The impact of a blended multidisciplinary training for the management of obstetric haemorrhage in Mbeya, Tanzania.

Background: The Maternal Mortality Rate (MMR) in Tanzania is 78 times higher than that of the UK. Obstetric haemorrhage accounts for two-thirds of these deaths in Mbeya, Tanzania. A lack of healthcare providers' (HCPs') competencies has been the key attribute. This study measured the impact on HCP's competencies from a blended training programme on obstetric haemorrhage. Methods: A "before and after" cohort study was undertaken with HCPs in 4 hospitals in the Mbeya region of Tanzania between August 2021 and April 2022. A multidisciplinary cohort of 34 HCPs (doctors, nurses, midwives, anaesthetists and radiologists) were enrolled on a blended face-to-face and virtual training course. The training was delivered by a multidisciplinary team (MDT) from London, UK, assisted by local multidisciplinary trainers from Mbeya, Tanzania and covered anaesthetic, obstetrics, haematology and sonographic use. Results: There were 33 HCP in the cohort of trainees where 30/33 (90.9%) of HCPs improved their Anaesthesia skills with a mean score improvement of 26% i.e., 0.26 (-0.009 -0.50), 23 HCPs (69.7%) improved obstetric skills 18% i.e., 0.18 (-0.16 to 0.50), 19 (57.6%), (57.6%) improved competences in Haematology 15%.i.e., 0.15 (-0.33 to 0.87), 20 out of 29 HCPs with ultrasound access (68.8%) improved Sonographic skills 13%.i.e., 0.13 (-0.31 to 0.54). All 33 HCPs (100%) presented a combined change with the mean score improvement of difference of 25% i.e., 0.25 (0.05-0.66). The deaths attributed to obstetric haemorrhage, the mortality rate declined from 76/100,000 to 21/100,000 live births. Actual number of deaths due to obstetric haemorrhage declined from 8 before training to 3 after the completion of the training. Conclusion: This comprehensive blended training on anaesthetic surgical, haematological, and sonographic management of obstetric haemorrhage delivers a significant positive impact on the detection, management and outcomes of obstetric haemorrhage.

Supporting healthcare professionals in a remote rural area of Tanzania.

In October 2017, as two semi-retired NHS doctors, we visited a local hospital and a health centre in Sumbawanga, a rural town in Tanzania. We were curious to find out how the healthcare system worked, to see what support might be helpful to the healthcare professionals themselves and whether and how ideas might be applied in the U.K. We found the health facilities we visited to be well organised and functioning with a small number of multi-skilled clinicians. However, we were aware that there are inadequate numbers of suitably trained healthcare professionals per head of the population in this area and that this could contribute to some of the poorer health outcomes. Our visit left us wondering whether the provision of support in the form of leadership coaching, educational consultancy and friendship with colleagues in the U.K. might enhance job satisfaction and, in turn, whether this might have a beneficial effect on staff recruitment and retention. These are ideas that we are now pursuing with a plan to return to Tanzania in the autumn of 2018.

Professional Support, London: the professional development unit supporting practitioner well-being, refreshment, remediation and revalidation.

London' s Professional Support Unit (PSU) was launched in April 2012 at a time when changes and financial pressures across the health service were placing considerable demand on the medical and dental workforce. At the same time the infrastructure to support medical revalidation was established. The PSU provides developmental support to clinicians across London in all career grades and specialities, to sustain and restore them to contribute effectively to health service delivery across the capital. The costs of medical training are high. Maintaining doctors at work has to be cost effective. Clinicians in multicultural London require diverse resources, as increasing numbers have trained abroad. The PSU offers a holistic, tailor-made approach to professional and personal development with a range of resources and approaches. It provides proven high quality educational interventions, creating a linked and integrated service, providing clinicians with new opportunities. Access is by self-referral with resources targeted at those going through transitions in their professional lives, as well as those who have specific developmental needs. A collaborative approach across the PSU and its education and governance communities ensured the provision of personal support to over 1300 clinicians in its first year, together with interdisciplinary group learning opportunities. Online materials were created to assist individuals, workplace groups and a broad network of support and expertise. To maximise the effectiveness of the service, learning events were also held for those working within the PSU. In commending the PSU and its positive impact, the General Medical Council has recommended the model be shared nationally. At the same time the London's three Local Education Training Boards have recommended that the PSU expand to encompass a more diverse range of professional groups. Our challenge is how to extend such flexible, responsive and values-based support across the workforce, given stringent financial pressures.

Speed supervision.

BACKGROUND: Over the last few years the London Deanery has offered workshops in supervision skills for clinical teachers. In response to the concern that supervision conversations are time consuming, we devised an exercise to promote the ability to carry out a small piece of supervision that can nudge forwards an issue in a short time (10 minutes or less): speed supervision. CONTEXT: The workshops are part of the faculty development programme for clinical and educational supervisors in primary and secondary care at the London Deanery. The workshops teach a question-based approach to help the supervisee reflect and shift their perspective. INNOVATION: Offering advice is often not the most time-efficient way to help someone towards the solution for an issue. We chose to introduce an approach that could help a supervisee think differently about an issue in a brief period of time. Helping a supervisee to make a small piece of progress in their thinking can in turn lead to future changes. Supervisors are encouraged to explore values and context as well as technical and scientific aspects. IMPLICATIONS: Even during a brief period of supervision, asking questions rather than reaching for the familiar solution may be surprisingly satisfying for both supervisee and supervisor alike. The skills can be applied to professional and personal dilemmas and situations.

Supervision.

Supervision has been defined in many ways, but is essentially a conversation between professionals aimed at promoting learning, reflective practice and improving patient safety and the quality of patient care.