Letters to the Editor: Letter to the Editor
To the Editor
Chan et al1 reported data from 2014 that few Rwandan medical students considered anesthesia as a desirable residency program. Reasons for not choosing anesthesiology included long work hours, high stress level, insufficient mentorship, and few job opportunities. Since this report, enrollment in the Rwandan anesthesia residency has improved substantially (Table). As a current resident, I describe the factors that helped shift anesthesiology from an undesirable to a desirable specialty.
LONG WORK HOURS
Dr Paulin Ruhato Banguti, the anesthesia program director, organized a recruitment process using the “snowball” method whereby interested individuals informed others of the specialty. As numbers increased, the workload was shared and residents acquired more flexible working schedules with a decreased stress level.
During clinical rotations, residents work under direct supervision by anesthesiologists. Since 2015, the primary responsibilities of final year residents, now called resident teachers, are teaching and mentoring junior residents and medical students. These responsibilities prepare them to be teachers after graduation and be more involved in mentorship. We are now approaching a goal that the program will be run by locally trained staff.
LOW JOB OPPORTUNITY
The issue of low job opportunities is more a perception than reality. The Rwandan Ministry of Health fully supports expansion of anesthesiology services. As an example, the Ministry of Health is designing the National Surgical Obstetric and Anesthesia Plan to meet the Lancet Commission on Global Surgery target of 20 surgeons, obstetricians, and anesthesiologists/100,000 by 2030.2 If we consider 6 anesthesiologists/100,000, there is a need of 720. However, this target will be difficult to achieve with the current training capacity of the University of Rwanda anesthesia residency program. This shows that there is a big need for anesthesiologists in Rwanda.
LOW KNOWLEDGE ABOUT THE SPECIALTY
Every resident knows that it is his job to recruit the next group of first-year residents. The message each delivers includes the following: (1) the level of training is one of the best in Rwanda with a good curriculum, excellent teachers both international and local, and international electives in Canada and the United States; (2) an explanation about the difference between an anesthesiologist and a nonphysician anesthetist; and (3) a discussion of career opportunities (fellowships, academic, private practice, research, and leadership). Residents give the recruitment message after teaching sessions during anesthesia rotations and after anesthesia lectures at the university. A follow-up message is shared on a WhatsApp group during the internship 1 month before the recruitment period with options to answer their questions by phone or email.
In summary, many factors that deterred medical students from considering a career in anesthesiology have been addressed. The Rwanda anesthesia residency program has moved from being an undesirable residency to one with a full complement of learners. Follow-up studies are needed to evaluate current perceptions of anesthesiology as a career among medical students in Rwanda.
Eugene Tuyishime, MDSchool of Medicine and PharmacyCollege of Medicine and Health SciencesUniversity of RwandaButare, Rwandatuyishime36@gmail.com
1. Chan DM, Wong R, Runnels S, Muhizi E, McClain CDFactors influencing the choice of anesthesia as a career by undergraduates of the University of Rwanda. Anesth Analg. 2016;123:481–487.
2. Meara GJ, Leather JMA, Hagander L, et al.Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569–624.