A framework for revising preservice curriculum for nonphysician clinicians: The mozambique experience.
A framework for revising preservice curriculum for nonphysician clinicians: The mozambique experience.
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DOI：
10.4103/1357-6283.152190
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发表时间：
2014-09-01
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影响因子：
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通讯作者：
de Oliveira, Justine Strand
中科院分区：
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作者：
Freistadt, Fernanda;Branigan, Erin;de Oliveira, Justine Strand
莫桑比克每 10,000 人约有 0.4 名医生和 4.1 名护士，是世界上医疗保健提供者与人口比例最低的国家之一。为了迅速扩大医疗保健覆盖范围，莫桑比克卫生部已推动加大对培训非医师临床医生 Tiotacnicos de Medicina (TM) 的投资。根据发现的 TM 临床表现差距，卫生部请求国际健康培训教育中心 (I-TECH) 提供技术援助，以修订两年半的职前课程。修订课程采用了六步流程：(i) 进行任务分析，(ii) 定义新的课程方法并选择基于学科和能力的教育综合模式，(iii) 修订和重组 30 个月的课程安排以强调临床技能，(iv) 为每门课程制定详细的教学大纲，(v) 为每节课制定内容，以及 (vi) 评估实施情况并整合反馈以进行持续改进。 2010年5月，莫桑比克卫生部长批准了修订后的课程，目前正在全国10个培训机构实施。主要经验教训： (i) 对培训机构的优势和劣势进行详细评估应为课程修订提供信息。 (ii) 建立一个由受人尊敬和积极主动的临床医生组成的技术工作组是促进当地认同和所有权的关键。 (iii) 提供即用型教学材料有助于解决资源有限环境中常见的一些挑战。 (iv) 全面修订课程是提高发展中国家卫生保健提供者培训质量的重要的第一步。培训机构和医疗保健机构实施的其他方面也必须得到解决，以确保提供者得到充分的培训和装备，以提供优质的医疗保健服务。这种课程修订和实施方法教授了几个关键教训，这些教训可能适用于其他欠发达国家的职前培训计划。
Mozambique, with approximately 0.4 physicians and 4.1 nurses per 10,000 people, has one of the lowest ratios of health care providers to population in the world. To rapidly scale up health care coverage, the Mozambique Ministry of Health has pushed for greater investment in training nonphysician clinicians, Tiotacnicos de Medicina (TM). Based on identified gaps in TM clinical performance, the Ministry of Health requested technical assistance from the International Training and Education Center for Health (I-TECH) to revise the two-and-a-half-year preservice curriculum. A six-step process was used to revise the curriculum: (i) Conducting a task analysis, (ii) defining a new curriculum approach and selecting an integrated model of subject and competency-based education, (iii) revising and restructuring the 30-month course schedule to emphasize clinical skills, (iv) developing a detailed syllabus for each course, (v) developing content for each lesson, and (vi) evaluating implementation and integrating feedback for ongoing improvement. In May 2010, the Mozambique Minister of Health approved the revised curriculum, which is currently being implemented in 10 training institutions around the country. Key lessons learned: (i) Detailed assessment of training institutions' strengths and weaknesses should inform curriculum revision. (ii) Establishing a Technical Working Group with respected and motivated clinicians is key to promoting local buy-in and ownership. (iii) Providing ready-to-use didactic material helps to address some challenges commonly found in resource-limited settings. (iv) Comprehensive curriculum revision is an important first step toward improving the quality of training provided to health care providers in developing countries. Other aspects of implementation at training institutions and health care facilities must also be addressed to ensure that providers are adequately trained and equipped to provide quality health care services. This approach to curriculum revision and implementation teaches several key lessons, which may be applicable to preservice training programs in other less developed countries.