title: Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda.
abstract: 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.
authors.affiliation: Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada, plivings@dal.ca.
authors.forename: Patricia
authors.initials: P
authors.lastname: Livingston
authors.forename: Faye
authors.initials: F
authors.lastname: Evans
authors.forename: Etienne
authors.initials: E
authors.lastname: Nsereko
authors.forename: Gaston
authors.initials: G
authors.lastname: Nyirigira
authors.forename: Paulin
authors.initials: P
authors.lastname: Ruhato
authors.forename: Joan
authors.initials: J
authors.lastname: Sargeant
authors.forename: Megan
authors.initials: M
authors.lastname: Chipp
authors.forename: Angela
authors.initials: A
authors.lastname: Enright
mesh_terms: D000488:Allied Health Personnel / Q000193:education; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008428:Maternal Mortality; D008611:Mentors; D011247:Pregnancy; D012432:Rwanda