Training of Anesthesiologists in Low- and Middle-Income Countries: A Case Study From Ecuador

Low- and middle-income countries are currently experiencing a significant shortage of physicians trained in anesthesia. This shortage has been widely attributed to multifactorial causes, including limited local training capacity, workforce migration, underfunded health education systems, and poor national workforce planning. Therefore, the present study aimed to evaluate the state of postgraduate anesthesia training in Ecuador focusing on the structure of current programs and the competencies of their senior residents.

A cross-sectional study was conducted in two-phases. During the first phase, we mapped and characterized accredited anesthesiology residency programs based on the information available on the webpage of the Ecuadorian Higher Education Council. During the second phase, we administered two surveys. First, we invited the medical directors of universities with active anesthesiology programs to fill out a survey developed by the Society for Education in Anesthesia's ad hoc Committee for Resident Evaluation. Then, we assessed self-perceived senior residents' competencies for anesthesia care defined by the Accreditation Council for Graduate Medical Education. A five-point Likert scale was used to determine whether the competency was met using a 70% cutoff value.

Seven universities in Ecuador offer postgraduate anesthesiology programs, ranging from 4 to 32 residents per cohort, with a total training capacity of 112 residents. Findings from both program directors (n = 4) and senior residents (n = 27) revealed deficiencies in resident evaluation processes, including low faculty-to-resident ratios and limited resident involvement in evaluation committees. Deficiencies in competency development were observed particularly in pain management; only 48.5% of those evaluated reported competence in managing complex pain at the perioperative level. Likewise, lack of competence was reported in using echocardiography for patient monitoring and revealing medical errors or complications with competence values at 14.8% and 33.3%, respectively.

Ecuador has a limited number of postgraduate anesthesiology programs, contributing to a shortage of anesthesia-trained physicians. Exacerbating this issue, within these programs, there are significant gaps in resident evaluation and competency development. Addressing these issues would improve the quality of anesthesiology training and enhance patient care and safety in Ecuador.