Comparing in-person, blended and virtual training interventions; a real-world evaluation of HIV capacity building programs in 16 countries in sub-Saharan Africa.

We sought to evaluate the impact of transitioning a multi-country HIV training program from in-person to online by comparing digital training approaches implemented during the pandemic with in-person approaches employed before COVID-19. We evaluated mean changes in pre-and post-course knowledge scores and self-reported confidence scores for learners who participated in (1) in-person workshops (between October 2019 and March 2020), (2) entirely asynchronous, Virtual Workshops [VW] (between May 2021 and January 2022), and (3) a blended Online Course [OC] (between May 2021 and January 2022) across 16 SSA countries. Learning objectives and evaluation tools were the same for all three groups. Across 16 SSA countries, 3023 participants enrolled in the in-person course, 2193 learners participated in the virtual workshop, and 527 in the online course. The proportions of women who participated in the VW and OC were greater than the proportion who participated in the in-person course (60.1% and 63.6%, p<0.001). Nursing and midwives constituted the largest learner group overall (1145 [37.9%] vs. 949 [43.3%] vs. 107 [20.5%]). Across all domains of HIV knowledge and self-perceived confidence, there was a mean increase between pre- and post-course assessments, regardless of how training was delivered. The greatest percent increase in knowledge scores was among those participating in the in-person course compared to VW or OC formats (13.6% increase vs. 6.0% and 7.6%, p<0.001). Gains in self-reported confidence were greater among learners who participated in the in-person course compared to VW or OC formats, regardless of training level (p<0.001) or professional cadre (p<0.001). In this multi-country capacity HIV training program, in-person, online synchronous, and blended synchronous/asynchronous strategies were effective means of training learners from diverse clinical settings. Online learning approaches facilitated participation from more women and more diverse cadres. However, gains in knowledge and clinical confidence were greater among those participating in in-person learning programs.

Introducing an E-learning Solution for Medical Education in Liberia.

BACKGROUND: The Ebola virus epidemic and civil war in Liberia left the country in need of strengthening the health workforce. E-learning in medical education provides relevant learning opportunities for students, develops faculty competencies, and assists with the retention of healthcare workers. The Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI), the College of Health and Life Sciences (COHLS) at the University of Liberia (UL), and the Health Resources and Services Administration (HRSA) formed a partnership to create an e-learning solution for the COHLS. OBJECTIVE: This article outlines the implementation of an e-learning solution for the COHLS in Monrovia, and describes the challenges met, the key successes achieved, and the lessons learnt. METHODS: An initial scoping visit to Liberia was followed by three further on-site visits. Problems identified were: very limited or no network and computer resources, no internet connection, intermittent power, and lack of IT skills. We followed an evolutionary approach to infrastructure implementation by trying various solutions before settling on an offsite-hosted solution using Software as a Service (SaaS). Local staff were upskilled to administer this while remote support from Stellenbosch IT was provided. A stable internet connection was established. Staff and students can access the Learning Management System (LMS) 24/7 using mobile devices and laptops. Workshops were held where staff were taught how to produce online teaching material. Each class has at least one teaching assistant to assist lecturers with uploading and indexing material on the LMS.A benchmarking visit by COHLS faculty to Stellenbosch University took place, during which an e-learning strategic plan was drawn up. Further online workshops were conducted, and teaching materials were placed on the new LMS. OUTCOMES: The intranet that was established consisted of internet connection and software as a service in the form of Office 365, providing access to several products and services. The e-learning model attended to technology and human resources simultaneously. The e-learning strategy aimed to improve teaching and learning at the COHLS, boost the number of qualified doctors, reduce the workload on lecturers, and be scalable in the future. CONCLUSION: It is challenging to implement e-learning in medical education. Inadequate infrastructure, limited bandwidth, lack of skilled IT staff, unreliable power supply, time commitment, and ongoing maintenance all need to be overcome. The creation of an e-learning solution for the COHLS over a period of 15 months was enabled by the common vision and close collaboration of the three partners. This model can potentially be replicated across other faculties in the University of Liberia and other educational institutions in Liberia.

'Going rural': driving change through a rural medical education innovation.

