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To the Editor,
We thank Law et al. for their letter regarding our summary of recommendations from a multidisciplinary symposium on access to anesthesia care in rural and remote regions of Canada.1,2 The letter highlights the importance of developing solutions that involve surgery, obstetrics, and anesthesia. We agree and would emphasize that in Canada, an integrated approach must also include the family physicians who live and work in rural and remote communities. Family physicians with additional training and competencies are important providers of anesthesia and obstetric care in many of these communities.
The authors also highlight the importance of undertaking training in rural locations. Factors that improve the recruitment and retention of physicians in rural practice include engaging medical students from rural communities, providing educational opportunities in rural settings during residency training, and ensuring that practices and community environments are welcoming to physicians and their families.3 To this end, several recent Canadian initiatives are worth mentioning. In Ontario, a curriculum is being developed that will allow senior anesthesia residents to complete electives in rural regions, under the supervision of local experts, such as family practice anesthetists and specialist anesthesiologists. One goal of these electives is to establish long-term relationships with rural anesthesia providers that will sustain bidirectional mentor/mentee interactions. British Columbia has led the way in developing these mentoring and coaching programs.4 In addition, Dr. Michael Cummings, chair of the Anesthesiology Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC), is supporting and endorsing the development of a new curriculum within local anesthesiology residency programs that is informed by the RCPSC report entitled Indigenous health in specialty postgraduate medical education guide.5 At the suggestion of Dr. Jason McVicar, the Global Health Committee of the Association of Canadian University Departments of Anesthesiology has expanded the committee’s mandate to include “Promotion of partnerships within the Canadian anesthesiology community in global and rural/remote anesthesia initiatives.” Similarly, the Canadian Anesthesiologists’ Society International Education Foundation, under the direction of Dr. Joel Parlow, has included rural regions of Canada within its mandate to provide educational opportunities in underserviced areas.
Overall, initiatives that aim to address rural access to anesthesia care must involve a broad group of stakeholders and must be guided by the wisdom and experience of physicians and community members who live and work in these regions of Canada.
References
Law TJ, Rose J, Gelb AW. Initiatives to support rural access to anesthesia. Can J Anesth 2022; https://doi.org/10.1007/s12630-022-02242-z
Orser BA, Wilson CR, Bainbridge D. Improving anesthesia care and pain medicine in rural Canada: nothing about us without us. Can J Anesth 2021; 68: 1731-7.
Rourke J. Increasing the number of rural physicians. CMAJ 2008; 178: 322-5.
Rural Coordination Centre of BC. BC Rural Update - Innovative E-Coaching Enables Revelstoke FPAs to Standardize Adductor Canal Block Technique. Available from URL: https://enews.rccbc.ca/2021/01/29/fpa-ecoaching (accessed February 2022).
Royal College of Physicians and Surgeons of Canada. Indigenous Health in Specialty Postgraduate Medical Education Guide. Available from URL: https://www.royalcollege.ca/rcsite/health-policy/indigenous-health-e (accessed February 2022).
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Funding statement
Existing resources from the Departments of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada, provided funding for this work.
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This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.
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Orser, B.A., Wilson, C.R. & Bainbridge, D. In reply: Initiatives to support rural access to anesthesia. Can J Anesth/J Can Anesth 69, 792–793 (2022). https://doi.org/10.1007/s12630-022-02243-y
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DOI: https://doi.org/10.1007/s12630-022-02243-y