Jolene Moore outlines how SAFE Programmes strengthen anaesthesia training worldwide, equipping providers with essential skills to improve patient safety and build sustainable healthcare capacity
By Jolene Moore, SAFE Programme Lead, published in the Association of Anaesthetists news magazine (January 2025)
Safer Anaesthesia from Education (SAFE) is a project initially developed in 2010 through a collaboration between the Association of Anaesthetists and the World Federation of Societies of Anaesthesiologists (WFSA) which provides short courses in subspecialty areas of anaesthesia practice.
The training initiative aims to equip anaesthesia providers with essential knowledge and skills so they can deliver safe care to their patients, and to create a sustainable training model which can be embedded in the national health system. More than 300 SAFE courses have been run in more than 50 countries, training over 9,000 providers.
Aimed at physician and non-physician anaesthesia providers, the 2–3-day courses use a modular approach and a variety of educational methods including lectures, small group discussions, low-fidelity simulation, and manikin-based skills practice. Flagship courses include:
- SAFE Obstetrics: The first SAFE course, developed in 2011, addresses the role of the anaesthesia provider in managing obstetric cases and emergencies, including clinical scenarios based on the conditions causing 80% of global maternal deaths (haemorrhage, sepsis and eclampsia), and maternal and newborn resuscitation
- SAFE Paediatrics: Developed in 2014, this course emphasises the principles of safe care for children, including anaesthesia for common elective and emergency conditions in children, pain management, fluid resuscitation, trauma, and newborn and paediatric life
In 2017, the SAFE Operating Room course was developed in recognition of the need for multidisciplinary training to support safe surgery. Developed in partnership with the Royal College of Surgeons of England, the Association for Perioperative Practice, the Royal College of Obstetricians and Gynaecologists, and the Lifebox Foundation, course content is based on the WHO Standards for Safe Surgery and includes sessions on leadership, teamwork, communication, decision making and conflict resolution, as well as surgical site infection prevention, the WHO Surgical Safety Checklist, procurement, and quality improvement.
SAFE courses can be run as standalone training, although are often run as part of broader capacity building projects and in collaboration with national anaesthesia societies, educational institutions, health authorities and partner organisations including Mercy Ships, Smile Train, Operation Smile, International Committee of the Red Cross and other international organisations and teams. This approach, along with training of local trainers, and provision of equipment and materials, contributes to building sustainability.
The initial approach combines visiting anaesthetists with local instructors, who are provided with a one-day SAFE ‘Training of Trainers’ course to become the in-country faculty of the future. Ongoing support is provided thereafter to establish local expertise in course delivery.
Over 1,350 trainers have taken part in the ‘Training of Trainers’ course and many courses are now being run independently by local and regional trainers. The SAFE initiative is managed by the Association of Anaesthetists’ SAFE Steering Group who oversee the management of SAFE including course materials and updates, language translations, funding, monitoring and evaluation, impact, and strategy.
Programme developments: new models & courses
As the SAFE initiative expands, further models of training have been developed and piloted to strengthen the impact and sustainability of SAFE including:
- Adaptations to create context specific courses for delivery in specific regions or countries; the modular nature of SAFE courses lends itself to this
- SAFE course refresher and commitment to change workshops
- SAFE on-site training and mentorship programmes to accompany classroom learning
- Incorporation of courses into national anaesthesia curricula or other training programmes
- Combining SAFE modules or courses with other short courses
- Online and hybrid options (see below)
In addition, new versions of SAFE Paediatrics courses have been developed in response to feedback and requests from SAFE partners.
These include:
- SAFE Paediatrics GB&I: A version of the original course adapted for UK anaesthetists in 2019. To date, 15 courses have been delivered in 10 UK locations, with funds over and above running costs directed back into supporting courses in low-resource settings
- SAFE Paediatrics Cleft: Launched in 2022, this course focuses on the principles of providing safe anaesthesia to children undergoing cleft lip and palate repair surgery including sessions on intercurrent illness and associated conditions and syndromes.
Whilst originally designed for low resource settings, there has been increasing interest in SAFE from higher-income settings. The Japanese Society of Pediatric Anesthesiology have been running a locally adapted version of SAFE Paediatrics GB&I since 2021, and there is growing interest from other countries, potentially expanding SAFE further as a global education programme.
SAFE Online
SAFE Online provides online SAFE courses (currently Obstetrics and Paediatrics) via interactive e-learning. Following development in 2021, and a two-year period offering online courses to registered groups, the platform launched open access in March 2024.
The learning platform is mobile compatible, minimises data usage and allows users to access materials and work offline, providing flexibility to continue learning when there is no connection, and the potential to reach more providers and enable shared learning across broader geographical locations.
Enabling both online and hybrid options, where e-learning is accompanied by interactive online discussions +/- in-person skills days, courses can be completed by individuals, or by groups who complete the courses over a given timescale. Materials can also be used as pre-course preparation and/or post-course refreshers. Since its open access launch in March 2024, the platform has over 800 registered users across 145 countries.
Programme impact
Standardised monitoring and evaluation have been used to evaluate learning and impact across multiple countries in East, Central, and Southern Africa, and in South Asia. These evaluations have demonstrated retention of knowledge and skills and, utilising qualitative methodology, reported improved confidence and positive behaviour changes.
In addition, workplace observations following the SAFE Obstetrics Course have shown positive behavioural change, suggesting translation of knowledge into clinical practice (for reference list see ‘Impact and Sustainability’ page). In addition to a continuous medical education opportunity, the courses have provided a platform for the development of support networks and collaboration among anaesthesia providers locally, regionally, and globally.
This article has been taken with approval from the Association of Anaesthetists news magazine, January 2025. Read the original article.
