Possible Reasons for Limited Effectiveness of a Skills and Drills Intervention to Improve Emergency Obstetric and Newborn Care

Allott, Helen; Smith, Helen; Kana, Terry; Mdegela, Mselenge; Bar-Zeev, Sarah; Ameh, Charles

doi:10.9745/ghsp-d-17-00055

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…Adegoke et al [ 9 ] reported that medical doctors in sub-Saharan Africa are generally trained for six years, nurse/midwives and mid-cadre staff for 3–5 years and junior cadre staff are trained for 1–1.5 years. Other factors that were considered as potentially affecting knowledge and skills of maternity care providers include, availability of and participation in regular relevant continuous professional education programmes, years of working in the maternity area and level of healthcare facility at which the healthcare provider works [ 13 ]. The latter is related to the workload and type of cases health care providers manage.…”

Section: Discussionmentioning

confidence: 99%

Retention of knowledge and skills after Emergency Obstetric Care training: A multi-country longitudinal study

et al. 2018

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ObjectiveTo determine retention of knowledge and skills after standardised “skills and drills” training in Emergency Obstetric Care.DesignLongitudinal cohort study.SettingGhana, Malawi, Nigeria, Kenya, Tanzania and Sierra Leone.Population609 maternity care providers, of whom 455 were nurse/midwives (NMWs)MethodsKnowledge and skills assessed before and after training, and, at 3, 6, 9 and 12 months. Analysis of variance to explore differences in scores by country and level of healthcare facility for each cadre. Mixed effects regression analysis to account for potential explanatory factors including; facility type, years of experience providing maternity care, months since training and number of repeat assessments.Main outcome measuresChange in knowledge and skills.ResultsBefore training the overall mean (SD) score for skills was 48.8% (11.6%) and 65.6% (10.7%). for knowledge. After training the mean (95% CI) relative improvement in knowledge was 30.8% (29.1% - 32.6%) and 59.8% (58.6%– 60.9%) for skills. Mean scores for knowledge and skills at each subsequent assessment remained between those immediately post-training and those at 3 months. NMWs who attended all four assessments demonstrated statistically better retention of skills (14.9%, 95% CI 7.8%, 22.0% p<0.001) but not knowledge (8.6%, 95% CI -0.3%, 17.4%. p = 0.06) compared to those who attended one or two assessments only. Health care facility level or experience were not determinants of retention.ConclusionsAfter training, healthcare providers retain knowledge and skills for up to 12 months. This effect can likely be enhanced by short repeat skills-training sessions, or, ‘fire drills’.

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Section: Discussionmentioning

confidence: 99%

Retention of knowledge and skills after Emergency Obstetric Care training: A multi-country longitudinal study

et al. 2018

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“…Effective training has been associated with improved perinatal outcomes [ 3 – 5 ] as well as positive impacts upon organisational and human factors [ 6 ]. Improvement in knowledge and attitudes does not always translate into improved outcomes [ 7 ]. Sustainability of effective training programmes following successful implementation projects remains a challenge [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study

Ghag¹,

Bahl²,

Winter³

et al. 2021

BMC Health Serv Res

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Background Multi-professional obstetric emergencies training is one promising strategy to improve maternity care. Sustaining training programmes following successful implementation remains a challenge. Understanding, and incorporating, key components within the implementation process can embed interventions within healthcare systems, thereby enhancing sustainability. This study aimed to identify key components influencing sustainability of PRactical Obstetric Multi-Professional Training (PROMPT) in the Philippines, a middle-income setting. Methods Three hospitals were purposively sampled to represent private, public and teaching hospital settings. Two focus groups, one comprising local trainers and one comprising training participants, were conducted in each hospital using a semi-structured topic guide. Focus groups were audio recorded. Data were analysed using thematic analysis. Three researchers independently coded transcripts to ensure interpretation consistency. Results Three themes influencing sustainability were identified; attributes of local champions, multi-level organisational involvement and addressing organisational challenges. Conclusions These themes, including potential barriers to sustainability, should be considered when designing and implementing training programmes in middle-income settings. When ‘scaling-up’, local clinicians should be actively involved in selecting influential implementation champions to identify challenges and strategies specific to their organisation. Network meetings could enable shared learning and sustain enthusiasm amongst local training teams. Policy makers should be engaged early, to support funding and align training with national priorities.

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“…The objectives of the AOAC are to improve capacity 1) for decision making, and leadership of maternity care teams, 2) to provide quality perinatal care, 3) to perform caesarean sections safely, and 4) to perform assisted vaginal birth, by addressing the topics listed in Box 1. Facilitator and participant manuals are made available to facilitate learning and standardise teaching (19,20).…”

Section: Interventionmentioning

confidence: 99%

Improving capacity for advanced training in obstetric surgery: Evaluation of a blended learning approach

Allott

Smith

White

et al. 2023

Preprint

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IntroductionSignificant differences in outcomes for mothers and babies following obstetric surgical interventions between low- and middle-income countries and high-income settings have demonstrated a need for improvements in quality of care and training of obstetric surgical and anaesthetic providers. To address this a five-day face-to-face training intervention was developed. When the COVID-19 pandemic interrupted its roll-out, the course was redesigned for delivery by blended learning.MethodsThis 3-part blended-learning course (part-1: 15 hours self-directed online learning, part-2: 13 hours facilitated virtual workshops and part-3: 10 hours face-to-face delivery), was conducted in Kenya. We assessed the completion rate of part-1 (21 assignments), participation rate in parts 2 and 3, participant satisfaction, change in knowledge and skills and compared the cost of the blended delivery compared to the 5-day face-to-face delivery, in GB Pounds.Results65 doctors took part in part 1, 53 completing at least 90% of the assignments. 60 doctors participated in part 2, and 53 participated in part 3. Participants completing an evaluation reported (n=53) attending the training was a good use of their time (each of parts-1 and 3: 98%, part-2: 94%) and would recommend this to other colleagues (part-1 and 3: 98%, part-2: 90%). Mean (SD) knowledge score improved from 64% (7%) to 80% (8%) and practical skills from 44% (14%) to 87% (7%). The blended course achieved a cost-saving of £207 per participant compared to the 5-day face-to-face delivery approach.ConclusionWe have demonstrated that a blended learning approach to clinical training in a low resource setting is feasible, acceptable and more cost effective. More studies are required to investigate the effectiveness of this approach on health outcomes.

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Possible Reasons for Limited Effectiveness of a Skills and Drills Intervention to Improve Emergency Obstetric and Newborn Care

Cited by 3 publications

References 6 publications

Retention of knowledge and skills after Emergency Obstetric Care training: A multi-country longitudinal study

Retention of knowledge and skills after Emergency Obstetric Care training: A multi-country longitudinal study

Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study

Improving capacity for advanced training in obstetric surgery: Evaluation of a blended learning approach

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