Anesthesiology Training in LMICs: Defining the Problem, Challenges, and Solutions

Tuyishime, Eugene; Powell, William F.; Evans, Faye M.

doi:10.1097/01.asm.0000795116.04062.61

Cited by 3 publications

(4 citation statements)

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“…While pediatric anesthesia curricula developed in HICs can be used to help develop local curriculums, they will need to be adapted to ensure they fit the local context. Pediatric fellowship training opportunities must be supported to help develop future educators and leaders [12]. In addition to training program development, there needs to be expansion of opportunities for continuing professional development and access to mentors [21, 22].…”

Section: Resultsmentioning

confidence: 99%

“…Data show that increasing the density of surgical, anesthesia, and obstetric specialists is associated with an improvement in surgical patient safety, therefore scaling up anesthesia provider density should be a priority in LMICs [12]. Moreover, anesthesia providers often practice in highly stressful, complex work environments, and staffing shortages and lack of support at work have been identified as factors contributing to burnout among anesthesiologists [13][14][15][16].…”

Section: Insufficient Numbers Of Anesthesia Providers and Training Pr...mentioning

confidence: 99%

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Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low‐ and Middle‐Income Countries

Powell,

Echeto‐Cerrato,

Gathuya

et al. 2023

World j. surg.

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Background Worldwide, perioperative mortality has declined over the past 50 years, but the reduction is skewed toward high-income countries (HICs). Currently, pediatric perioperative mortality is much higher in low-and middle-income countries (LMICs) compared to HICs, despite studied cohorts being predominantly low-risk. These disparities must be studied and addressed. Methods A narrative review of the literature was undertaken to identify contributing factors and potential knowledge gaps. Interventions aimed at alleviating the outcomes disparities are discussed, and recommendations are made for future directions. Results and conclusions There is a lack of adequately trained pediatric anesthesia providers in LMICs, and the number must be bolstered by making such training available. Essential anesthesia medications and equipment, in pediatric-appropriate sizes, are often not available; neither are essential infrastructure items. Perioperative staff are underprepared for emergent situations that may arise and simulation training may help to ameliorate this. The global anesthesia community has implemented several solutions to address these issues. The World Federation of Societies of Anaesthesiologists (WFSA) and Global Initiative for Children's Surgery have published standards that outline essential items for the provision of safe perioperative pediatric care. Several short educational courses have been developed and introduced in LMICs that either specifically address pediatric patients, or contain a pediatric component. The WFSA also maintains a collection of discrete tutorials for educational purposes. Finally, in Africa, largescale, prospective data collection is underway to examine pediatric perioperative outcomes. More work needs to be done, though, to improve perioperative outcomes for pediatric patients in LMICs.

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Section: Resultsmentioning

confidence: 99%

Section: Insufficient Numbers Of Anesthesia Providers and Training Pr...mentioning

confidence: 99%

Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low‐ and Middle‐Income Countries

Powell,

Echeto‐Cerrato,

Gathuya

et al. 2023

World j. surg.

Self Cite

View full text Add to dashboard Cite

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“…However, such shifting of professional norms requires that anaesthesiology be better recognised so anaesthesiologists can advocate for themselves, e.g., on the importance of preoperative assessments and conducting these at least 2–3 days before scheduled surgery to help develop rapport with patients as surgeons do. The National Society of Anaesthesiologists could work to ensure rights of anaesthesiologists in the private sector, minimum acceptable or percentage wages according to qualifications, and reporting of malpractice in private hospitals and push for more out-of-theatre exposure [ 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives

Shahbaz

Zakar

Fischer

et al. 2022

IJERPH

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Global anesthesia workforce limitations contribute to the emigration of skilled anesthesiologists from lower- to higher-income countries, jeopardizing workforce balance and patient outcomes in Pakistan. This study aimed to explore the challenges experienced by anesthesiologists in Punjab, Pakistan’s most populous province, and the necessary changes to encourage their retention. We conducted a qualitative study to examine the perspectives of anesthesiologists who chose to serve in Pakistan. We drew data from semi-structured interviews conducted with 25 purposively sampled consultant anesthesiologists. We analyzed the data thematically and distinguished the practice hurdles faced by anesthesiologists in the public and private hospitals of Punjab. The main reasons many consultants chose to work abroad instead of in Pakistan differed between public and private sectors, which provided distinct challenges that compromised anesthesia workforce numbers and quality. Key outcomes were security, promotion/incentive structures, and gender inequalities in the government sector versus inadequate salary and facilities, surgeon dependency, and the lack of out-of-theatre practice in the private sector that minimized the scope and earnings of anesthesiologists within Pakistan. There is a need to increase performance-based incentivization, qualification-dependent promotion, along with overcoming surgeon dependency and hospital manipulation by fixing salary percentages for each surgical case and encouraging direct patient–anesthesiologist relationships.

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“…The national society of anaesthesiologist should work to ensure rights of anaesthesiologist in the private sector. They should work on minimum acceptable or percentage wages according to qualification of anaesthesiologist and encourage reporting of malpractice in private hospitals [44].…”

Section: Implications For Policy and Practicementioning

confidence: 99%

Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives

Shahbaz¹,

Zakar²,

Howard³

et al. 2022

Preprint

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Global anaesthesia workforce limitations contribute to emigration of skilled anaesthesiologists from lower- to higher-income countries, jeopardizing workforce balance and patient outcomes in Pakistan. This study aims to explore challenges experienced by anaesthesiologists in Punjab, Pakistan’s most populous province, and necessary changes to encourage their retention. We conducted a qualitative study to examine perspectives of anaesthesiologists who chose to serve in Pakistan. We drew data from semi-structured interviews conducted with 25 purposively-sampled consultant anaesthesiologists. We analysed data thematically and distinguished the practice hurdles faced by anaesthesiologists in public and private hospitals of Punjab. The main reasons to work abroad could be broadly categorized under two inductive themes, i.e. practice hurdles in public and private sector. Both had distinct issues which compromised the number and quality of anaesthesia workforce in the country. The key outcomes were workplace security, promotion/incentive issues and gender inequalities in the government sector. The private sector had improper salaries and facilities, anaesthesiologist’s dependency on surgeons for getting work and lack of out-of-theatre practice which minimise the scope and earnings of anaesthesiologist within the country. There is a need to overcome surgeon dependency and hospital manipulation by fixing salary percentages for each surgical case and encouraging direct patient-anaesthesiologist relationships.

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Anesthesiology Training in LMICs: Defining the Problem, Challenges, and Solutions

Cited by 3 publications

References 0 publications

Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low‐ and Middle‐Income Countries

Delivery of Safe Pediatric Anesthesia Care in the First 8000 days: Realities, Challenges, and Solutions in Low‐ and Middle‐Income Countries

Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives

Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives

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