - Sergio Cattaneo
- Department of Anesthesia and Intensive Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ilaria Blangetti
- Department of Emergency and Critical Care, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Sabino Scolletta
- Unit of Anesthesia and Critical Care Medicine, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandro Locatelli
- Department of Emergency and Critical Care, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Luigi Tritapepe
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Ferdinando L Lorini
- Department of Anesthesia and Intensive Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Arcadipane
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
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