title: Preparing the health workforce in Ethiopia: A Cross-sectional study of competence of anesthesia graduating students.
abstract: BACKGROUND
  Efforts to address shortages of health workers in low-resource settings have focused on rapidly increasing the number of higher education programs for health workers. This study examines selected competencies achieved by graduating Bachelor of Science and nurse anesthetist students in Ethiopia, a country facing a critical shortage of anesthesia professionals.
  
  
  METHODS
  The study, conducted in June and July 2013, assessed skills and knowledge of 122 students graduating from anesthetist training programs at six public universities and colleges in Ethiopia; these students comprise 80% of graduates from these institutions in the 2013 academic year. Data was collected from direct observations of student performance, using an objective structured clinical examination approach, and from structured interviews regarding the adequacy of the learning environment.
  
  
  RESULTS
  Student performance varied, with mean percentage scores highest for spinal anesthesia (80%), neonatal resuscitation (74%), endotracheal intubation (73%), and laryngeal mask airway insertion check (71%). Average scores were lowest for routine anesthesia machine check (37%) and preoperative screening assessment (48%). Male graduates outscored female graduates (63.2% versus 56.9%, P = 0.014), and university graduates outscored regional health science college graduates (64.5% versus 55.5%, P = 0.023). Multivariate linear regression found that competence was associated with being male and attending a university training program. Less than 10% of the students believed that skills labs had adequate staff and resources, and only 57.4% had performed at least 200 endotracheal intubations at clinical practicum sites, as required by national standards.
  
  
  CONCLUSIONS
  Ethiopia has successfully expanded higher education for anesthetists, but a focus on quality of training and assessment of learners is required to ensure that graduates have mastered basic skills and are able to offer safe services.
authors.affiliation: Jhpiego, An affiliate of Johns Hopkins University, Addis Ababa, Ethiopia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kibwana
authors.forename: Damtew
authors.initials: D
authors.lastname: Woldemariam
authors.forename: Awoke
authors.initials: A
authors.lastname: Misganaw
authors.forename: Mihereteab
authors.initials: M
authors.lastname: Teshome
authors.forename: Leulayehu
authors.initials: L
authors.lastname: Akalu
authors.forename: Adrienne
authors.initials: A
authors.lastname: Kols
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Kim
authors.forename: Samuel
authors.initials: S
authors.lastname: Mengistu
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
authors.forename: Jelle
authors.initials: J
authors.lastname: Stekelenburg
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003657:Decision Making; D004508:Education, Nursing, Baccalaureate / Q000592:standards* / Q000706:statistics & numerical data; D004511:Education, Nursing, Graduate / Q000592:standards* / Q000706:statistics & numerical data; D004521:Educational Measurement / Q000379:methods / Q000592:standards; D005002:Ethiopia; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D009719:Nurse Anesthetists / Q000193:education* / Q000592:standards / Q000600:supply & distribution; D015397:Program Evaluation; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data; D017678:Sex Distribution; D000066908:Simulation Training / Q000379:methods; D055815:Young Adult