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

Track 1.0 Program Meeting2 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 Today, I-TECH has 225 staff worldwide working from 10 field offices in partnership with approximately 100 non-governmental organizations.

Track 1.0 Program Meeting3 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.

Track 1.0 Program Meeting4 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

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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.

Track 1.0 Program Meeting7 Clinical Training Five Levels of Training - Adapted from U.S. AETCs

Track 1.0 Program Meeting8 Clinical Mentoring Toolkit

Track 1.0 Program Meeting9 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

Track 1.0 Program Meeting10 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

Track 1.0 Program Meeting11 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

Track 1.0 Program Meeting12 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

Track 1.0 Program Meeting13 Clinical Mentoring Toolkit  Multi-platform organized to accommodate lowest IT denominator:  CD-ROM   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+

Track 1.0 Program Meeting14 Next Steps – Revise Toolkit  Solicit feedback and participation of partners using online survey   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

Track 1.0 Program Meeting15 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

Track 1.0 Program Meeting16 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.

Track 1.0 Program Meeting17 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

Track 1.0 Program Meeting18 Launch date for Version 2.0: August 2008 at World’s AIDS Conference in Mexico City

Track 1.0 Program Meeting19 Expect to hear from us…