clinical mentorship
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2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Dan K. Senjovu ◽  
Sarah Naikoba ◽  
Pallen Mugabe ◽  
Damazo T. Kadengye ◽  
Carey McCarthy ◽  
...  

Abstract Introduction Clinical mentorship is effective in improving knowledge and competence of health providers and may be a useful task sharing approach for improving antiretroviral therapy. However, the endurance of the effect of clinical mentorship is uncertain. Methods The midlevel health providers who participated in a cluster-randomized trial of one-on-one, on-site, clinical mentorship in tuberculosis and HIV for 8 h a week, every 6 weeks over 9 months were followed to determine if the gains in knowledge and competence that occurred after the intervention were sustained 6- and 12-months post-intervention. In December 2014 and June 2015, their knowledge and clinical competence were respectively assessed using vignettes and a clinical observation tool of patient care. Multilevel mixed effects regression analysis was used to compare the differences in mean scores for knowledge and clinical competence between times 0, 1, 2, and 3 by arm. Results At the end of the intervention phase of the trial, the mean gain in knowledge scores and clinical competence scores in the intervention arm was 13.4% (95% confidence interval ([CI]: 7.2, 19.6), and 27.8% (95% CI: 21.1, 34.5) respectively, with no changes seen in the control arm. Following the end of the intervention; knowledge mean scores in the intervention arm did not significantly decrease at 6 months (0.6% [95% CI − 1.4, 2.6]) or 12 months (− 2.8% [95% CI: − 5.9, 0.3]) while scores in the control arm significantly increased at 6 months (6.6% [95% CI: 4.4, 8.9]) and 12 months (7.9% [95% CI: 5.4, 10.5]). Also, no significant decrease in clinical competence mean scores for intervention arm was seen at 6 month (2.8% [95% CI: − 1.8, 7.5] and 12 months (3.7% [95% CI: − 2.4, 9.8]) while in the control arm, a significant increase was seen at 6 months (5.8% [95% CI: 1.2, 10.3] and 12 months (11.5% [95% CI: 7.6, 15.5]). Conclusions Mentees sustained the competence and knowledge gained after the intervention for a period of one year. Although, there was an increase in knowledge in the control group over the follow-up period, MLP in the intervention arm experienced earlier and sustained gains. One-on-one clinical mentorship should be scaled-up as a task-sharing approach to improve clinical care. Trial Registration The study received ethics approvals from 3 institutions—the US Centers for Disease Control and Prevention Institutional Review Board (USA), the Institutional Review Board “JCRC’s HIV/AIDS Research Committee” IRB#1-IRB00001515 with Federal Wide Assurance number (FWA00009772) based in Kampala and the Uganda National Council of Science and Technology (Uganda) which approves all scientific protocols to be implemented in Uganda.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Mubarak ◽  
M Al Saeed ◽  
M Alalawi

Abstract Aim Approximately 20% of inpatients have urinary catheters. Deficiencies in knowledge and errors in catheterization techniques can cause short and long-term complications. This study aims to evaluate the short-term benefit of peer-led sessions on the knowledge and confidence of junior doctors in performing urethral catheterizations. Method 81 Foundation Year doctors participated in a one-hour basic catheterization workshop. Data was collected via a validated questionnaire covering three domains (confidence, procedural knowledge, and knowledge about complications) administered before and after the workshop. Confidence was measured using a 5-point Likert scale; knowledge was assessed through 10 questions about the procedure and three further questions about complications. Data are expressed as mean±standard deviation and were analyzed using SPSS v23. Result The majority (96.4%) had performed less than five catheterizations. 21% felt adequately trained to catheterize, 70% believed they would benefit from semi-formal training, and 97.5% found the information covered in the session to be very useful. The average pre-session confidence in performing easy and difficult catheterizations were 3.03±1.05 and 2.01±1, respectively, and increased to 3.7±1 and 3±1.1, respectively, following the session (p < 0.005). Out of a total of 10 points, pre-workshop knowledge assessment scores were 3.9±1.6 and increased to 8.85±1.4 (p < 0.005). Likewise, from a total of three points, the average pre-session knowledge of complications score was 1.75±0.7, which increased to 2.65±0.6 after the session (p < 0.005). Conclusions Peer-led mentorship is an important and efficient educational tool. Short sessions have shown to improve the confidence and knowledge of junior doctors in urethral catheterization.


