Ultrasound-guided regional anesthesia: feasibility and effectiveness of teaching via telesimulation in Ethiopia.

BACKGROUND: Acute pain management in resource-poor countries remains a challenge. Ultrasound-guided regional anesthesia is a cost-effective way of delivering analgesia in these settings. However, for financial and logistical reasons, educational workshops are inaccessible to many physicians in these environments. Telesimulation provides a way of teaching across distance by using simulators and video-conferencing software to connect instructors and students worldwide. We conducted a prospective study to determine the feasibility of ultrasound-guided regional anesthesia teaching via telesimulation in Ethiopia. METHODS: Eighteen Ethiopian orthopedic and emergency medicine house staff participated in telesimulation teaching of ultrasound-guided femoral nerve block. This consisted of four 90-min sessions, once per week. Week 1 consisted of a precourse test and a presentation on aspects of performing a femoral nerve block, weeks 2 and 3 were live teaching sessions on scanning and needling techniques, and in week 4, the house staff undertook a postcourse test. All participants were assessed using a validated Global Rating Scale and Checklist. RESULTS: Participants were provided with a validated checklist and global rating scale as a pretest and post-test. The participants showed significant improvement in their test scores, from a total mean of 51% in the pretest to 84% in their post-test. CONCLUSIONS: Teaching ultrasound-guided regional anesthesia of the femoral nerve remotely via telesimulation is feasible. Telesimulation can greatly improve the accessibility of ultrasound-guided regional anesthesia teaching to physicians in remote areas.

Cochrane, evidence-based medicine and associated factors: A cross-sectional study of the experiences and knowledge of Ethiopian specialists in training.

INTRODUCTION: Evidence-based healthcare is a core competency for practicing healthcare practitioners and those in speciality training. In sub-Saharan Africa, little is known about the teaching of evidence-based medicine (EBM) in residency program. This survey evaluated the experiences and knowledge of Cochrane, EBM and associated factors among Ethiopian specialists in training. METHODS: A convenient sample of trainee specialists completed a pretested self-administered survey. The majority (93%) were ≤30 years old, males (63%) and 41% in paediatrics speciality. The associations of categorical variables with EBM knowledge was assessed by Fisher's exact or Chi-Square tests. Covariates contributing to EBM knowledge were identified using multivariate logistic regression analysis. RESULTS: Eighty-three trainees participated in the survey (response rate 88.2%). About 75% have heard about Cochrane but no one recognized Cochrane South Africa. Only 25% of the trainees knew the Cochrane Library but none used it in clinical practice. Most (78%) have heard of EBM, 15% had attended EBM course, 96% wanted to attend EBM course and 81% had positive attitudes to EBM. Trainees EBM knowledge was associated with awareness of Cochrane [Adjusted odds ratio (AOR) = 8.5, 95% Confidence interval (CI) 1.3-54.6, P = 0.02], EBM (AOR = 51.2, 95% CI 2.7-960.8, P = 0.009), and being in third year training (AOR = 28.4, 95% CI 1.9-427.2, P = 0.02). The promotion of EBM in residency hospital (AOR = 22.2, 95% CI 2.2-223.8, P = 0.008) and being aware of Cochrane (AOR = 4.8, 95% CI 1.1-21.7, P = 0.04) were predictors of positive attitude. Familiarity with Cochrane Library was influenced by EBM knowledge (AOR = 6.6, 95% CI 1.4-31.5, P = 0.02) and perceived organization barrier to accessing the resource (AOR = 3.2, 95% CI 1.03-10.1, P = 0.04). CONCLUSION: Ethiopian trainee specialists lacked formal EBM training, awareness and use of the Cochrane Library. To improve the healthcare quality and patient outcomes, EBM education should be integrated into residency curricula.

Cochrane, evidence-based medicine and associated factors: A cross-sectional study of the experiences and knowledge of Ethiopian specialists in training

Introduction: Evidence-based healthcare is a core competency for practicing healthcare practitioners and those in speciality training. In sub-Saharan Africa, little is known about the teaching of evidence-based medicine (EBM) in residency program. This survey evaluated the experiences and knowledge of Cochrane, EBM and associated factors among Ethiopian specialists in training.Methods: A convenient sample of trainee specialists completed a pretested self-administered survey. The majority (93%) were ≤30 years old, males (63%) and 41% in paediatrics speciality. The associations of categorical variables with EBM knowledge was assessed by Fisher's exact or Chi-Square tests. Covariates contributing to EBM knowledge were identified using multivariate logistic regression analysis.Results: Eighty-three trainees participated in the survey (response rate 88.2%). About 75% have heard aboutCochrane but no one recognized Cochrane South Africa. Only 25% of the trainees knew the Cochrane Library but none used it in clinical practice. Most (78%) have heard of EBM, 15% had attended EBM course, 96% wanted to attend EBM course and 81% had positive attitudes to EBM. Trainees EBM knowledge was associated withawareness of Cochrane [Adjusted odds ratio (AOR) = 8.5, 95% Confidence interval (CI) 1.3­54.6, P = 0.02], EBM (AOR = 51.2, 95% CI 2.7­960.8, P = 0.009), and being in third year training (AOR = 28.4, 95% CI 1.9­427.2, P = 0.02). The promotion of EBM in residency hospital (AOR = 22.2, 95% CI 2.2­223.8, P = 0.008) and being aware of Cochrane (AOR = 4.8, 95% CI 1.1­21.7, P = 0.04) were predictors of positive attitude. Familiarity with Cochrane Library was influenced by EBM knowledge (AOR = 6.6, 95% CI 1.4­31.5, P = 0.02) and perceived organization barrier to accessing the resource (AOR = 3.2, 95% CI 1.03­10.1, P = 0.04). Conclusion: Ethiopian trainee specialists lacked formal EBM training, awareness and use of the Cochrane Library. To improve the healthcare quality and patient outcomes, EBM education should be integrated into residency curricula