The aims of this training workshop are to:
- Review the quality of care for children in this country
- Introduce the WHO clinical guidelines (the WHO Pocketbook for Hospital Care for Children) and teach health workers how to use them in everyday clinical practice
- Discuss the obstacles to improving quality of hospital care for children and suggest ways to improve
A training workshop is generally held in a large district, provincial or regional hospital; of sufficient size to have clinical cases for participants to practice using the WHO guidelines during the course. Trainees will include doctors, nurses and senior health workers. Trainees can be from the same hospital where the training is taking place or from several hospitals in the country or province.
The teaching material can be presented in a large group setting or in smaller groups, depending on facilities available and the number of trainers available. We have found that a large group session of 20-25 participants works well if the teaching methodology employed is participatory and interactive. The course generally runs for 4 days.
The workshop materials
The technical material contained within the CD-ROM includes clinical case notes with power point presentations for each case. The clinical cases illustrate the chapters in the Pocketbook: Neonate and Young Infant (2 cases included plus clinical photographs), Cough or Difficult Breathing (clinical case plus videos in chapter 4 & 10), Diarrhoea, Fever, Severe Malnutrition, HIV/AIDS, and Surgical problems.
The cases discussed illustrate clinical signs, the decision making approach for each condition, and the common stages or processes of care relevant to all sick children: triage, emergency treatment, history and examination, differential diagnosis, monitoring and supportive care, discharge planning and follow-up. Short video clips are included in several of the chapters to illustrate specific clinical signs and procedures from the WHO guidelines.
Practical work is carried out in the hospital wards involving children who have presented or been admitted.
The roles of trainers
The main role of trainers (or facilitators) is to support the learning for the participants. They should emphasize that the aim of the course is not to teach health workers all the technical content of the guidelines, but to teach how to use the guidelines in everyday clinical practice. Trainers should also emphasize that the course is about learning the processes of care (triage, emergency treatment, history and examination, differential diagnosis, monitoring and supportive care, discharge planning and follow-up). Good quality hospital care is
not just about making a diagnosis and giving a drug treatment.
The trainer needs to create a positive and open attitude in the group so that participants can feel free to take an active part in discussions. The trainer should be encouraging and motivating. They may ask open-ended questions to expand the discussion and praise participants for their efforts. The trainers need to know and state the objectives of the course. They should be familiar with all the cases, power point presentations, videos and sessions to be held, so that the workshop program can run smoothly. They should find clinical cases on the wards for the practical work that is necessary for the course.
Schedule of the workshop (see sample time-table Appendix 1)
Two or three cases will be covered each day. The cases that will be covered are:
- Cough or difficult breathing
- Fever and coma
- Infections in young infants
- Severe malnutrition
- Children with HIV/AIDS
- Low birth weight babies newborns
Other important sessions that should be covered are communicating the results of:
- Assessments of the quality of care conducted in hospitals in the country (on the first morning)
- Discussions of what participants think are obstacles to improving the quality of care in their hospital, region or country (often on the last day).
- Discussions of how hospitals can work together with the health system and other sectors to contribute to greater equity, child rights and community development.
Introduction of the course
The course begins with self-introduction of participants and trainers. Some workshop guidelines should be agreed upon by trainers and participants to make most effective use of time and to enhance the learning environment. These could include:
- Attendance at each sessions every day
- Arrival on time
- Participation in all activities
- Work co-operatively and show respect for each other
- Complete the tasks for each given day
In the introduction trainers will describe the course; how it will be run and what can be achieved.
Working through the cases
The case discussions begin with a participant reading out the case history. The problems are worked through as they arise. Participants should be encouraged to ask questions, and trainers should be alert to complex areas within cases that participants may not understand initially. Trainers should explain unfamiliar concepts in several ways where possible, and seek confirmation from participants of their understanding.
Participants should be encouraged to use the Pocketbook to answer all questions that arise during the presentation of the cases, to continually refer to these resources so they become familiar with their layout and content.
Use of other material on the CD-ROM
Video clips as listed below will be shown during classes that illustrate specific clinical signs or procedures:
- Emergency and priority signs: short clinical videos (Chapter 1)
- Signs of serious neonatal illness: clinical photographs (Chapter 3)
- Respiratory case videos: bronchiolitis, asthma, etc (Chapter 4)
- The diagnosis and management of wheeze (Chapter 4)
- Dengue fever (Chapter 6)
- How to give oxygen (Chapter 10)
Practical clinical work consists of using the WHO guidelines to work through similar problems in clinical cases on the wards. This helps reinforce knowledge and skills, thus providing an opportunity to practice developing management plans in real clinical situations, using the Pocketbook or the RCM as the technical resource. Participants should be encouraged to systematically work through the processes of care with each clinical case seen, and to use the Pocketbook or the RCM to make a diagnosis, suggest differential diagnoses, and to decide on treatment, the type of monitoring and supportive care that will be required for that patient.
Evaluation of the course
The participants will be given an evaluation form (Appendix 2) at the end of the last session. This should be anonymous and consists of a self-administered questionairre to know their views on the course and suggestions. Feedback from the participants will be considered when further developing the implementation course.