Ethiopian Anesthetist Licensing Examination: A Qualitative Study of Concerns and Unintended Consequences

Yohannes Molla Asemu; Tegbar Yigzaw; Firew Ayalew; Leulayehu Akalu; Fedde Scheele; Thomas van den Akker

doi:10.2147/AMEP.S418743

Ethiopian Anesthetist Licensing Examination: A Qualitative Study of Concerns and Unintended Consequences

Adv Med Educ Pract. 2023 Sep 25:14:1055-1064. doi: 10.2147/AMEP.S418743. eCollection 2023.

Authors

Yohannes Molla Asemu^{1

2}, Tegbar Yigzaw¹, Firew Ayalew¹, Leulayehu Akalu^{3

4}, Fedde Scheele^{2

5

6}, Thomas van den Akker^{2

7}

Affiliations

¹ Health Workforce Improvement Program, Jhpiego, An Affiliate of Johns Hopkins University, Ethiopia Country Office, Addis Ababa, Ethiopia.
² Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
³ Ethiopian Association of Anesthetists (EAA), Addis Ababa, Ethiopia.
⁴ School of Anesthesia, Addis Ababa University, Addis Ababa, Ethiopia.
⁵ Department of Obstetrics and Gynecology, OLVG Teaching Hospital, Amsterdam, the Netherlands.
⁶ Department of Obstetrics and Gynecology, Amsterdam University Medical Center (AUMC), Amsterdam, the Netherlands.
⁷ Department of Obstetrics and Gynecology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands.

Abstract

Background: Ethiopia increased its anesthesia workforce drastically by expanding the training of associate clinician anesthetists. Following this expansion, the Ministry of Health established an entry-level anesthesia licensing examination to ensure patient safety. However, there is limited empirical evidence on the impacts of licensing exams in low- and middle-income countries. This study aimed to explore the concerns and undesirable consequences of the anesthetist licensing examination in Ethiopia.

Methods: A qualitative design using a grounded theory approach was employed by collecting data from 10 anesthesia teaching institutions. We conducted 15 in-depth interviews with instructors and six focus groups with students and graduates who took the exam recently. Interviews and focus groups were audio-recorded, transcribed verbatim, and analyzed using Atlas.ti 23. We also extracted secondary data from the academic committee meeting minutes, curricula, faculty appraisal reports, and program quality self-review reports.

Results: Qualitative analysis revealed three central categories of concerns and untoward consequences of the anesthetist NLE: exam management, educational management, and student behavior. Exam management concerns were related to exam validity, fairness, and consistent enforcement of pass/fail decisions. The unintended consequences of the exam on education management were perceived as promoting teaching and learning for the exam, increasing faculty workload, and resulting in superficial and patchy educational reforms. Study participants also reported adverse psychosocial effects and increased cheating behaviors among students as undesirable consequences of the exam on student behavior.

Conclusion: Our study identified some concerns and unintended consequences of the Ethiopian anesthetist licensing examination. These lessons learned may contribute to improving the quality of licensing examinations in Ethiopia and beyond.

Keywords: anesthesia; anesthetist; associate clinician; licensing examination; non-physician.

Grants and funding

This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Cooperative Agreement No. 72066320CA00008. The contents are the authors’ responsibility and do not necessarily reflect the views of USAID or the United States Government.