Evaluating the effect of interventions for strengthening non-physician anesthetists' education in Ethiopia: a pre- and post-evaluation study.

BACKGROUND: Access to safe surgery has been recognized as an indispensable component of universal health coverage. A competent anesthesia workforce is a prerequisite for safe surgical care. In Ethiopia, non-physician anesthetists are the main anesthesia service providers. The Government of Ethiopia implemented a program intervention to improve the quality of non-physician anesthetists' education, which included faculty development, curricula strengthening, student support, educational resources, improved infrastructure and upgraded regulations. This study aimed to assess changes following the implementation of this program. METHODS: A pre-and post-evaluation design was employed to evaluate improvement in the quality of non-physician anesthetists' education. A 10-station objective structured clinical examination (OSCE) was administered to graduating class anesthetists of 2016 (n = 104) to assess changes in competence from a baseline study performed in 2013 (n = 122). Moreover, a self-administered questionnaire was used to collect data on students' perceptions of the learning environment. RESULTS: The overall competence score of 2016 graduates was significantly higher than the 2013 class (65.7% vs. 61.5%, mean score difference = 4.2, 95% CI = 1.24-7.22, p < 0.05). Although we found increases in competence scores for 6 out of 10 stations, the improvement was statistically significant for three tasks only (pre-operative assessment, postoperative complication, and anesthesia machine check). Moreover, the competence score in neonatal resuscitation declined significantly from baseline (from 74.4 to 68.9%, mean score difference = - 5.5, 95% CI = -10.5 to - 0.5, p < 0.05). Initial gender-based performance differences disappeared (66.3% vs. 65.3%, mean score difference = - 1.0, 95% CI = - 6.11-3.9, p > 0.05 in favor of females), and female students scored better in some stations. Student perceptions of the learning environment improved significantly for almost all items, with the largest percentage point increase in the availability of instructors from 38.5 to 70.2% (OR = 3.76, 95% CI = 2.15-6.55, p < 0.05). CONCLUSION: The results suggest that the quality of non-physician anesthetists' education has improved. Stagnation in competence scores of some stations and student perceptions of the simulated learning environment require specific attention.