OSS Results

1. A. Miceli1, L. Mpanga-Sebuyira2, I. Crozier3, M. Cooke4, A.P. Omwangangye2, L. Rayko-Farrar1, A. Ronald5, M. Tumwebaze2, K. Willis3 ,M. Weaver11. University of Washington, Seattle, WA; 2. Infectious Diseases Institute, Kampala, Uganda; 3. Accordia Global Health Foundation, Washington, D.C.; 4.University of California, San Francisco, CA; 5. University of Manitoba, Winnipeg, Canada Recent calls for reform in global medical education have stressed the need for approaches that strengthen clinical reasoning skills. However, little research has focused on determining the most effective methods for strengthening clinical reasoning capacity in settings with severe human resource shortages and complex disease presentations. The Integrated Infectious Disease Capacity Building Evaluation (IDCAP) created a training program using current best practices in clinical education among clinicians in rural Uganda. Thirty-six health facilities across Uganda were selected to participate in IDCAP. Each site nominated two individuals - a Clinical Officer (CO), and/or Nursing Officer (NO) - to be trained. The results of the evaluation of IDCAP’s training program are expected in mid2012. Objective: Describe IDCAP’s approach as a model for how modern medical education theory can be applied in resource-limited settings. Introduction / Background Methods OSS Results The process that expert clinicians use to make decisions has been a source of debate in the medical education literature—particularly, the use of adaptive reasoning (i.e. analytic, conscious) versus routine reasoning (i.e. non-analytic, automatic) to solve clinical problems. Progressive strategies for clinical teachers enable students to practice thinking about medicine in both routine and adaptive ways. IDCAP focused on 3 key practices for building both routine and adaptive reasoning skills. IDCAP Key Practices Image 1: A facilitator leads an IMID Booster Course. Results ClassroomTraining Advances in Medical Education: A Model for Infectious Disease Training for Mid-level Practitioners in Uganda IDCAP designed a sustained intervention while minimizing out-of-clinic time, combining classroom training, distance learning and on-site support (OSS), spanning a 9-month period. • Classroom training consisted of a 3-week Core Course, Integrated Management of Infectious Diseases, and two 1-week Booster Courses. Training features included: • Design aimed to integrate infectious diseases and mirror the clinical reasoning process. • Primary means of instruction: detailed case studies and discussion. • Each session used a case-based approach to simulate clinical thinking; relevant medical concepts arise in group case discussion. • Design provides ample opportunity for trainees and facilitators to talk through their reasoning. • Clinical decision-making guides (CDGs) lead trainees through formal decision points • 1-week Booster Courses with case presentations from the trainees’ clinical practice held at 12 and 25 weeks after Core Course completion. • 12 half-day clinical rotations under the guidance of highly specialized mentors; rotations ranged from pediatric clinics, to tuberculosis wards to general admission. • Over the course of the program, IDCAP trainees applied complex clinical reasoning concepts by: • analyzing and discussing 40-50 structured cases • hearing 20-30 peer presentations • writing-up 30-40 of their own cases • spending 36 hours in clinical placements, discussing cases with expert clinicians • meeting and discussing cases with 20 expert facilitators (in the classroom, during clinical placements and during on-site support visits) Core Course Modules Box with Modules • Introduction to IDCAP Infectious Disease Training • Introduction • Clinical Management in Infectious Diseases • Emergency Care in Infectious Diseases • Introduction to Quality Improvement • Adult Outpatient Clinic • A Patient w/ Fever: Malaria • A Patient w/ Fever: Negative Malaria Smear • A Patient w/ Cough: Respiratory Illness, Tuberculosis (TB) • A Patient w/ Mouth or Throat Problem • A Patient w/ Skin Problem • A Patient w/Headache: Central Nervous System (CNS) Infection • A Patient w/ Diarrhea • Routine Care of the HIV Patient • A Patient for HIV Testing • A Newly Diagnosed HIV Patient • An HIV-infected Patient who needs ART • A Patient on ART for Follow-Up • Antenatal Clinic • A Pregnant Woman in Antenatal Clinic • A Pregnant Woman diagnosed w/ HIV • CQI: Designing an Improvement Project • Pediatric ID: Unique Issues in HIV • An HIV-exposed Infant • A Child w/ Symptomatic HIV Infection • An Adolescent w/ HIV • Pediatric ID: Focused Cases • A Child w/ Cough • Designing an Improvement Project • A Child w/ Fever: Meningitis • A Sick Neonate: Management of Fever • A Child w/ Diarrhea • A Patient w/ Malnutrition • HIV Prevention • Overview of HIV Prevention • A Patient at Risk: STIs and HIV Prevention • A Health Worker w/ Needle Stick Injury: PEP • A Discordant Couple and HIV Prevention • Complex Problems in ID • A Patient w/ HIV, Cough: HIV/TB Co-infection • A Patient w/ History of Treated TB and Cough • Designing an Improvement Project • A Patient w/Chronic Cough: HIV, Respiratory Illness • A Patient w/ Persistent Fever • A Patient on ART who gets sicker • A Patient w/ Complicated Malaria • Orientation to Distance Learning • Complex Problems in ID • A Patient w/ HIV, Cough: HIV/TB Co-infection • A Patient w/ History of Treated TB and Cough • Designing an Improvement Project • A Patient w/Chronic Cough: HIV, Respiratory Illness • A Patient w/ Persistent Fever • A Patient on ART who gets sicker • A Patient w/ Complicated Malaria • Orientation to Distance Learning Image 2: A nursing officer presenting a case during an OSS session at an IDCAP intervention site. Distance Learning • Between courses, trainees used a clinical practice logbook that supported three practices: • recognizing interesting and complex cases in their day-to-day practice, • identifying sources for consultation; and • articulating case details for another clinician. • Trainees recorded 1 case each week, questions and problems that arose, and sources consulted for additional information. Accordia’s IDCAP Partners About IDCAP Distance Learning Accordia’s IDCAP is a 3-year program with the goal of evaluating the cost-effectiveness of building capacity among mid-level health practitioners in sub-Saharan Africa for the treatment and prevention of infectious diseases. IDCAP will measure the impact of a novel package of classroom training, distance learning, and on-site support services on individual competence and clinical practice, facility performance, and health outcomes . On-SiteSupport (OSS) • Thirty-six health facilities’ multidisciplinary staff were visited monthly by a four-member mobile team comprised of: • 1 Medical Officer • 1 Clinical Officer, • 1 Nurse Officer, and • 1 Laboratory Technologist. • Over a two-day OSS visit, facility staff participated in team-based training that included a broader cross-section of staff, cadre-specific breakout sessions, mentoring for the clinical and laboratory professionals, and continuous quality improvement. Distance Learning Conclusion The IDCAP model provides longer-term support to translate clinical experiences into learning, and support the development of complex reasoning skills in understaffed, rural settings. Final Poster Number: 47.005