PMID- 31307460
OWN - NLM
STAT- MEDLINE
DCOM- 20200123
LR  - 20200225
IS  - 1472-6920 (Electronic)
IS  - 1472-6920 (Linking)
VI  - 19
IP  - 1
DP  - 2019 Jul 15
TI  - Reinvigorating postpartum intrauterine contraceptive device use in Pakistan: an 
      observational assessment of competency-based training of health providers using 
      low-cost simulation models.
PG  - 261
LID - 10.1186/s12909-019-1683-y [doi]
LID - 261
AB  - BACKGROUND: Improved training approaches have the potential to overcome barriers 
      to the use of postpartum intrauterine devices (PPIUDs) in Pakistan, including a 
      shortage of female providers who are able to insert the device. This study 
      assessed the effectiveness and acceptability of a competency-based onsite 
      training approach that employed a newly developed anatomic model (the Mama-U) to 
      train doctors and midwives on postpartum family planning (PPFP) and the insertion 
      of PPIUDs. METHODS: An observational, mixed methods study conducted training 
      evaluations and knowledge and skills assessments with 11 trainers and 88 doctors 
      and midwives who participated in eight PPIUD training sessions. Two months later, 
      follow-up interviews and clinical assessments were conducted with 20 providers, 
      and interviews and a focus group discussion were conducted with 85 married women 
      who received a PPIUD from a trained provider. RESULTS: The training significantly 
      improved provider knowledge (p < 0.001), and follow-up assessments showed that 
      clinical skills were retained for at least two months post-training. After 
      training, 81.8% of providers were confident in their ability to provide PPIUD 
      services, and midwives and doctors had similar PPIUD insertion skills. However, 
      midwives were more likely than doctors to meet all 10 key requirements during 
      PPIUD counseling sessions (63.9% versus 13.3%, p = 0.004). Providers found the 
      Mama-U model to be a useful tool for client counseling as well as training and 
      skills practice, and clients agreed. Trainers identified the low cost, light 
      weight, and portability of the Mama-U model as advantages over the conventional 
      training model and noted that its abstract shape reduced embarrassment among 
      trainers, providers, and clients. CONCLUSIONS: Competency-based training with the 
      Mama-U model can improve the quality of PPIUD counseling and PPIUD insertion 
      services and has the potential to extend PPFP/PPIUD service delivery to midwives 
      working in rural Pakistan. The portable, low-cost Mama-U permits onsite, 
      on-the-job PPIUD insertion training that is tailored to the local setting; it is 
      also well suited for the continuing practice that providers need to maintain 
      their skills. Further research is needed to confirm the usefulness and 
      cost-effectiveness of the Mama-U at scale and in other settings.
FAU - Zafar, Zonobia
AU  - Zafar Z
AD  - Jhpiego Pakistan, 1st Floor, 85 - East Kamran Center Jinnah Avenue, Blue Area, 
      Islamabad, Pakistan.
FAU - Habib, Hammad
AU  - Habib H
AD  - Common Unit for Managing the Global Fund, Ministry of National Health Services 
      Regulations and Coordination, NIH, 1st Floor, Chak Shahzad, Islamabad, Pakistan.
FAU - Kols, Adrienne
AU  - Kols A
AD  - Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA.
FAU - Assad, Fauzia
AU  - Assad F
AD  - Jhpiego Pakistan, 1st Floor, 85 - East Kamran Center Jinnah Avenue, Blue Area, 
      Islamabad, Pakistan.
FAU - Lu, Enriquito R
AU  - Lu ER
AD  - Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA.
FAU - Schuster, Anne
AU  - Schuster A
AD  - Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA. 
      anne.cb.schuster@gmail.com.
LA  - eng
GR  - AID-OAA-F-13-00005/United States Agency for International Development/
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
DEP - 20190715
PL  - England
TA  - BMC Med Educ
JT  - BMC medical education
JID - 101088679
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - *Clinical Competence
MH  - Competency-Based Education/*methods
MH  - Cost Savings
MH  - Developing Countries
MH  - Family Planning Services/*education
MH  - Female
MH  - Focus Groups
MH  - Health Personnel/education
MH  - Humans
MH  - Intrauterine Devices/*statistics & numerical data
MH  - Midwifery/*education
MH  - Models, Educational
MH  - Pakistan
MH  - Postpartum Period
MH  - Pregnancy
MH  - Simulation Training/*economics
MH  - Young Adult
PMC - PMC6631998
OTO - NOTNLM
OT  - Anatomic models
OT  - Intrauterine contraceptive device
OT  - Pakistan
OT  - Postpartum family planning
OT  - Task shifting
COIS- The authors declare that they have no competing interests. Laerdal provided the 
      Mama-U models used in the field test. However, they did not contribute to the 
      study design, implementation, or data analysis, nor did they fund any study 
      activities beyond donation of the models.
EDAT- 2019/07/17 06:00
MHDA- 2020/01/24 06:00
PMCR- 2019/07/15
CRDT- 2019/07/17 06:00
PHST- 2018/01/09 00:00 [received]
PHST- 2019/06/24 00:00 [accepted]
PHST- 2019/07/17 06:00 [entrez]
PHST- 2019/07/17 06:00 [pubmed]
PHST- 2020/01/24 06:00 [medline]
PHST- 2019/07/15 00:00 [pmc-release]
AID - 10.1186/s12909-019-1683-y [pii]
AID - 1683 [pii]
AID - 10.1186/s12909-019-1683-y [doi]
PST - epublish
SO  - BMC Med Educ. 2019 Jul 15;19(1):261. doi: 10.1186/s12909-019-1683-y.