World Health Organization – World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia. Full text available from SpringerLink < https://doi.org/10.1007/s12630-018-1111-5 >.
Save the date.
10th Annual Anesthesia for Global Outreach Course,
Friday, October 26, 2018 7:15 AM – Sunday, October 28, 2018 5:00 PM
Due to the NOTSS course, the academic day for anesthesia residents was moved from Monday to Tuesday morning. We spent another fantastic morning with the residents teaching each other and engaging in passionate discussions over the best way to do difficult cases. After the half day was finished, Margaret and I were picked up for our drive to Butare.
Butare (now named Huye) is in the Southern province and it takes about 2.5 hours to get there. It was the original intellectual seat of Rwanda – the university was founded there and the other main University Teaching Hospital (CHUB) is located there. While in Butare we stayed with the wonderful family of one of the anesthesiologists (who happened to be in Halifax of all places, so I did not get to meet him). It was lovely to stay in a home with children and puppies and gardens and a wonderful host. It was a short trip to Butare due to the NOTSS course and the Good Friday holiday. But it was very worthwhile.
We would like to congratulate Dr. Gaston Nyirigara a Rwanda colleague with the 2018 IASP (international Association for the Study of Pain) award of excellence in pain research and management in developing countries. Dr. Nyirigara has always been close with CASIEF and Queen’s pain research and management program. Once again congratulations.
I would like to summarize and describe key features for why Gaston received this award. “Intensely involved in clinical pain management in Rwanda, as well as a devoted teacher across the country. Committed to developing a network of pain management services across the country. Received one scholarship for training in Canada. Strong clinical care, patient advocacy and mentoring/education during clinical shifts. Very strong letter of support (mentioned by 2 reviewers). Established and leads Acute Pain Management Team, and this pain care program is the first of its kind in Rwanda. Hard-working and with a clear mission. Obtained support/funding to establish a Quality Improvement Strategy for pain care suggesting a plan to monitor the quality of care provided.”
Dr. Nyirigara also gave a Grand Rounds presentation for the Department of Anesthesia, Pain Management and Perioperative Medicine at Dalhousie University, March 21, 2018. That talk is available below.
2018 CASIEF Gala Dinner
Sunday, June 17, 2018.
Auberge Saint-Gabriel, 426 Rue Saint-Gabriel, Montreal
Reception 18:30, Dinner & Speaker 19:00 – 22:00
Tickets are now available online.
Dr. Dan Poenaru – Guest Speaker
Dr. Poenaru is a Canadian pediatric surgeon who has dedicated his life to treating needy children throughout eastern Africa. Motivated “by the enormous needs of African children,” not only those of Kenya, but also the numerous Somali refugees entering the country, Dr Poenaru opened a surgical practice in Kijabe, Kenya. Throughout his career, he has treated patients through civil war
and in refugee camps, exposing himself to tremendous personal risk. Dr Poenaru is the recipient of the 2014 Teasdale-Corti Humanitarian Award of the Royal College of Physicians and Surgeons of Canada and the 2015 ACS/Pfizer Surgical Humanitarianism Award of the American College of Surgeons.
To learn more about our speaker:
To view our dinner venue:
- (In English) http://aubergesaint-
- (In French) http://aubergesaint-
View the Gala Brochure for more information.
It’s alive…It’s alive!
Victor Frankenstein recounts how he “infused a spark of being into the lifeless thing at his feet”. The idea for the VAST Course sprouted in July 2017 and for months, it existed only on my hard drive. Without the enthusiasm and support of the team around me, there is no doubt that VAST would still be a lifeless entity. With the financial support of CASIEF and Dalhousie University, we were able to commit to piloting the course in Rwanda in January. In late December, the series of subfolders and files materialised into a set of tangible printed materials, resources and VAST paraphernalia. The great unknown was how all of this would transform into a 3-day simulation course.
We were off to an auspicious start. The first thing our eyes were drawn to at the Rwanda Military Hospital (RMH) Simulation Centre was an expansive banner heralding the piloting of the VAST Course. The months of meticulous preparation, testing, refinement and co-ordination were over and it was time to launch the first of three pilot courses. Throughout VAST, we focus a lot of attention on anaesthetists’ non-technical skills. Our team had to draw heavily on these same set of skills to effectively launch this project.
In the months leading up to the VAST Course, Patty had on several occasions referred to us (Michelle, Christian, Patty and I) as the ‘dream team’. My initial concern was to wonder I if had to settle for the role of the “Hick from French Lick” aka Larry Bird. Come game time, despite having never worked before together in this capacity, we functioned like a well-oiled machine. The first pilot course was underway and we were running two parallel groups through the various components of the course. Michelle behind the scenes, setting up rooms, Patty and Christian riffing off each other in debriefing sessions and I taking the helm of facilitating and debriefing the other group. It wasn’t long however before the line-up of the dream team was to get some fresh faces.
Stewart was certainly a prized recruit to the team. After a quick ‘pre-season’, namely the VAST Facilitator Course, Stew held a firm place in the starting five. In fact, by pilot week three, he was the front runner for MVP, having to step his responsibilities when other key players were out due to illness and a late season trade to the Butare Black Mambas. Rotating strongly off the bench we also had an injection of talent from our trainee facilitators. With some on-going coaching from the side-lines, these ‘trainee’ members of the team were soon more than pulling their weight, running and debriefing sessions following the VAST playbook. More on the surprise recruit, Laurence, later.
No team can function without an extensive support network. Daily buffets at both RMH and CHUK hospitals kept our energy levels high. The team transport was dutifully and punctually conducted by Alphonse. Christophe at the CASIEF apartment was working overtime ensuring our team uniforms (scrubs) were cleaned and pressed ready for game time each day. In all of this, like in any well-functioning team, there was a real sense of camaraderie and common understanding that developed amongst the team members.
