Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda

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Study Justification:
– High rates of maternal mortality in developing countries
– Lack of access to continuing education for anesthesia providers in low-resource settings
– Anesthesia technicians in Rwanda managing complex maternal emergencies with limited training
Highlights:
– Implementation of the SAFE Obstetric Anesthesia course in Rwanda
– Three-day refresher course to improve obstetrical anesthesia knowledge and skills
– Knowledge-to-action (KTA) cycle followed to promote uptake of new knowledge into clinical practice
– Locally relevant teaching interventions and revision of curricula
– Active experiential learning during the course
– Encouragement of supportive relationships with peers and mentors
– Use of participant action plans for change, post-course logbooks, and follow-up interviews
– Reported improvements in clinical practice and greater confidence in coordinating team activities
Recommendations:
– Address resource limitations and resistance to change by healthcare providers who did not attend the course
– Future teaching interventions should focus on team training
Key Role Players:
– Anesthesia providers
– Obstetricians
– Educators
– Mentors
– Policy makers
– Healthcare administrators
Cost Items for Planning Recommendations:
– Training materials and resources
– Venue and logistics for training sessions
– Travel and accommodation for participants and trainers
– Compensation for trainers and mentors
– Monitoring and evaluation of the program
– Administrative support for organizing and coordinating the training

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The abstract provides a clear description of the implementation of the SAFE Obstetric Anesthesia course in Rwanda and how it facilitated the knowledge-to-action cycle. It also includes interviews with participants six months after the course, where they reported improvements in clinical practice and greater confidence. However, the abstract does not provide specific data or statistics to support these claims. To improve the evidence, the authors could include quantitative data on the number of participants, their pre- and post-course knowledge and skills assessments, and any measurable outcomes of the course. Additionally, conducting a controlled study or including a comparison group would further strengthen the evidence.

High rates of maternal mortality remain a widespread problem in the developing world. Skilled anesthesia providers are required for the safe conduct of Cesarean delivery and resuscitation during obstetrical crises. Few anesthesia providers in low-resource settings have access to continuing education. In Rwanda, anesthesia technicians with only three years of post-secondary training must manage complex maternal emergencies in geographically isolated areas. The purpose of this special article is to describe implementation of the SAFE (Safer Anesthesia From Education) Obstetric Anesthesia course in Rwanda, a three-day refresher course designed to improve obstetrical anesthesia knowledge and skills for practitioners in low-resource areas. In addition, we describe how the course facilitated the knowledge-to-action (KTA) cycle whereby a series of steps are followed to promote the uptake of new knowledge into clinical practice. The KTA cycle requires locally relevant teaching interventions and continuation of knowledge post intervention. In Rwanda, this meant carefully considering educational needs, revising curricula to suit the local context, employing active experiential learning during the SAFE Obstetric Anesthesia course, encouraging supportive relationships with peers and mentors, and using participant action plans for change, post-course logbooks, and follow-up interviews with participants six months after the course. During those interviews, participants reported improvements in clinical practice and greater confidence in coordinating team activities. Anesthesia safety remains challenged by resource limitations and resistance to change by health care providers who did not attend the course. Future teaching interventions will address the need for team training.

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One innovation for improving access to maternal health is the implementation of the SAFE (Safer Anesthesia From Education) Obstetric Anesthesia course in low-resource areas like Rwanda. This three-day refresher course is designed to enhance obstetrical anesthesia knowledge and skills for practitioners in geographically isolated areas. The course focuses on locally relevant teaching interventions, active experiential learning, and supportive relationships with peers and mentors. It also includes participant action plans for change, post-course logbooks, and follow-up interviews to ensure continued knowledge translation and improvement in clinical practice. This innovation aims to address the challenges of anesthesia safety in resource-limited settings and promote the uptake of new knowledge into clinical practice.
AI Innovations Description
The recommendation described in the article is to implement the SAFE (Safer Anesthesia From Education) Obstetric Anesthesia course in low-resource areas, specifically in Rwanda, to improve obstetrical anesthesia knowledge and skills for practitioners. This three-day refresher course is designed to address the lack of access to continuing education for anesthesia providers in low-resource settings. The course follows the knowledge-to-action (KTA) cycle, which involves steps to promote the uptake of new knowledge into clinical practice.

To ensure the effectiveness of the course, the authors emphasize the importance of tailoring the curriculum to suit the local context and incorporating active experiential learning. They also highlight the significance of fostering supportive relationships with peers and mentors, as well as using participant action plans for change, post-course logbooks, and follow-up interviews to track progress and outcomes.

According to the publication, participants who attended the course reported improvements in clinical practice and increased confidence in coordinating team activities. However, challenges remain, including resource limitations and resistance to change among healthcare providers who did not attend the course. Future teaching interventions are suggested to address the need for team training.

Overall, the recommendation is to implement the SAFE Obstetric Anesthesia course, along with the KTA cycle and supportive measures, to improve access to maternal health by enhancing the knowledge and skills of anesthesia providers in low-resource areas.
AI Innovations Methodology
To simulate the impact of the main recommendations in this abstract on improving access to maternal health, a methodology could involve the following steps:

1. Identify the target low-resource areas: Determine the specific regions or healthcare facilities in low-resource areas where the implementation of the SAFE Obstetric Anesthesia course would be most beneficial.

2. Assess the baseline knowledge and skills of anesthesia providers: Conduct a pre-course assessment to evaluate the current knowledge and skills of anesthesia providers in the identified areas. This will serve as a baseline for comparison.

3. Implement the SAFE Obstetric Anesthesia course: Organize and conduct the three-day refresher course, tailored to the local context, using active experiential learning methods. Ensure that the course follows the knowledge-to-action (KTA) cycle, incorporating the recommended teaching interventions.

4. Track participant progress and outcomes: Use participant action plans for change, post-course logbooks, and follow-up interviews to monitor and evaluate the progress and outcomes of the anesthesia providers who attended the course. Assess improvements in clinical practice, confidence in coordinating team activities, and any other relevant indicators.

5. Assess the impact on access to maternal health: Measure the impact of the course on access to maternal health by comparing the outcomes and improvements observed in the anesthesia providers who attended the course with the baseline assessment conducted in step 2. This could include indicators such as reduction in maternal mortality rates, improved anesthesia management during Cesarean deliveries, and enhanced resuscitation skills during obstetrical crises.

6. Address challenges and barriers: Identify and address any challenges or barriers encountered during the implementation of the course, such as resource limitations and resistance to change among healthcare providers who did not attend the course. Develop strategies to overcome these challenges and ensure sustainability of the knowledge and skills gained.

7. Continuous monitoring and improvement: Continuously monitor the impact of the course on access to maternal health and make necessary adjustments or improvements to the curriculum and teaching interventions based on feedback and evaluation results.

By following this methodology, it would be possible to simulate and evaluate the impact of implementing the SAFE Obstetric Anesthesia course, along with the recommended measures, on improving access to maternal health in low-resource areas.

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