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  2. Survey of World Federation of Societies of Anaesthesiologists Fellowship Graduates: Applying a Theory-Driven Framework to Assess Training Outcomes

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Survey of World Federation of Societies of Anaesthesiologists Fellowship Graduates: Applying a Theory-Driven Framework to Assess Training Outcomes

Published: April 1, 2026

DOI 10.1213/ANE.0000000000007860

Categories: Global Health

Language: English

Authors

Faye M. Evans, MD; Kiana Winslow, MD; J. Bradley Cousins, PhD; Yuanting Zha, MD, MPH; Jenny Hoang, MD; V. Mark Gacii, MBChB, MMed; Balavenkat Subramanian, MD, DA; M. Dylan Bould, MBChB, MEd

Abstract

BACKGROUND: For nearly 30 years, the World Federation of Societies of Anaesthesiologists (WFSA) has supported fellowship programs to develop subspecialty anesthesia leaders from low- and middle-income countries (LMICs). To date, no formal program evaluation has assessed the educational effectiveness, accountability, or impact of such interventions. This study is part of a mixed-methods evaluation and aimed to survey graduates from all WFSA-supported fellow ship programs about program processes and consequences.

METHODS: This survey is the second phase of an exploratory sequential mixed-methods study. All graduates from WFSA-supported fellowships from 1996 to 2024 were eligible for inclusion. Survey content was informed by Guskey’s 5-level evaluation framework for evaluating training programs and findings from a prior qualitative phase. The instrument was pretested and piloted with anesthesiologists not eligible for inclusion and distributed electronically in English, Spanish, and French.

RESULTS: We received 264 responses from 388 surveys distributed (response rate of 68.0%). Most respondents completed their fellowship in the past 10 years; fewer graduates were reported between 2020 and 2022 due to the coronavirus disease 2019 (COVID-19) pandemic. Over 90% of respondents reported consistent access to clinical learning, teaching, and mentorship, peer support, and financial support during their fellowships. Fewer than 5% expressed a lack of confidence in their ability to deliver subspecialty care upon returning home. However, nearly 25% reported being unable to provide clinical care to the same standard as during their fellowship, and almost one-third reported insufficient access to essential equipment required for their subspecialty practice.

CONCLUSIONS: WFSA-supported fellowship programs were viewed favorably by graduates across all 5 levels of Guskey’s framework. The most frequently cited challenge was the transfer of skills and knowledge to home institutions, often due to contextual disparities between well-resourced training centers and under-resourced home environments. These barriers were most pronounced among fellows returning to the most resource-constrained settings. Addressing these barriers— particularly for fellows from the most under-resourced settings should be a priority for further program investment. Despite these limitations, most participants reported contributing to improved clinical service delivery—often beyond their individual practice—supporting the program’s goal of developing subspeciality leadership in anesthesiology.