Objective: The World Health Organisation Surgical Safety Checklist improves surgical outcomes in resource poor settings but the best method of implementing the checklist is unknown. We aimed to evaluate three different methods of training in Guinea and evaluated the outcome at 3-6 months.Methods: A total of 13 individuals (4 surgeons, 7 anaesthetists and 2 nurses) from 6 different hospitals underwent 3 methods of training (hospital team training, hospital individual training and classroom only training). None had previous knowledge the checklist. Effectiveness of training was evaluated by hospital visits and structured interview at 3-6 months. Corroborating evidence was obtained from interviews with the Hospital Directors and other staff. Findings:Team training was the most successful. All the hospitals who received team training reported improvements in teamwork, anaesthesia, and infection control. No hospital managed to implement the checklist in its entirety. Anaesthetists who received individual training were unable to implement any changes in their own hospitals. Conclusion:Team training is more effective than individual training in ensuring more of the key steps of the checklist are followed. Our results question the effectiveness of running a one day classroom training for implementation of the WHO checklist for single groups of professionals such as anaesthetists in the absence of support from other members of the operating team.
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