DECENTRALIZING CLINICAL TRAINING: TACKLING THE CHALLENGES The University of Nairobi PRIME-K Experience Prof James N. Kiarie PI: University of Nairobi MEPI Site Wednesday, 07 August 2013 University of Nairobi is ISO certified

PROBLEM IDENTIFICATION Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified BACKGROUND UON has increased its admission of students into College of Health Sciences. Staff establishment has not changed significantly Tertiary hospital (Kenyatta National Hospital) congested as clinical training site Patient population and facilities don’t reflect what is at lower level facilities Increase in internship training centers with medical specialists– currently 51 Admitted students mostly drawn from urban areas particularly Nairobi Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified College of Health Sciences Graduates Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified GOAL IN TRAINING HEALTH PROFESSIONALS Explicit Concerns regarding psychomotor and affective domain of practice Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified CHALLENGES TACKLED Communication Identification Buy in Present problem with the solution Present data and other evidence Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified PROGRAM DESIGN Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified FINDING THE SOLUTION Visit to University of Washington (UW) to study WWAMI model of training Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified WWAMI UW School of Medicine trains for 5 states Washington, Wyoming, Alaska, Montana and Idaho WWAMI is a five state, 40 year old partnership. Wednesday, 07 August 2013 University of Nairobi is ISO certified

AGREEMENT ON SITES WITH MoH Sites selected for rotation of medical, nursing, dental and pharmacy students Adjunct faculty Baseline assessment Capacity building Use of data CME Faculty visits Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified CHALLENGES TACKLED Expectations Responsibilities Buy in Mutual benefit Engagement of leadership Clear Plans Wednesday, 07 August 2013 University of Nairobi is ISO certified

PROGRAM IMPLEMENTATION Wednesday, 07 August 2013 University of Nairobi is ISO certified

ADJUNCT FACULTY TRAINING Total Trained N=156 3 day training on medical education and mentorship course adapted from St John’s Christian Medical College, Bangalore. After training can apply to be adjunct faculty and to host students at their facility. Wednesday, 07 August 2013 University of Nairobi is ISO certified

Appointment of adjunct faculty Cadre of Staff Appointed N=30 Medical specialists 20 Dentists 2 Pharmacists 3 Nurses 5 Total 30 Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified CHALLENGES TACKLED Some faculty decline appointment Requirement of postgraduate training Demand for pay Flexibility Emphasize benefits Clinical instructor Keep student number low Wednesday, 07 August 2013 University of Nairobi is ISO certified

BASELINE SITE ASSESSMENTS 6 Had general dental practitioners 5 Can train > 60% of clinical disciplines 6 have broken down equipment 1 had two dental specialists 1 has CPD program in oral health 0 has ongoing research in oral health Average patients per day 20-50 Wednesday, 07 August 2013 University of Nairobi is ISO certified

Decentralized Training Sites Busia District Hospital Kisii District Hospital Naivasha District Hospital Karatina District Hospital Pumwani Maternity Hospital Mbagathi District Hospital Kitui District Hospital Garisa Provincial Hospital Coast Provincial General Hospital Homa Bay District Hospital Isiolo District Hospital Litein AIC Hospital Mama Lucy Kibaki Hospital Tigoni District Hospital Wednesday, 07 August 2013 University of Nairobi is ISO certified

TABLES AND CHAIRS DELIVERED TO KISII LEVEL 5 HOSPITAL CME ROOM Wednesday, 07 August 2013 University of Nairobi is ISO certified

RENOVATED TB MANYATTA IN GARISSA (CAN HOUSE UP TO 16 STUDENTS) Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified CHALLENGES TACKLED Competition at sites from other institutions Distance from Nairobi Change in Government structures Selected sites without University affiliations Process of developing MOU Negotiating with county governments Use developed networks Wednesday, 07 August 2013 University of Nairobi is ISO certified

NUMBER OF STUDENTS PER SITE Total 205 Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified CHALLENGES TACKLED Student expectations Accommodation 2 day orientation prior to visiting Regular faculty visits Self sponsored students Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified PROGRAM EVALUATION Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified COMPETENCIES STUDENTS SELF EVALUATED AS HAVING MOST IMPROVED AFTER DECENTRALIZED ROTATION Communicator Collaborator Health advocate Scholar Manager Wednesday, 07 August 2013 University of Nairobi is ISO certified

QUALITATIVE ASSESSMENT OF STUDENT EXPERIENCES PRE ROTATION Motivated by desire to gain more hands-on clinical experience Seeking opportunity to exercise clinical skills. Lacked confidence in patient interaction POST ROTATION Felt they had been actively involved in patient management Confident to perform common clinical and surgical procedures. Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified CHALLENGES TACKLED IRB approval for evaluations Need to track students for impact Impact on facilities more difficult to measure Submitted M&E plan for IRB approval Set up system to track individual students Using morbidity and mortality reports of facilities Wednesday, 07 August 2013 University of Nairobi is ISO certified

University of Nairobi is ISO certified CONCLUSION Tackling challenges calls for innovation Not all challenges will be fully addressed The program has been successful UoN now in process of integrating into routine training Wednesday, 07 August 2013 University of Nairobi is ISO certified

ACKNOWLEDGEMENTS UNIVERSITY OF WASHINGTON PRIME-K TEAM MOH TRAINING SITES AIM 2 TEAM Prof Ruth Nduati Dr. Peter Njoroge Prof. Erastus Amayo, Dr. Tom Dienya Dr. Dismus Ongore, Dr. Minnie Kibore Mrs. Margaret Muiva, Ms. Mara Child, Dr. Marybeth Maritim, Mr. Raphael Kinuthia Dr. Evans Mwangangi, Dr. Carey Farquhar fogarty international center Wednesday, 07 August 2013 University of Nairobi is ISO certified