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Regional anesthesia training model for resource-limited settings: a prospective single-center observational study with pre–post evaluations
  1. Mark A Brouillette1,2,
  2. Alfred J Aidoo3,
  3. Maria A Hondras4,
  4. Nana A Boateng3,
  5. Akwasi Antwi-Kusi3,5,
  6. William Addison3,5,
  7. Sanjeev Singh3,5,
  8. Patrick T Laughlin6,
  9. Benjamin Johnson7 and
  10. Swetha R Pakala1,2
  1. 1Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
  2. 2Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
  3. 3Directorate of Anaesthesia and Intensive Care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
  4. 4Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
  5. 5School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  6. 6Department of Anesthesiology, US Anesthesia Partners, Denver, Colorado, USA
  7. 7Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Mark A Brouillette, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA; mark.brouillette{at}


Background and objectives Educational initiatives are a sustainable means to address provider shortages in resource-limited settings (RLS), yet few regional anesthesia curricula for RLS have been described. We sought to design a reproducible training model for RLS called Global Regional Anesthesia Curricular Engagement (GRACE), implement GRACE at an RLS hospital in Ghana, and measure training and practice-based outcomes associated with GRACE implementation.

Methods Fourteen of 15 physician anesthesiologists from the study location and three from an outside orthopedic specialty hospital consented to be trainees and trainers, respectively, for this prospective single-center observational study with pre–post evaluations. We conducted an initial needs assessment to determine current clinical practices, participants’ learning preferences, and available resources. Needs assessment findings, expert panel recommendations, and investigator consensus were then used to generate a site-specific curriculum that was implemented during two 3-week periods. We evaluated trainee satisfaction and changes in knowledge, clinical skill, and peripheral nerve block (PNB) utilization using the Kirkpatrick method.

Results The curriculum consisted of didactic lectures, simulations, and clinical instruction to teach ultrasound-guided PNB for limb injuries. Pre–post evaluations showed trainees were satisfied with GRACE, median knowledge examination score improved from 62.5% (15/24) to 91.7% (22/24) (p<0.001), clinical examination pass rate increased from 28.6% (4/14) to 85.7% (12/14) (p<0.01), and total PNB performed in 3 months grew from 48 to 118.

Conclusions GRACE applied in an RLS hospital led to the design, implementation, and measurement of a regional anesthesia curriculum tailored to institutional specifications that was associated with positive Kirkpatrick outcomes.

  • Anesthesia, Conduction
  • Nerve Block
  • Methods

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  • Twitter @markbrouillette

  • Contributors MAB, AJA, MAH, AA, SS, and SRP obtained ethics approval. MAB and MAH drafted and revised the manuscript. All authors contributed to study design and protocol implementation, and approved the final manuscript.

  • Funding Funding was provided by Hospital for Special Surgery Department of Anesthesiology, Critical Care and Pain Management. MAB has an academic stipend from Hospital for Special Surgery to undertake global health equity work.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.