Department of Anesthesiology, Vanderbilt University, 2200 Children's Way Suite 3115, Nashville, TN 37232-9070, USA.
World J Surg. 2010 Mar;34(3):445-52. doi: 10.1007/s00268-009-0195-z.
The lack of appropriate numbers of anesthesia and surgical care providers in many resource-poor countries around the world, especially in rural populations, prevents adequate care of the large numbers of patients who require surgery in these settings.
This article provides a 10-year review of a rural hospital located in East Africa which developed a training program based on parallel training of anesthesia and surgical care providers. We report the process of building the foundational aspects of a customized medical education program that addresses specific concerns related to the work in a rural African context, which may be very different from medical care provided in the urban settings of low income countries (LIC). We analyzed how the parallel training can provide the clinical tools needed to have a practical impact on the surgical burden in rural Africa.
The parallel training program combining training of nurse-anesthetists with the training of multiple levels of surgical care providers, from interns to fellows, led to a fourfold increase in the number of surgical cases. Surgical subspecialty training and the development of an anesthesia care team with anesthesia consultant(s) oversight can serve to maintain a high level of complex and expanding surgical case volume in a rural African hospital setting.
This model can be applied to other similar situations in LIC, where the anesthesia and surgical care can be coupled and then customized for the unique clinical rural setting.
在世界上许多资源匮乏的国家，尤其是农村地区，缺乏足够数量的麻醉和手术护理提供者，这使得这些地区大量需要手术的患者无法得到充分的治疗。
本文对东非一家农村医院进行了为期 10 年的回顾，该医院根据麻醉和手术护理提供者的并行培训制定了一项培训计划。我们报告了建立一个定制医学教育计划的基础方面的过程，该计划解决了与农村非洲背景下工作相关的具体问题，这些问题可能与低收入国家（LIC）的城市环境中的医疗服务非常不同。我们分析了并行培训如何为在农村非洲减轻手术负担提供必要的临床工具。
将护士麻醉师培训与多个级别的手术护理提供者（从实习医生到研究员）的培训相结合的并行培训计划，使手术病例数增加了四倍。外科专科培训和麻醉护理团队的发展，以及麻醉顾问的监督，可以在农村非洲医院环境中维持高水平的复杂和不断扩大的手术病例量。
该模型可应用于 LIC 中的其他类似情况，在这些情况下，可以将麻醉和手术护理结合起来，并针对独特的临床农村环境进行定制。