INTRODUCTION: Medical education across the globe is in a state of flux influenced by a number of drivers for change. In response, institutions are seeking to re-align their curricula to address the prevailing imperatives. Against this backdrop, the training of practitioners for practice in rural communities was identified as an educational priority, and led to the establishment of a rural clinical school (RCS) within a Faculty of Medicine and Health Sciences in South Africa in 2011. This article describes the students' experiences in the first year that this innovative educational model was implemented and explores the extent to which it influenced their thinking and practice. METHODS: A qualitative, formative evaluation study of the first year of implementation was undertaken. Data was generated from in-depth interviews. This article focuses on individual interviews conducted with the eight students at the RCS, which explored their experiences during a year-long clerkship. Transcripts of interviews were thematically analysed. RESULTS: Four themes emerged from the analysis: a learning experience that differed from what was experienced at the tertiary training hospital, an enabling clinical environment in the district and regional hospital, the positive role played by the specialists, and the influence of the community immersion. Underlying all of the responses was the building of relationships over time both with supervisors and with patients. Evident from the responses was that students' confidence in their clinical skills and decision-making abilities was heightened while their approaches to their own learning were enhanced. CONCLUSIONS: To respond to the call for educational reform and a heightened awareness of social realities, innovative approaches to the training of medical students, such as those adopted at the RCS, are indicated. It is argued that the learning facilitated by these rural medical education models has the potential to offer learning experiences that can lead to transformation through a change in practice and attitude among the students, and ultimately also enable curricular renewal at the institutional core.

The knowledge and skills gap of medical practitioners delivering district hospital services in the Western Cape; South Africa

Introduction District (community) hospitals play an important role in the delivery of health services at community level; especially in rural areas. These hospitals provide comprehensive level-one health services to their communities; and serve as a resource for the whole health district. Most district hospitals are situated in rural areas; with medical services in these hospitals being rendered by generalist medical practitioners. The education and training of generalist practitioners for rural practice needs specific attention. Firstly; the unique nature of rural practice makes it necessary for doctors to undergo relevant and focused instruction. Rural family practice requires that doctors have the knowledge and skills to practise in settings where high technology and specialist resources are not available; while at the same time requiring that they be able to perform a wide range of advanced functions and procedures. Secondly; it is argued that appropriate education and training for rural practice can positively influence the recruitment and retention of medical practitioners in rural areas.5 The teaching of the knowledge and skills required for rural practice should take place in an appropriate setting that promotes interest in rural practice and familiarises the student with its particular challenges. There is a paucity of data in South Africa on medical practitioners staffing district hospitals; especially in terms of their knowledge and skills levels. Such information is critical if rural hospitals are to deliver equitable and quality health services; and also for guiding appropriate undergraduate; postgraduate and continuing professional education for rural practice. With this as background; health service managers in the Western Cape requested a skills audit of medical officers in district hospitals to identify a possible gap in competencies that may impact on service delivery. The aim of this study was thus to identify the knowledge and skills of medical practitioners delivering these services in the Western Cape and to compare them with service needs in order to make recommendations for education and training. This article reports on the results of the knowledge and skills gap analysis; while the results of the district hospital performance data and in-depth interviews are reported elsewhere. Method The competencies of medical practitioners working in 27 district hospitals were explored by using a self-administered questionnaire containing a competency rating of proxy markers. The data were analysed using the SAS statistical package. Variables were examined for statistically significant differences. Results A response rate of 75

The Knowledge and Skills Gap of Medical Practitioners Delivering District Hospital Services in the Western Cape; South Africa

