Challenges in practice and training structure of residents in obstetric anaesthesia: a perspective from teaching hospitals in Sindh province of Pakistan

Objectives: To document information on the available obstetric anaesthesia services and structure of resident training in a Pakistani setting. METHODS: The survey was conducted from June to September 2018 across the Sindh province of Pakitan after approval from the ethics reiew committee of the Pakistan Society of Anaesthesiology, and covered all teaching hospitals in both public and private sectors recognised for residents' training for fellowship in Anaesthesiology by the College of Physician and Surgeons of Pakistan. A standardised questionnaire was filled by either the department chairperson or a senior designated faculty member in each institution regarding obstetric anaesthesia services and structure of resident training. Data was analyse using SPSS 22. RESULTS: The results reflect the obstetric anaesthesia practice in 12 teaching institutions of Sindh province, seven government-run, and five private. Only 2 (17%) hospitals had dedicated preoperative assessment clinics for obstetric patients. Epidural service for pain free labour was available in 8(67 %) of the hospitals. Eleven (91.6%) hospitals had dedicated operating rooms and nine (75%) had separate recovery facilities. Onsite laboratory and blood banks were available in only 3(42%) of government and 3(60%) of private institutions. In 9( 75%) hospitals staffing of these units were by Senior Medical Officers. Regarding training of residents, a shortage of trainers was observed in two government and one private hospital leading to unsupervised work by the trainees. There was wide variation in training in spite of a standardised curriculum provided by the national training body. CONCLUSIONS: Gaps were identified in the practice of obstetric anaesthesia and structure of residents' training. It is important to improve both service and training to improve patient safety.