Innovations in Training

IDCAP developed a novel package of training interventions that incorporates three key elements: 1) a focus on mid-level practitioners, 2) integration across infectious disease, and 3) on-site clinic training. The IDCAP approach was a sustained intervention that minimized out-of-clinic time by combining classroom training, distance learning and on-site support.

Integrated Management of Infectious Disease (IMID)

IMID consisted of a three-week classroom core course followed by two one-week boost courses over an 8-month period, separated by periods of independent distance learning. IMID was designed to create efficiencies by integrating existing infectious disease curricula and harmonizing guidelines into a single course targeting MLP.

IMID Classroom Training:

The three-week classroom-based core course mirrors the clinical reasoning process by structuring each session around a case. Rather than vertical content silos, IMID focuses on the patient – more than the disease – and teaches clinical reasoning skills. Beginning with the patient describing their symptoms, trainees determine possible diagnoses by working through the steps of conducting a history, physical examination and ordering laboratory tests. For many of the sessions, clinical decision-making guides that harmonized existing guidelines were developed to lead trainees through a set of formal decision points.

A sample session from the course can be found here. To request a full set of IMID course materials, please fill out a request form . A distance learning version of IMID, which includes audio lectures that cover the full three-week core course, is also available. If you are interested in the distance learning version of the course, please fill out the same request form and indicate your interest in the "Institutional Affiliation" box.

Boost Courses:

Twelve and 25 weeks after the three-week Core Course, trainees returned to the classroom to participate in one-week boost courses. The Boost Courses focused on analysis of complex cases, some of which were taken from the trainees’ own clinical practice. The first Boost Course included four half-day clinical placements, so that by the end of all classroom training, participants had completed 12 half-day clinical rotations.

Distance Learning:

Between classroom-based trainings, MLP used clinical practice logbooks to: 1) recognizing complex cases in their daily practice; 2) identifying sources for consultation; and 3) articulating case details for another clinician. Participants recorded at least 1 case each week detailing the process and description of their clinical reasoning to arrive at a final diagnosis.

On-Site Support (OSS)

Training programs are widely believed to be more effective when they are performed at the trainee’s place of work, but this is thought to be expensive and little evidence exists to support this theory. IDCAP set-out to test the effectiveness of on-site training programs by randomizing an on-site support (OSS) intervention to half of the participating health centers.

To reach beyond the two MLP from each clinic who participated in IMID, IDCAP designed an on-site support (OSS) intervention to provide team-based training to multidisciplinary staff at the clinics in which they work. Merging clinical training and Continuous Quality Improvement (CQI), OSS aimed to improve the capacity of participating MLP as well as overall facility performance. Intervention Arm clinics received two-day, monthly OSS visits for nine months.

OSS is based on the idea that the transfer of learning to practice happens in the workplace and among teams. OSS combined four key elements: multidisciplinary team training, break-out sessions for cadre-specific learning, reinforcement through one-on-one clinical coaching and CQI activities. Nine OSS modules were developed, each of which addressed a different infectious disease topic. A Mobile Team comprised of a doctor, a clinical officer, a laboratory professional, and a local District Health Team nurse delivered the OSS trainings.

The OSS visits encouraged members of the multidisciplinary teams to learn together and examine systems issues that interfere with good patient care. The visits were structured to minimize demands on the short supply of health workers, and avoid exacerbating patient wait times. While IDCAP focused on infectious disease, OSS can be adapted to different types of care to effectively and efficiently deliver specific skills in trainees’ work environments.

IDCAP Training Attributes

Focus on mid-level health practitioners

Nurses and other mid-level health practitioners need incremental training to facilitate their performance of tasks normally associated with doctors, and limited training opportunities for this segment of the health workforce currently exist. Governments also lack evidence in support of the policy changes needed to legally empower such mid-level health practitioners. IDCAP’s new course aimed at mid-level health practitioners will add value to the field of training, and evidence about the ability of these practitioners to perform task-shifted activities adequately, and will support policy decisions.

Integration across infectious disease

There is general consensus that the compartmentalization of disease content in different training programs causes detrimental inefficiencies. IDCAP’s new program integrates proven content from several disease-specific training programs in infectious disease to achieve efficiencies in the course duration, and greatly improved impact on clinical reasoning skills among trainees. The new IDCAP course addresses HIV/AIDS, malaria, tuberculosis, and other childhood diseases, from a syndromic perspective – with a unique focus on the patient as the center of all learning exercises.

On-Site Support (OSS) component

Training programs are widely believed to have more lasting effect when they are performed at the trainee’s place of work, and some limited evidence does exist to support this theory. But adoption of this approach has been slow to catch on due to the cost and complexity of implementation. IDCAP builds on the success seen in Accordia's multidisciplinary approach to fever case management training, carried out by mobile teams that perform training and other on-site support (OSS) activities at the health facility level, and seek to build new evidence in support of the cost-effectiveness of an OSS approach.