2021 ◽  
Author(s):  
Tumbwene Mwansisya ◽  
Columba Mbekenga ◽  
Kahabi Isangula ◽  
Loveluck Mwasha ◽  
Stewart Mbelwa ◽  
...  

Abstract BackgroundDelivery of quality reproductive health services has been documented to depend on the availability of healthcare workers who are adequately supported with appropriate training. However, unmet training needs among healthcare workers in reproductive, maternal, and newborn health (RMNH) in low-income countries remain disproportionately high. This study investigated the effectiveness of trainings with onsite clinical mentorship towards perceived importance and performance in RMNH among healthcare workers in Mwanza Region of Tanzania.MethodsThe study used a quasi-experimental design using single group pre-and post-intervention evaluation strategy. The training needs of healthcare workers from the selected health facilities were assessed, skills gaps identified and ranked according to priority. Training courses that addressed skills gaps were developed and delivered with adaptations of the national guidelines followed by onsite clinical mentorship for one year. The baseline and endline survey were conducted at 3 years interval to assess change in HCWs on their perceived importance and performance on different aspects of RMNH care. Independent samples t-tests were used to compare differences in perceived performance in selected training areas between baseline and endline. Significance was set at p < 0.05.ResultsTNA was administered to 152 and 216 healthcare workers at baseline and endline respectively. In total, 141 (65%) of the 216 end line survey participants had received at least one IMPACT project training course and at least three mentorship visits. Participants were matched on their age and duration in RMNH services, but differed in age and duration of employment. Comparison between baseline and endline by using the training needs analysis questionnaire scores showed statistically significant positive changes (p ≤ .05) in most training needs analysis items, except for some items including those related to research capacity and provision of health education for cancer.ConclusionsThe findings revealed that the training and onsite clinical mentorship program that address the actual needs of healthcare workers to have significant positive changes in perceived performance in a wide range of RMNH services. However, further studies with rigorous designs are warranted to evaluate the long-term effect of such training programs on RMNH outcomes.


BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042523
Author(s):  
Sandrine Uwisanze ◽  
Anaclet Ngabonzima ◽  
Oliva Bazirete ◽  
Celestin Hategeka ◽  
Cynthia Kenyon ◽  
...  

ObjectivesTo identify mentors’ perspectives on strengths and weaknesses of the Training, Support and Access Model for Maternal, Newborn and Child Health (TSAM-MNCH) clinical mentorship programme in Rwandan district hospitals. Understanding the perspectives of mentors involved in this programme can aid in the improvement of its implementation.DesignThe study used a qualitative approach with in-depth interviews.SettingMentors of TSAM-MNCH clinical mentorship programme mentoring health professionals at district hospitals of Rwanda.Participants14 TSAM mentors who had at least completed six mentorship visits on a regular basis in three selected district hospitals.ResultsMentors’ accounts demonstrated an appreciation of the two mentoring structures which are interprofessional collaboration and training. These structures are highlighted as the strengths of the mentoring programme and they play a significant role in the successful implementation of the mentorship model. Inconsistency of mentoring activities and lack of resources emerged as major weaknesses of the clinical mentorship programme which could hinder the effectiveness of the mentoring scheme.ConclusionThe findings of this study highlight the strengths and weaknesses perceived by mentors of the TSAM-MNCH clinical mentorship programme, providing insights that can be used to improve its implementation. The study represents unique TSAM-MNCH structural settings, but its findings shed light on Rwandan health system issues that need to be further addressed to ensure better quality of care for mothers, newborns and children.


2021 ◽  
Author(s):  
Mary Adetinuke Boyd ◽  
Sombo Fwoloshi ◽  
Peter A. Minchella ◽  
James Simpungwe ◽  
Terence Siansalama ◽  
...  