Introduction: District (community) hospitals play an important role in the delivery of health services at community level; especially in rural areas. These hospitals provide comprehensive level-one health services to their communities; and serve as a resource for the whole health district. Most district hospitals are situated in rural areas; with medical services in these hospitals being rendered by generalist medical practitioners. The education and training of generalist practitioners for rural practice needs specific attention. Firstly; the unique nature of rural practice makes it necessary for doctors to undergo relevant and focused instruction. Rural family practice requires that doctors have the knowledge and skills to practise in settings where high technology and specialist resources are not available; while at the same time requiring that they be able to perform a wide range of advanced functions and procedures. Secondly; it is argued that appropriate education and training for rural practice can positively influence the recruitment and retention of medical practitioners in rural areas.5 The teaching of the knowledge and skills required for rural practice should take place in an appropriate setting that promotes interest in rural practice and familiarises the student with its particular challenges. There is a paucity of data in South Africa on medical practitioners staffing district hospitals; especially in terms of their knowledge and skills levels. Such information is critical if rural hospitals are to deliver equitable and quality health services; and also for guiding appropriate undergraduate; postgraduate and continuing professional education for rural practice. With this as background; health service managers in the Western Cape requested a skills audit of medical officers in district hospitals to identify a possible gap in competencies that may impact on service delivery. The aim of this study was thus to identify the knowledge and skills of medical practitioners delivering these services in the Western Cape and to compare them with service needs in order to make recommendations for education and training. This article reports on the results of the knowledge and skills gap analysis; while the results of the district hospital performance data and in-depth interviews are reported elsewhere.Method: The competencies of medical practitioners working in 27 district hospitals were explored by using a self-administered questionnaire containing a competency rating of proxy markers. The data were analysed using the SAS statistical package. Variables were examined for statistically significant differences.Results: A response rate of 75 (110/147) was achieved. Part-time (older) medical officers regarded themselves as more experienced and more competent than full-time (younger) employees in most areas; except when managing problems relating to HIV/AIDS. Termination of pregnancy was the procedure most frequently not performed despite practitioners being competent to do so. A substantial need for supervision was identified for managing less common emergency conditions; as well as for some outpatient problems; including preventative; promotive and rehabilitation activities.Conclusions: The knowledge and skills gaps varied considerably according to the individuals' education; training and experience; as well as their circumstances and working conditions. The superior competencies of the older practitioners reinforce the importance of the recruitment and retention of more experienced practitioners. The uneven skill and knowledge base in aspects of HIV/AIDS management should be addressed urgently by initiatives such as the internet-based course on HIV/AIDS developed by the Family Medicine Education Consortium (FaMEC). Departments of Family Medicine should urgently re-orientate their curricula to meet the training needs for level-one hospital practice

The Maintenance of Competence of Rural District Hospital Practitioners

Introduction: It is important for rural district hospital practitioners to maintain their competence to provide equitable health service for rural communities. The scope of their practice dictates that they must stay up-to-date with a large variety of knowledge and skills despite limited educational opportunities. Rural practitioners use continuing professional development (CPD) activities that are most accessible to them; but it is not known whether these activities are educationally sound and effective.Aim: We designed a study to investigate the content and methods used for the maintenance of competence by rural district hospital practitioners in the Western Cape Province; South Africa.Methods: Expert opinion was sought to evaluate the topics requiring up-dating and the validity of the learning methods to maintain competence in practice. This was achieved by employing the Delphi technique to reach consensus on content and methodology. Categorical data analysis and a principal factor analysis were performed. The qualitative data were developed into themes and presented as a conceptual framework.Results: Consensus was reached on the principal content areas requiring updating. Methods that were found most useful were in-service learning under supervision; structured courses; small group discussions and practical workshops. Rotations in tertiary hospitals; lectures by specialists; journal reading and Internet learning were less supported.Conclusion: This study provides a practical model for continuing instruction plus self-directed learning in context. Three content domains were established namely; commonly encountered areas of practice; identified gaps and needs specific to the practitioner and the setting. The implementation of external updating programmes must be tailored to suit the practitioners while the self-directed aspects should include reflective practice. Priority areas are identified and classified as well as educational methods which can contribute towards the maintenance of competence of rural practitioners

The current status and future needs of education and training in family medicine and primary care in South Africa.

South Africa is undergoing tremendous political and social change affecting every sphere of society, including medical education and the delivery of health services. The legacy of its history created a health system that in some respects can be compared to the best in the world, but one also characterized by inequity, discrimination and lack of access to even basic services for the rural and the poor. Its medical education system trails behind modern trends such as problem-based learning, community-based education and the utilizing of general/family practitioners as trainers. Vocational training in family practice is not compulsory for independent practice. The discipline of family practice has nevertheless developed the programmes and core infrastructure for such a future undertaking in the form of masters programmes in family medicine at all medical schools. The recently introduced system of compulsory recertification through continuous professional development provides a window of opportunity to develop locally relevant curricula and appropriate education and training methods for family practitioners. Challenges for family practice include the establishment of the role and value of the discipline in a developing country with a health system based on a nurse-driven primary care service and the re-orientation of family medicine teachers, trained in a biomedical paradigm, to the patient-centred approach. The aspirations of family practice are to define the core content of the discipline, establish and nurture a culture of research in primary care, and to develop and introduce appropriate under and postgraduate training programmes for the new generation of family doctors.