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Focus on Education 6 Continuing Medical Education: what do African Anaesthetists need? Stella A Eguma MBBS DA FWACS Department of Anaesthesia PO Box 3573 Ahmadu Bello University Teaching Hospital Kaduna Nigeria Introduction Continuing Medical Education (CME) describes those educational activities undertaken by physicians after the completion of formal graduate and postgraduate training. The purpose of CME is to enable practitioners to maintain and upgrade their standards of knowledge, skills, attitude and practice. Since opportunities for medical education for anesthetists in Africa are few, it is important that the few course organised are structured so the practicing anaesthetists obtain maximum benefit from attending them. In order to run a useful and cost-effective refresher course, the learning needs of potential participants should be identified and prioritised. A learning need is the discrepancy between what a physician ought to know and what he/she actually knows. Trainee objectives can be identified for the target group and a programme consistent with the identified needs and objectives can be implemented and its effectiveness subsequently evaluated. Currently, topics for update/refresher courses are largely determined by the personal preferences of the organisers and their perception of perceived needs. These may not always accord with the needs of the participants. This survey was carried out to identify the actual learning needs of different groups of anaesthetists in a developing country, Nigeria, in the hope that its findings might help those responsible for training and education in Africa to provide more beneficial and cost-effective courses and workshops. Method Questionnaires were given to all anaesthetists (both examiners and candidates) attending the Anaesthetic Fellowship examinations of the West African College of Surgeons. The same questionnaire was given to nurse anaesthetists at various hospitals in the country. Information was sought on the respondents’ grade, place of work, number of years in anaesthetic practice, number of courses attended since starting in anaesthetic practice, reasons for non-attendance at courses and perceived areas in which the anaesthetist felt inadequately informed and in which he/she would like further training. Results Fifty three practicing anaesthetists completed the questionnaire. Forty nine (92.5%) worked in Teaching hospitals and four (7.5%) were in private practice. No replies were obtained from anaesthetists in general hospitals. Table 1. Grades of Responding Anaesthetists Category Number Percentage Consultants 8 15% Residents 20 38% DA holders 16 30% Nurses 9 17% Thirty six respondents had spent less than 10 years in practice whilst seventeen had been in practice for between 10 and 30 years. The majority (88%) of the latter group were consultants or nurses. Table 2. Course attended No. of course No. of Percentage attended anaesthetists No course 23 43% 10 courses 8 15% The eight anaesthetists who had attended more than ten courses in their professional life were consultants. All respondents considered update courses to be essential to their practice and, given the opportunity, would love to attend such courses regularly. The reasons given for not attending courses were: ● Lack of information about suitable courses ● Lack of sponsorship to attend courses ● Pressure of work ● Financial constraints Discussion Anaesthetists all over the world have one ultimate goal: to provide safe anaesthesia for their patients. In order to do this effectively they need not only to have been properly trained in the art and science of anaesthesia but also to keep up to date with constantly changing trends in practice. One cannot but agree with Last who wrote in 1991 that “change is one of the most striking features of our time…A large part of the medical knowledge we possess at the end of our apprenticeship in medical training has become obsolete within ten years. No specialist can remain competent without taking energetic steps to keep in touch with the growing edge of the specialty.” Anaesthetists in developing countries face a particularly difficult task in that they have to practice safe medicine with a limited range of drugs and equipment. Learning resources are scarce and opportunities to attend refresher courses are few. In addition, their workload is often so heavy that there is little time for academic activities. In spite of these difficulties, both the West African College of Surgeons and the National Postgraduate Medical College of Nigeria do manage to organise annual courses for resident doctors preparing for their professional examinations. The World Federation of Societies of Anaesthesiologists sends visiting lecturers to the annual meeting of the Society of Anaesthetists of West Africa to assist in the refresher course that is an integral part of the meeting. Other anaesthetic practitioners such as nurse anaesthetists receive no organised continuing education. Table 3. Grades of Responding Anaesthetists Consultants Residents Nurses Critical care medicine Critical care medecine Obstetric anaesthesia Pain medicine Regional anaesthesia Paediatric anaesthesia Medico-legal aspects Paediatric anaesthesia Regional anaesthesia of practice Statistics Pain control Anaesthesia and concurrent disease Telemedicine Cardiopulmonary resuscitation Local anaesthetics