Abstract Background Although Zambia has increased the proportion of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) in recent years, progress toward HIV epidemic control remains inconsistent. Some districts are still failing to meet the UNAIDS 90/90/90 targets where 90% of PLHIV should know their status, 90% of those who know their status should be receiving sustained ART, and 90% of those on ART should have documented viral load suppression (VLS) by 2020. Providing consistently excellent HIV services at all ART health facilities is critical for achieving the UNAIDS 90/90/90 targets and controlling the HIV epidemic in Zambia. Zambia Ministry of Health (MoH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), aimed to achieve these targets through establishing a national HIV clinical mentorship program in which government-employed mentors were assigned to specific facilities with a mandate to identify and ameliorate programmatic challenges. Methods Mentors were hired, trained and deployed to individual facilities in four provinces to mentor staff on quality HIV clinical and program management. The pre-mentorship period was July 2018–September 2018 and the post-mentorship period was July 2019–September 2019. Results Review of key programmatic indicators from the pre and post-deployment periods revealed HIV testing yield improved from 4.2–6.8% (P < 0.001) as fewer HIV tests were needed despite the number of PLHIV being identified and placed on ART increasing from 492,613 to 521,775, and VLS increased from 84.8–90.1% (p < 0.001). Conclusions Key considerations in the establishment of an HIV clinical mentorship program include having a government-led process of regular site level data review and continuous clinical mentorship underpinned by quality improvement methodology.


2020 ◽  
Author(s):  
Dan Kaggwa Senjovu ◽  
Sarah Naikoba ◽  
Pallen Mugabe ◽  
Damazo T. Kadengye ◽  
Carey McCarthy ◽  
...  

Abstract Introduction : Clinical mentorship is effective in improving knowledge and competence of health providers and may be a useful task sharing approach for improving antiretroviral therapy. However, the endurance of the effect of clinical mentorship is uncertain. Methods : The midlevel health providers who participated in a cluster-randomized trial of one-on-one, on-site, clinical mentorship in tuberculosis and HIV for 8 hours a week, every 6 weeks over 9 months were followed to determine if the gains in knowledge and competence that occurred after the intervention were sustained 6- and 12-months post-intervention. In December 2014 and June 2015, their knowledge and clinical competence were respectively assessed using vignettes and a clinical observation tool of patient care. Multilevel mixed effects regression analysis was used to compare the differences in mean scores for knowledge and clinical competence between times 0, 1, 2, and 3 by arm.Results: At the end of the intervention phase of the trial, the mean gain in knowledge scores and clinical competence scores in the intervention arm was 13.4% (95% confidence interval ([CI]: 7.2, 19.6), and 27.8% (95% CI: 21.1, 34.5) respectively, with no changes seen in the control arm. Following the end of the intervention; knowledge mean scores in the intervention arm did not significantly decrease at 6 months (0.6% [95% CI -1.4, 2.6]) or 12 months (-2.8% [95% CI: -5.9, 0.3]) while scores in the control arm significantly increased at 6 months (6.6% [95% CI: 4.4, 8.9]) and 12 months (7.9% [95% CI: 5.4, 10.5]). Also, no significant decrease in clinical competence mean scores for intervention arm was seen at 6 month (2.8% [95% CI: -1.8, 7.5] and 12 months (3.7% [95% CI: -2.4, 9.8]) while in the control arm, a significant increase was seen at 6 months (5.8% [95% CI: 1.2, 10.3] and 12 months (11.5% [95% CI: 7.6, 15.5]).Conclusions : Mentees sustained the competence and knowledge gained after the intervention for a period of one year. Although, there was an increase in knowledge in the control group over the follow-up period, MLP in the intervention arm experienced earlier and sustained gains. One-on-one clinical mentorship should be scaled-up as a task-sharing approach to improve clinical care.Trial Registration : The study received ethics approvals from 3 institutions – the US Centers for Disease Control and Prevention Institutional Review Board (USA), the Institutional Review Board “JCRC’s HIV/AIDS Research Committee” IRB#1-IRB00001515 with Federal Wide Assurance number (FWA00009772) based in Kampala and the Uganda National Council of Science and Technology (Uganda) which approves all scientific protocols to be implemented in Uganda.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jacqueline Umunyana ◽  
Felix Sayinzoga ◽  
Jim Ricca ◽  
Rachel Favero ◽  
Marcel Manariyo ◽  
...  

Abstract Background Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials. This “system-oriented” approach was implemented in all public health facilities (n = 172) in ten districts in Rwanda from 2015 to 2018. Methods A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to 1 year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach. Results Nearly 40 % (n = 772) of health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n = 456), 60 % demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of 5 months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 min of birth (19% reduction, p = 0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.


