1. 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

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

3. 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

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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. 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

17. 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

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

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

20. 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

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

22. 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

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

24. 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

25. 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

26. 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

27. 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

28. 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