Task-based Training for Medical Officers in Spinal Anesthesia: An Innovative Approach to the Specialist Workforce Crisis in Rural Indian Hospitals
A severe surgical and anesthesia workforce shortage is a major contributing factor to the lack of surgical care for 5 billion people across the world. This workforce shortage is particularly severe for anesthesia care, with anesthesiologists representing less than 20 percent of surgical care providers globally. Seventy percent of India’s population lives in rural areas where surgery is critically limited in availability because of the absence of anesthesiologists. The use of task-based training has the potential to expand access to safe surgical care and reduce patient morbidity and mortality in these regions.
Where we started
Task-based training of non-specialist medical officers in the safe provision of spinal anesthesia offers an opportunity to meet the unmet anesthesiology need of rural Indian healthcare facilities. The first stage of this initiative began with online and simulation-based spinal anesthesia training for medical officers. A randomized clinical trial is currently being conducted to assess whether anesthesia outcomes for medical officers who have undergone simulation-based spinal anesthesia training are similar to outcomes of anesthesiologists.
To date, five medical officers have been trained in performing spinal anesthesia, and nearly 300 patients have been enrolled in this trial. Three sites in rural India are currently involved in the data collection stage of this study.
This pilot phase of the project will be done in the coming months with subsequent work will involve a qualitative analysis of providers’ experience conducting this trial and performing spinal anesthesia. Pending final analysis, we hope to expand task-based training to other rural facilities or other countries.
Anna Alaska Pendleton, MD
Developing a Localized Surgical Innovation Ecosystem in Partnership with Saveetha Institute of Medical and Technical Sciences
Significant opportunity exists to leverage innovation and emerging technologies to tackle the challenges of delivering surgical care in low-resource settings. However, those who live in these settings, experience challenges in surgical care, and are potentially best positioned to apply innovation often do not receive technical or financial support from high-resource institutions.
Where we started
Through a collaboration with a faculty member at Saveetha Institute of Medical and Technical Sciences, we sought to seed a surgical innovation ecosystem that could extend the opportunity to problem-solve for improved surgical care across the state of Tamil Nadu. A global surgery hackathon held in March 2019 acted as a launchpad for a surgical innovation academic center called SEED (Saveetha Entrepreneurship and Empowerment Department). Following that event, our team hosted a global surgery innovation workshop for local medical students in November 2019.
The two-day surgical innovation hackathon involved more than 1,000 medical, engineering, and business students and brought together more than 40 local hospital leaders, surgeons, faculty members, entrepreneurs, and computer scientists. Concepts in global surgery, innovation, and ethics were shared with participants. Three winning innovations have been developed by SEED and are moving into the beta testing phase.
We will help SEED host another global surgery innovation hackathon in March 2020 and conduct an innovation curriculum workshop for university faculty members. Additionally, as part of a larger effort over the last four years across India and Rwanda, we are creating an open access website on localized surgical innovation ecosystems that will share key learnings, programs, and methods with a wider global audience eager to solve problems they witness in their communities.
Anna Alaska Pendleton, MD
Improving Surgery Systems in India
The Program in Global Surgery and Social Change (PGSSC) is working in India on a broad range of projects related to implementation science, by supporting local partners in adapting and implementing The Lancet Commission on Global Surgery’s (LCoGS) recommendations for the Indian context. Through the LCoGS-India initiative, our team draws partners from all regions and over 20 states in a variety of projects, including: partnering with the Association of Rural Surgeons of India to derive a consensus statement of priority action items for surgical systems improvement; partnering with CARE India to model demand for blood supplies, evaluate surgical sterilization practices, and produce a report for the state government; assessing mortality and quality of life after intervention implementation at two public university hospitals in urban India.
The Bangalore Boston Nutrition Collaborative
India has a wide range of nutrition and health problems, which require professionals with appropriate skills, knowledge, and trans-disciplinary collaborative abilities to influence policy making at the national and global level. The Bangalore Boston Nutrition Collaborative (BBNC) was established as a collaboration between St. John’s Research Institute (SJRI), Harvard T.H. Chan School of Public Health, and Tufts University, with a focus on nutrition research and training. The goals of the BBNC were to conduct an interdisciplinary course, develop web-based courses and identify promising Indian students and junior faculty for graduate training in Boston. Currently, 30 providers are trained yearly and four faculty members/graduate students from SJRI have visited Boston for collaborative research efforts. Christopher Duggan, MD, MPH is studying the impact of vitamin B12 on neurodevelopment and cognitive function from early life into school age.