2020 ◽  
Author(s):  
Jacqueline Umunyana ◽  
Felix Sayinzoga ◽  
Jim Ricca ◽  
RACHEL FAVERO ◽  
Marcel Manariyo ◽  
...  

Abstract Background: Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials. This “system-oriented” approach was implemented in all public health facilities (n=172) in ten districts in Rwanda from 2015 to 2018. Methods: A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to one year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach.Results: Nearly forty percent (n= 772) of health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n=456), sixty percent demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of five months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 minutes of birth (19% reduction, p=0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions: Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.


2020 ◽  
Author(s):  
Limakatso Lebina ◽  
Tolu Oni ◽  
Olufunke A. Alaba ◽  
Mary Kawonga

Abstract Background: Chronic care models like the Integrated Chronic Disease Management (ICDM) model strive to improve the efficiency and quality of care for patients with chronic diseases. However, there is a dearth of studies assessing the moderating factors of fidelity during the implementation of the ICDM model. The aim of this study is to assess moderating factors of implementation fidelity of the ICDM model. Methods: This was a cross-sectional mixed method study conducted in two health districts in South Africa. The process evaluation and implementation fidelity frameworks were used to guide the assessment of moderating factors influencing implementation fidelity of the ICDM model. We interviewed 30 purposively selected healthcare workers from four facilities (15 from each of the two facilities with lower and higher levels of implementation fidelity of the ICDM model). Data on facility characteristics were collected by observation and interviews. Linear regression and descriptive statistics were used to analyse quantitative data while qualitative data were analysed thematically.Results: The median age of participants was 36.5 (IQR: 30.8-45.5), and they had been in their roles for a median of 4.0 (IQR: 1.0 – 7.3) years. The moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). One feature of the ICDM model that seemingly compromised fidelity was the inclusion of tuberculosis patients in the same stream (waiting areas, consultation rooms) as other patients with non-communicable diseases and those with HIV/AIDS with no clear infection control guidelines. Participants also suggested that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads.Conclusion: There are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors influencing implementation fidelity of the ICDM model. Augmenting facilitation strategies (training and clinical mentorship) could further improve the degree of fidelity during the implementation of the ICDM model.


CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S86-S87
Author(s):  
L. Luo ◽  
M. Bhimani

Introduction: The Canadian College of Family Medicine Emergency Medicine Program (CCFP-EM) program is a 1-year enhanced skills program available to family medicine graduates interested in emergency medicine. Strong mentorship relationships were thought to assist residents with navigating the challenges of this program. Over the past 4 years, the CCFP-EM program at one academic centre initiated a novel mentorship program that matches residents with staff physicians in three areas of mentorship: clinical, research, and personal. This study aimed to determine the program success and areas for improvement. Methods: We conducted a cross-sectional study through an online survey distributed to all CCFP-EM residents and staff mentors from July 2015 to June 2019. Surveys included questions on the degree of satisfaction with the mentorship program, perceptions on the mentor/mentee experience, and areas for improvement. We asked staff and residents to rate their level of satisfaction with each mentorship component. Descriptive statistics were used to analyze satisfaction levels. Open-ended responses were analyzed for common themes. Results: 51.3% (19/37) of residents and 63.6% (35/55) of staff participated. For clinical mentorship, 68.5% of residents and 96.0% of staff rated the program as satisfactory/outstanding. For research mentorship, 73.7% of residents and 76.5% of staff rated the program as satisfactory/outstanding. The personal mentorship program was rated satisfactory/outstanding by 72.2% of residents and 95.3% of staff. Analysis for common themes revealed that continuity of support, development of autonomy, and opportunity for direct teaching were the main areas valued by residents. However, scheduling, teaching time, and mentor-mentee compatibility were the main challenges for residents. For mentors, scheduling was a main barrier to clinical mentorship, time constraint and resident commitment were the barriers to research mentorship, and resident engagement was the main barrier to personal mentorship. When asked which component(s) of mentorship should be continued for future residents, “personal mentorship only” was the most popular choice for staff (37.1%), while “mentorship in all three areas” was the most popular choice for residents (47.4%). Conclusion: Mentorship is an important aspect of the CCFP-EM program valued by staff and residents alike. Utilizing resident and staff feedback will allow for continuous improvement to the mentorship program.


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