Rwandan anesthesia providers show improvement in ANTS practice during cesarean delivery after 1 teaching session using a low-cost high psychological fidelity simulation model with debriefing.

Simulation replicates clinical experiences without patient risk; it remains uncommon in lower-income countries. We outline the creation of Rwanda's first centre for simulation and skills training. We secured funding for renovations, equipment and staff; curricula were developed, tested, and refined; local clinicians were trained to teach. In 13 months the centre provided 2,377 learning-encounters and 822 hours of training to Rwandan health care professionals. Our strategy represents an adaptable model for simulation and skills centre development in low-resources settings

Background: Short educational programmes are important in building global anaesthesia workforce capacity. The Vital Anaesthesia Simulation Training (VAST) course is a 3-day immersive simulation-based programme concentrating on core clinical challenges and non-technical skills required by anaesthesia providers in low-resource settings.Methods: This mixed methods study prospectively evaluated the impact of VAST in Rwanda. Anaesthetists' Non-Technical Skills (ANTS) scores were quantitatively assessed for 30 course participants at three time points (pre-, post-, and 4 months after VAST). Qualitative data were gathered during focus groups (4 months after VAST) to learn of participants' experiences implementing new knowledge into clinical practice. Results: The ANTS total scores improved from pre-(11.0 [2.3]) (mean [standard deviation]) to post-test (14.0 [1.6]), and improvements were maintained at retention (14.2 [1.7]). A similar pattern was observed when data were analysed using the four ANTS categories (all P<0.001). The key theme that emerged during focus group discussions was that the use of cognitive aids and clinical algorithms, repeated and reinforced across simulated scenarios, encouraged a systematic approach to patient care. The participants attributed the systematic approach to improving their problem-solving skills and confidence, particularly during emergencies. They found value in well-functioning teams and shared decision-making. After VAST, the participants described empowerment to advocate for better patient care and system improvement. Conclusions: VAST offers a simulation-based training to anaesthesia providers working in low-resource settings. Skills retention and self-reported application of learning into the workplace reflect the scope of impact of this training.

Simulation-based education (SBE) of health care providers is ubiquitous in well-resourced locations and has been used successfully to teach clinical and nontechnical skills. Numerous barriers prevent this important educational tool from widespread use in resource-limited and remote settings. Vital Anaesthesia Simulation Training (VAST) was founded with the aim of promoting the use of vivid, experiential simulation-based learning regardless of location. As an organization, VAST now offers a range of training opportunities. The 3-day VAST Course is a highly portable program that uses low-cost materials to teach core perioperative practices and non-technical skills for health care practitioners in diverse settings. The VAST Course is paired with the VAST Facilitator Course to build skills for SBE among local educators. The VAST Design Course equips simulation facilitators with tools for developing their own simulation scenarios. The VAST Foundation Year is a 48-week curriculum of active learning sessions for early anesthesia trainees, made available to VAST facilitators. This manuscript describes many of the challenges faced when delivering SBE in varied environments and indicates VAST’s strategies to help overcome potential barriers. An overview of the VAST scenario template and stepwise approach to scenario design is included (Supplemental Digital Content 1, http://links.lww.com/IJSGH/A14). While challenges facing SBE in resource-limited settings are significant, its potential value in this context is immense. VAST offers a viable platform for expanding SBE beyond the traditional simulation center.

IntroductionPatient safety depends on excellent practice of anaesthetists’ non-technical skills (ANTS). The ANTS framework has been validated in developed countries but there is no literature on the practice of ANTS in low-income countries. This study examines ANTS in this unexplored context.MethodsThis qualitative ethnographic study used observations of Rwandan anaesthesia providers and in-depth interviews with both North American and Rwandan anaesthesia providers to understand practice of ANTS in Rwanda.ResultsCommunication is central to the practice of ANTS. Cultural factors in Rwanda, such as lack of assertiveness and discomfort taking leadership, and the strains of working in a resource-limited environment hinder the unfettered and focused communication needed for excellent anaesthesia practice.ConclusionDespite the challenges, anaesthesia providers are able to coordinate activities when good communication is actively encouraged. Future teaching interventions should address leadership and communication skills through encouraging both role definition and speaking up for patient safety.