There is a lot of focus in VAST on managing complex tasks, particularly on how to assess and organise available resources. Day 1 of the first week of the VAST Course is now a bit of a blur. The unknown of the mechanics of the running the course were playing out in front of us. Fortunately, we had the invaluable resource of Michelle to draw on. With Michelle at the helm co-ordinating set up and changeover between scenarios, the rest of us were able to focus on the other tasks of session delivery and mentorship of the trainee facilitators.
Many of the decisions regarding course logistics and design had been set in stone months in advance. There was opportunity however for some on the fly experimentation with order of sessions, timings of breaks and finer details of how some sessions were to be conducted. This helped to maximise our short period of time with participants and to promote a favourable learning environment.
One key decision that was suggested to us early on by Dr Paulin was the inclusion of Laurence, the sim centre co-ordinator from CHUK hospital. Laurence joined Michelle from the beginning of the first week of pilot courses, shadowing her every move and learning from the best. By the start of the second week of courses, Laurence was setting up stations and preparing the rooms for subsequent scenarios. Come week 3, Michelle was back in Canada and Laurence stepped up to the plate to independently run the ‘back of house’. An unexpected highlight was to watch Laurence spring to action on academic following the completion of the VAST Course pilots. Patty had tasked the residents with designing their own simulation scenario and within moments Laurence had the equipment set up in the same systematic manner in which we organise the gear for the VAST Course. This is just one example of what we have now seen as some of the ripple effect of the VAST Course…positive implications that are extend beyond our initial set of objectives.
Language posed one of the key challenges to conducting these pilot courses. Whilst English is the official language in Rwanda, there is a transition from French and ubiquitous use of Kinyarwanda. Our participant group was also not uniform in their level of English. Being aware of this dilemma was of crucial importance. As much as possible, we encouraged Christian to deliver his sessions in French/Kinyarwanda. For the rest of us, it was important to take the time to meter our pace of speech, allow for translation and explanation amongst the group. It will be important that once the course materials are finalised post pilot, that we make the effort to translate resources and as much as is feasible, deliver of the program in a more ‘comfortable’ language.
It is still a little hard to come to terms with what has been achieved over months leading up to the piloting the VAST Course and subsequent course delivery. Certainly, there have been lots of lessons learned. Components of the course can be tweaked, elements that we should dedicate more attention to and some less effective components that can be pared back. In essence however, we are chalking down the previous few weeks as a great success. There is an encouraging amount of local support and endorsement of the project moving forward from both official channels and from participant feedback. The next exciting steps will involve refinement of the course and conducting formal evaluation of future courses delivered. I wholeheartedly thank everyone that has been involved to date with this project and I certainly look forward to the future of VAST in Rwanda and beyond.
There are also a number of photos in the original post at https://simcentreopening.blogspot.ca/2018/01/adam-on-vast-worth-wait.html.
My second week in Guyana started with the arrival of three more CAS IEF volunteers – Drs. Joel Hamstra, Senthil Thiyagarajan, and Anne Wong. We met with the CEO of Georgetown Public Hospital Corporation, Mr. Lewis, and had a great discussion about faculty development and the broader, “non-medical expert” roles of physicians and nurses within the hospital. Monday evening Dr. Wong gave a talk about mentorship. It was clear from the comments and questions afterwards that the junior residents and doctors are hungry for mentorship in their careers and also that the senior doctors in the group don’t feel equipped with the time or knowledge to be a mentor.
We spent the rest of the week teaching the Inspire Through Clinical Teaching course. This course began as an international collaboration between five anesthesiologists in Canada (myself, Duncan McLuckie, Dylan Bould), United Kingdom (Sonia Akrimi), and South Africa (Dean Nolte) and is now supported by the WFSA and the Society of Anesthesiologists of Zambia. It’s a four-day course with five workshops covering lesson planning, small and large group teaching, simulation, and teaching in the clinical environment.
We were lucky to meet a group of thirty-three talented, passionate, energetic, and hardworking doctors and nurses from Obstetrics and Gynecology, Emergency Medicine, Family Medicine, Internal Medicine, Anesthesia, Pediatrics, General Surgery, and Orthopedics. We had interesting, thought provoking, and sometimes very spirted (!!!), discussions about managing challenging learners, ways of giving feedback, the role of the learner in the clinical environment, and much, much more. This was a group of teachers and educators facing the same challenges we face at home: how to achieve a balance between service and education, finding time to teach during a busy clinical practice, teaching while still providing patient centred care. It was really exciting for us, as facilitators of the course, to provide the opportunity for participants to come together and talk to each other about their struggles, share strategies, and learn from each other.
As the week went on our participants had the chance to practice some of their skills by delivering a small and a large group teaching session. We learnt so many things! How to properly wash a cat, how to cook the perfect omelette, and the proper way to fold laundry to name just a few.
On the last day groups wrote and ran simulation scenarios. The Obstetrician/Gynecologists, Emergency Medicine doctors, and Pediatricians at GPHC are already running regular in situ simulation in their own departments. “Sim Day” gave them some new ideas on how to plan, conduct, and debrief a scenario. It also sparked the interest of some of the other departments who hadn’t been exposed to simulation before. I even heard hallway chit chat about a combined ER/Ortho ATLS simulation.
The course ends with each participant sharing something they’ve learnt that they will take back to their workplace. It’s always my favourite part of the course and this time was no exception. There was a lot of excitement, energy, and momentum within the group and I’m looking forward to seeing what they do next.
The four of us ended our week with an invitation to the Anesthesia and Critical Care New Year’s party. It was a great chance to spend some time with new friends.