{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T07:57:24Z","timestamp":1774252644161,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low\u2010 and middle\u2010income countries are currently experiencing a significant shortage of physicians trained in anesthesia. This shortage has been widely attributed to multifactorial causes, including limited local training capacity, workforce migration, underfunded health education systems, and poor national workforce planning. Therefore, the present study aimed to evaluate the state of postgraduate anesthesia training in Ecuador focusing on the structure of current programs and the competencies of their senior residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2010sectional study was conducted in two\u2010phases. During the first phase, we mapped and characterized accredited anesthesiology residency programs based on the information available on the webpage of the Ecuadorian Higher Education Council. During the second phase, we administered two surveys. First, we invited the medical directors of universities with active anesthesiology programs to fill out a survey developed by the Society for Education in Anesthesia's ad hoc Committee for Resident Evaluation. Then, we assessed self\u2010perceived senior residents' competencies for anesthesia care defined by the Accreditation Council for Graduate Medical Education. A five\u2010point Likert scale was used to determine whether the competency was met using a 70% cutoff value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seven universities in Ecuador offer postgraduate anesthesiology programs, ranging from 4 to 32 residents per cohort, with a total training capacity of 112 residents. Findings from both program directors (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a04) and senior residents (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a027) revealed deficiencies in resident evaluation processes, including low faculty\u2010to\u2010resident ratios and limited resident involvement in evaluation committees. Deficiencies in competency development were observed particularly in pain management; only 48.5% of those evaluated reported competence in managing complex pain at the perioperative level. Likewise, lack of competence was reported in using echocardiography for patient monitoring and revealing medical errors or complications with competence values at 14.8% and 33.3%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ecuador has a limited number of postgraduate anesthesiology programs, contributing to a shortage of anesthesia\u2010trained physicians. Exacerbating this issue, within these programs, there are significant gaps in resident evaluation and competency development. Addressing these issues would improve the quality of anesthesiology training and enhance patient care and safety in Ecuador.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70269","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T02:54:56Z","timestamp":1770951296000},"page":"626-635","source":"Crossref","is-referenced-by-count":0,"title":["Training of Anesthesiologists in Low\u2010 and Middle\u2010Income Countries: A Case Study From Ecuador"],"prefix":"10.1002","volume":"50","author":[{"given":"Santiago","family":"Romo","sequence":"first","affiliation":[{"name":"Escuela de Especialidades M\u00e9dicas, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito USFQ  Quito Ecuador"},{"name":"Department of Anesthesiology Hospital Clinica San Agust\u00edn  Loja Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karla","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito USFQ  Quito Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7503-9044","authenticated-orcid":false,"given":"Ivan","family":"Sisa","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito USFQ  Quito Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002258"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006836"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003928"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0050121"},{"key":"e_1_2_12_7_1","unstructured":"INEC Registro Estad\u00edstico de Recursos y Actividades en Salud(2020) [Internet][cited 2023 Jul 31] https:\/\/www.ecuadorencifras.gob.ec\/actividades\u2010y\u2010recursos\u2010de\u2010salud\/."},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.46997\/revecuatneurol32200010"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010022\u201008056\u20105"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102018\u2010001005"},{"key":"e_1_2_12_11_1","unstructured":"WFSA \u201cWorld Anaesthesiology Workforce Map \u201d (2026) [Internet][cited 2026 Jan 16] https:\/\/wfsahq.org\/resources\/workforce\u2010map\/#\/m\/EC."},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.4300\/JGME\u2010D\u201018\u201001031"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2017.10.008"},{"key":"e_1_2_12_14_1","unstructured":"CES \u201cOferta Acad\u00e9mica Vigente Del Sistema De Educaci\u00f3n Superior \u201d Accessed Mar 4 2025: [Internet] [cited 2025 Mar 4] https:\/\/appcmi.ces.gob.ec\/oferta_vigente\/."},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1550144"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0952\u20108180(99)00084\u20107"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2015.12.026"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12909\u2010023\u201004939\u20101"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40670\u2010016\u20100244\u20109"},{"key":"e_1_2_12_20_1","unstructured":"AMIR.Plazas Y Aspirantes(2025) [Internet][cited 2025 Oct 18] https:\/\/amirmexico.com\/el\u2010enarm\/plazas\u2010y\u2010aspirantes\/."},{"key":"e_1_2_12_21_1","unstructured":"MedSchoolCoach How Competitive Is an Anesthesiology Residency? 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