Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda Une anesthésie obstétricale plus sécuritaire grâce à l’éducation et au mentorat: un modèle de transfert des connaissances au Rwanda

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 threeday refresher course designed to improve obstetrical anesthesia knowledge and skills for practitioners in lowresource 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. This article is accompanied by an editorial. Please see Can J Anesth 2014; 61: this issue. Author contributions See Appendix 2. P. Livingston, MD (&) M. Chipp, MAdEd Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada e-mail: [email protected] F. Evans, MD Department of Anesthesiology Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA E. Nsereko, MSc College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda G. Nyirigira, MD Department of Anesthesia and Intensive Care, University of Rwanda, Butare, Rwanda P. Ruhato, MD Department of Anesthesia, King Faisal Hospital, Kigali, Rwanda J. Sargeant, PhD Division of Medical Education, Dalhousie University, Halifax, NS, Canada A. Enright, MB Department of Anesthesia, Royal Jubilee Hospital, Victoria, BC, Canada 123 Can J Anesth/J Can Anesth DOI 10.1007/s12630-014-0224-8