Undoubtedly, the rapid and tremendous improvements in anaesthesia that have occurred in recent years have generated a need for both skill maintenance and developmental training. The need for continuing education has been realised and some efforts have been made to organise training. Specific training needs must now be identified and training geared to meet those needs. Since opportunities for continuing medical education are few, it is imperative that the courses that are organised are tailored to the needs of practicing anaesthetists. This survey suggests that all anaesthetists wish to update their knowledge and skills so as to improve their practice. Perceived learning needs, however, differed between grades of anaesthetist. While consultants were interested in learning more about the fundamentals of research and medico-legal aspects of practice, junior anaesthetists were more interested in regional and paediatric anaesthesia. Both groups were interested in critical care and pain management. The majority of anaesthetics in Nigerian are administered by junior residents and nurse anaesthetists. Both groups indicated a need for further training in paediatric and regional anaesthesia. Common to all physician anaesthetists was the desire to acquire more knowledge in critical care and pain control. This indicates that there are skill deficits in these areas that need to be addressed. Truelove has suggested that skill gaps may be due to lack of resources, lack of ability, lack of motivation or inadequate training. African anaesthetists have motivation and the ability and desire to do their best for their patients. They are constrained, however, by poor resources and inadequate training opportunities. The practice of anaesthesia in Africa cannot improve unless steps are taken to enable practitioners to keep informed of the ever-changing trends in our technologydependent speciality. New drugs, equipment and techniques are constantly introduced into practice and present new opportunities and challenges in the management of pain, obstetric, paediatric, regional anaesthesia and intensive care. Our knowledge constantly needs to be updated yet 43% of Nigerian anaesthetists have never attended a refresher course since qualifying. This study has tried to establish what our training priorities might be. The Beer Sheva Project Since 1992, an amazing project has been ongoing at Ben Gurion University of the Negev in Beer Sheva, Israel. It has been led by one man whose energy, drive and enthusiasm know no bounds, Prof. Gabriel Gurman. He recognised from his own background and experience that young anesthesiologists in Eastern Europe would benefit from experience in an academic department with modern facilities and methods. The project began in 1992 with anaesthesiologists from Romania. In 1995, Hungary sent four trainees. Since then, Bulgaria, Moldova, Slovenia and Slovakia have been participating. In all, a total of 89 young anaesthesiologists have taken part in the programme spending one or two months in Soroka Medical Centre. They can choose to study anaesthesia and its subspecialties or intensive care. Beside the clinical aspects, they are also taught about the organisation and administration of the unit. Dr Mihai Sava wrote: “I am one of the Romanian anaesthesiologists who had the opportunity to train at Beer Sheva. These grants are very useful not only because we got used to modern hospital technologies but also because we learned how to efficiently manage an Anaesthesia and Intensive Care Department.” All of these young anaesthesiologists return home where they share their special skills and knowledge with their colleagues. Professor Valeriu Ghereg, President of the Society of Anaesthesia and Intensive Care of Moldova, writes “They are real promoters of new ideas in the field of health care reform. The impact of the programme is not limited only to direct participants.” The project is supported by the WFSA, Ben Gurion University and Soroka Medical Centre. It is a fine example of what can happen when groups work together. Recently, the Faculty of Health Sciences at Ben Gurion University announced a Post-doctoral Fellowship in Anaesthesiology and Related Fields. This will offer a one to two year training period to young specialists in anaesthesia from Eastern Europe, Asia, Africa and South America with guaranteed research time and training. Travel expenses and a stipend are paid. This new initiative has sprung directly from the Eastern Europe project and congratulations are due to the Dean and Faculty of the Ben Gurion University and especially Professor Gurman for developing it. It will be of great benefit to all those who participate but also to their home departments and universities. Further information about the project can be obtained from Caroline Simon Faculty of Health Science Ben Gurion University of the Negev Beer Sheva 84105, Israel Tel: 972-8-6477406 Fax: 972-8-6477632 Email: caroline@bgumail.bgu.ac.il Job Opportunity in Australia Locum Consultant Anaesthetist required for one year the Royal Hobart Hospital in Hobart, Tasmania. The post will commence in mid-April 2003. The Royal Hobart department has 14 full time anaesthetists and 10 registrars in training. It serves a 300 bed University Tertiary Referral Teaching Hospital. All anaesthetic subspecialties are represented. Hobart is a delightful city with a population of 250,000 and is the capital of the island state of Tasmania. There are plenty of cultural and natural attractions/distractions to keep home-sickness away! For further information, contact Dr Haydn Perndt at Haydn.Perndt@utas.edu.au 7 Focus on Education
Page 1 and 2: Volume 6 Number 2 September 2002 IS
Page 3 and 4: Training the Trainers Kester Brown
Page 5: Micronesia Anaesthetic Refresher Co
Page 9 and 10: Anaesthetic Experiences in Sri Lank
Page 11 and 12: there was little happening, we were
Page 13 and 14: Return to Cambodia Dr Gillian Davie
Page 15 and 16: Anaesthesia in the Republic of Naur
Page 17 and 18: A Surgeon’s experience of an Inte
Page 19 and 20: vehicles, generally passing on the
Page 21 and 22: Introducing Primary Trauma Care (PT
Page 23 and 24: critically ill patients we have to
Page 25 and 26: or Docteur Jacques Meynadier Centre
Page 27 and 28: Anaesthetic web sites to try Resour
Page 29 and 30: The WFSA in a new century The world
Page 31 and 32: ✃ World Anaesthesia Database Why

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