Delivering a sustainable trauma management training programme tailored for low-resource settings in East, Central and Southern African countries using a cascading course model
Delivering a sustainable trauma management training programme tailored for low-resource settings in East, Central and Southern African countries using a cascading course model
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DOI：
10.1016/j.injury.2015.11.042
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发表时间：
2016-05-01
影响因子：
2.5
通讯作者：
Lavy, C.
中科院分区：
文献类型：
--
作者：
Peter, N. A.;Pandit, H.;Lavy, C.
背景：全球每年因伤害导致500万人死亡和279个残疾调整生命年（DALYS）。东南非合作理事会牛津骨科联系方案是一个多国伙伴关系方案，采用由联合王国教员讲授“初级”课程，然后由当地教员讲授“阶梯式”课程的模式，向9个撒哈拉以南国家的广大保健工作者骨干提供创伤管理培训。本研究探讨了对卫生工作者的知识和临床信心的影响，并比较了在低资源环境下提供的“级联”和“初级”课程的表现。从1030名候选人中收集了数据（119名临床主任、540名医生、2012年至2013年期间，在9个撒哈拉以南非洲国家培训了28门课程（9门“初级”课程和19门“级联”课程）的260名护士和111名医科学生。知识和临床信心的候选人进行了评估，使用前和后的课程MCQ和临床情景的置信矩阵评级。对性别、工作角色和初级课程与级联课程的协变量的变化进行了衡量。多元回归模型和成本分析进行检查的影响，主要与级联课程对候选人的performance.Findings：有一个显着的改善，在知识（58%至77%，p < 0.05）和临床信心（68%至90%，p < 0.05）课程后。“非医生”在课程结束后表现出更大的知识（22%）和信心（24%）改善（p < 0.05）。MCQ分数的改善程度差异显著，级联课程（21%）优于初级课程（15%）（p < 0.002）。多元回归模型进一步支持了这一点，其中级联课程是MCQ评分改善的强有力预测因素（Coef = 4.83，p < 0.05）。解释：卫生工作者的创伤管理培训在应对非洲日益增长的创伤负担方面发挥着关键作用。我们的研究表明，级联PTC课程可能是在低资源环境中提供创伤培训的有效模式，但需要进一步研究以确定其在长期提高临床能力和保留知识和技能方面的有效性。(C)2016作者由Elsevier Ltd.发布。这是CC BY-NC-ND许可下的开放获取文章。
Background: Injuries cause five million deaths and 279 Disability Adjusted Life Years (DALYS) each year worldwide. The COSECSA Oxford Orthopaedic Link (COOL) is a multi-country partnership programme that has delivered training in trauma management to nine sub-Saharan countries across a wide-cadre of health-workers using a model of "primary" courses delivered by UK instructors, followed by "cascading" courses led by local faculty. This study examines the impact on knowledge and clinical confidence among health-workers, and compares the performance of "cascading" and "primary" courses delivered in low-resource settings.Methods: Data was collated from 1030 candidates (119 Clinical Officers, 540 Doctors, 260 Nurses and 111 Medical Students) trained over 28 courses (9 "primary" and 19 "cascading" courses) in nine subSaharan countries between 2012 and 2013. Knowledge and clinical confidence of candidates were assessed using pre- and post-course MCQs and confidence matrix rating of clinical scenarios. Changes were measured in relation to co-variants of gender, job roles and primary versus cascading courses. Multivariate regression modelling and cost analysis was performed to examine the impact of primary versus cascading courses on candidates' performance.Findings: There was a significant improvement in knowledge (58% to 77%, p < 0.05) and clinical confidence (68% to 90%, p < 0.05) post-course. "Non-doctors" demonstrated a greater improvement in knowledge (22%) and confidence (24%) following the course (p < 0.05). The degree of improvement of MCQ scores differed significantly, with the cascading courses (21%) outperforming primary courses (15%) (p < 0.002). This is further supported by multivariate regression modelling where cascading courses are a strong predictor for improvement in MCQ scores (Coef = 4.83, p < 0.05).Interpretation: Trauma management training of health-workers plays a pivotal role in tackling the ever-growing trauma burden in Africa. Our study suggests cascading PTC courses may be an effective model in delivering trauma training in low-resource settings, however further studies are required to determine its efficacy in improving clinical competence and retention of knowledge and skills in the long term. (C) 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license.