“I Need to Be the First One With a Different Approach and to Make a Difference to the People” - Transforming Pediatric Training for Non-physician Clinicians in Malawi: A Mixed-method Study

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>Malawi has a critical shortage of skilled health workers limiting its ability to achieve its outlined national health goals. To address this, in 2012, theMinistry of Health and the College of Medicine introduced a three-year specialist Bachelor of Science (BSc) degree in Paediatric and Child Health (PCH) for Clinical Officers, a non-physician clinician cadre. In this training program, learning occurs through supervised ward rounds, bloc courses, and a research project. The German Society of Paediatrics and International Child Health, with funding from the German government, provided support between 09/2017 and 08/2019. This study aims to evaluate this support project to model the training for the coming cohorts of BSc PCHCO students.<jats:bold>Methods:</jats:bold>All 17 currently enrolled students took partin this study. Quantitative data was collected between 01/2018 using the Research Self-Efficacy Scale (RSES, ten-point scale), Stages of Change (SOC, four-point scale), and the post-self-assessment survey of bloc courses (five-point scale). In addition, three focus group discussions and five in-depth interviews with students and key informants were conductedduring April 1-10, 2019.<jats:bold>Results:</jats:bold>The mean (SD) scores for RSES and SOC model were 9.10 (0.91) and 3.54 (0.40) respectively; for the bloc course post-self-assessment it was 3.26 (0.48). Students found the program well-paced, felt that their clinical knowledge and skills had improved, and valued the acquired holistic approach of disease management which included the social determinants of health. They reported increased confidence and being more prepared for leadership roles at their facility and community. The involvement of international lecturers enriched their global perspectives. Students had concerns about theirrecognition in the government system and continued support after graduation. The shortage ofsupervising and teaching staff was perceived as a key barrier to continuing the program. <jats:bold>Conclusion: </jats:bold>Studentsimproved theirclinical expertise, developed self-efficacy, andnew attitudes towards research. Application of various educational strategies through this project and the involvement of teachers from diverse backgrounds may enable them to build their professional networks. Continuous professional development and alumni mentoring are recommended to sustain the achieved results.</jats:p>

Emergency medicine physician supervision and mortality among patients receiving care from non-physician clinicians in a task-sharing model of emergency care in rural Uganda: a retrospective analysis of a single-centre training programme

“…Few studies exist addressing training of non-physician clinicians for roles in the African acute care settings outside of trainings focused on specific obstetric, surgical or anaesthesia procedures,34–37 while others find that emergency and acute care training is lacking in non-physician clinician education in many SSA countries including Uganda 34 38. There are documentation a few short courses designed to teach non-physician clinicians’ emergency care skills in SSA 39–42.…”

Mortality Outcomes in Task-Sharing for Emergency Care: Impact of Emergency Physician Supervision on Non-Physician Emergency Care in Rural Uganda

“…Few articles exist addressing training of NPCs for roles in the African acute care settings outside of trainings focused on specific obstetric, surgical or anesthesia procedures [34][35][36][37], while others find that emergency and acute care training is lacking in NPC education in many SSA countries including Uganda. [34,38] While our research group has published on an EC NPC training program and its associated outcomes, we are not aware of any additional studies documenting a comprehensive EC NCP training program in a LMIC.…”