I-TECH’s Clinical Mentoring Model E. Michael Reyes, MD, MPH CoDirector, I-TECH UCSF

1. I-TECH’s Clinical Mentoring Model E. Michael Reyes, MD, MPH CoDirector, I-TECH UCSF

2. Background • I-TECH was founded in April 2002 by the Health Resources and Services Administration and the Centers for Disease Control & Prevention to be the “International AIDS Education & Training Center (AETC)” • I-TECH is a joint collaboration between the University of Washington and the University of California San Francisco • Additional funds from USAID since 2003 for work in Caribbean • $30 million in total funding for 2007. Today, I-TECH has 225 staff worldwide working from 10 field offices in partnership with approximately 100 non-governmental organizations.

3. I-TECH Mission • I-TECH promotes activities that increase human and organizational capacity for providing HIV/AIDS clinical care and support in countries and regions hardest hit by the AIDS epidemic. • I-TECH supports the ongoing development of health care worker training systems that are locally-determined, optimally resourced, highly responsive and self-sustaining. Project efforts target development and support of training content, delivery and systems.

4. Countries I-TECH supports capacity development in 25 countries, including more than a dozen countries in the large Caribbean region. • Botswana • Caribbean (Antigua, Bahamas, Barbados, Dominica, Grenada, Guyana, Haiti, Jamaica, St. Kitts & Nevis, St. Lucia, St. Vincent & the Grenadines, Surinam, Trinidad & Tobago) • Ethiopia • India • Kenya • Malawi • Mozambique • Namibia • South Africa • Tanzania • Thailand • Vietnam • Zimbabwe

6. Clinical Mentoring Overview • I-TECH builds on nearly two decades of experience from the 11 U.S.-based AIDS Education and Training Centers. I-TECH also uses evidence-based training practices derived from literature on health behavior change, adult learning theory, and clinical care. • Our clinical mentoring approach is consistent with World Health Organization guidelines.

7. Clinical Training Five Levels of Training - Adapted from U.S. AETCs

8. Clinical Mentoring Toolkit

9. Objectives of the Toolkit • To facilitate successful clinical mentoring encounters • To support clinical mentors who are working in varied clinical settings in resource-constrained countries • To provide a set of adaptable tools for in-country providers • To provide a practical resource to organizations conducting clinical mentoring-like activities

10. Use of Toolkit NOT meant to be prescriptive! No two mentorships are alike Tools are designed to be adaptable NOT a substitute for skilled trainers/mentors Mentors can use it to help inform activities, but they are ultimately responsible for organizing materials in a coherent and appropriate manner Designed as a resource for both mentors and persons at facilities in the absence of mentors A capacity building product

11. Development Process: Version 1 • Formulated an outline of the different components of the toolkit at a clinical mentoring meeting with I-TECH staff in July 2005 • Compiled resources developed by I-TECH staff and clinical consultants that could lend themselves to field work for inclusion in the toolkit • Contracted with consultants and had staff fill in some missing gaps • Conducted small number of usability tests and content review of the toolkit in January 2006 • Finished a pilot-version February 1, 2006 • Version one completed in July 2006

12. Seven Sections of Toolkit • Overview of Clinical Mentoring: I-TECH's approach. • Getting Started: Hiring mentors and site preparation. • Needs Assessment: Provider competencies and systems. • Training: Training methods, communication, and TOT worksheets. • Curricula: Courses, workshops, and video. • Monitoring and Evaluation: Methods and tools. • Resources: References materials, glossary, image library, Web materials

13. Clinical Mentoring Toolkit • Multi-platform organized to accommodate lowest IT denominator: • CD-ROM • http://www.go2itech.org/HTML/CM06/toolkit.html • Original Version 1.1 launched at World AIDS Conference in Toronto in August 2006 • Widely disseminated • 300+ requested via website from over 45 countries • 300+ distributed in Toronto • Average visitors to online toolkit version: 56 hits/day • Total files downloaded from website: 20,500+

14. Next Steps – Revise Toolkit • Solicit feedback and participation of partners using online survey • https://catalysttools.washington.edu/survey/sburnett/42240 • Review, revise, adapt or remove existing materials • Develop and pilot new tools • Prioritization of what mentor can affect, what is achievable and how to prioritize a certain number of tasks to make them meaningful • Identifying and training leaders during mentorship • Anticipating barriers during mentorship and addressing them • How to teach history taking, differential diagnosis and physical exam skills

15. Next Steps – Revise Toolkit (2) • Organize around core competencies for clinical mentors • Expand image library • Capture lessons learned and experiences from clinical mentors • Translate into multiple languages • Portuguese • Spanish • French

16. Sample Competencies • Assessing and improving your skills as a clinical mentor. • Identifying and training potential clinical mentors among your on-site trainees. • Assessing and improving the HIV-specific knowledge and practice skills of trainees. • Constructing and evaluating a clinical mentoring project at a clinical site.

17. Track 1.0 Partner Expertise • Pediatric mentoring • Family Centered Care • Integration of TB/HIV, PMTCT/HIV • Focus on outcomes over time • Multiple tools and curricula • Nursing expertise • Documenting lessons learned

18. Launch date for Version 2.0: August 2008 at World’s AIDS Conference in Mexico City

19. Expect to hear from us…