Strengthening Midwifery education & training in Guyana

Stakeholder meeting GPHCJanuary 29, 2015

Why are we here

• To improve maternal health• To achieve MDG 5• To ensure that the women of Guyana get the

best possible pregnancy care

Improvements in physician training

Identified need (reiterated in the MAF)• Training & retention of a local cadre of competent skilled

obstetric specialists• GPHC ObGyn residency program launched 2012– Supported by UH Case Medical Centre WONDOOR– Now 3 classes, 17 residents– Improvements in physician competency, system improvements

(triage, protocols)• BUT identifiable gap developing between the

competencies and professionalism of nursing staff and the physicians

Need identified:

• Improve competency of all callibre of health worker particularly in the obstetric emergency (MAF)

• Improve the capacity of midwives through the strengthening of in-service and basic midwifery training

Stakeholder meeting: November 2013• ObGyn faculty from UH met with GPHC Nursing

administration & representatives from the Nursing School

• Issues raised– Decreased number of available trained midwives– Limited capacity of the nursing school and the

suggestions that GPHC take on a batch of students similar to Linden & New Amsterdam

– Everyone agreed the current curriculum for the Certificate of Midwifery needed review

• Suggestions proposed– Improve current Certificate of Midwifery curriculum– Consider development of Diploma/degree in Obstetric Nursing at UG– Everyone acknowledged the importance of collaborating with, &

ensuring the programs were accredited by, Guyana Nursing Council– UH & collaborating hospitals could provide initial faculty with local

faculty development through these programs to ensure sustainability• A committee was proposed, including representatives from

the nursing council, midwifery school, GPHC Maternity & UH• Guyana nursing school to send documents to UH• Timeline

– Curriculum & budget by mid January 2014– Application and intake April/May 2014

• The committee never met

Stakeholder meeting: January 2014

• 28 stakeholders, GPHC nursing, medical & HR admin, Maternity supervisors and educators, GNC, MOF, MOH, Director HSE, Faculty from UH – incl , Director of the Nurse Midwifery Program UH/Case

Western, PhD in Education, on the board that Reviews and accredits Midwifery programs across the United States

• “to improve midwifery and obstetric nursing care and opportunities and in the present climate of improved medical training to avoid leaving nurses behind “

• Issues / Questions raised– Is the objective to strengthen the skills of the current

midwifery providers OR enhanced the midwifery program?

– Both are needed– 1st priority to enhancing the midwifery training by

reviewing the curriculum, designing a new program for delivery and piloting this at GPHC.

– 2nd: the development of a degree program in Obstetric nursing offered to people who have completed their midwifery training

– Curriculum review need to incl the assessment of competence not just what needs to be taught

– any review of curriculum or improvement in training opportunities should not be limited to GPHC but spread across the country.

• Physician & Midwifery faculty from UH comment on the current Midwifery curriculumthe curriculum as it exists is academically comprehensive however, it does not – include progressive time lines and accompanying

evaluation tools. – clearly define what is acceptable student objectives that

result in achieved benchmarks. – Include a plan for remediation if benchmarks are not

reached . Lack of these key elements do not enable faculty to evaluate the level of baseline knowledge and skill base that insures adequate patient care.

• Entry criteria- should nursing training be required? For GPHC yes

• Class size (20-25 at GPHC with 15 to return)• Satellite sites (WDRH, Suddie) suggested but the

importance of competent Faculty raised• Faculty development:– develop a degree program at UG (long process) OR– Intensive 6 month course of select group chosen for their

leadership potential• Incentive & remuneration for faculty– Educators get a stipend or salary raise– Non-financial incentives include reduced clinical load

with protected time to teach & prepare

• Second option unanimously supported• Timeline– Selection criteria & recruitment process by late

January 2014– Applications due end of Feb 2014– Interview & announce successful candidates March– Commence training in May 2014

– Concurrently work would begin on curriculum review, development of evaluation tools & instructional methods

• No one applied!

• Why??– Skeptical, unknown, what were the benefits– Some single trained midwives very interested– Other RN/RM interested currently enrolled at UG

• At the same time, need to increase the capacity of midwifery staff at GPHC immediately, becoming more obvious

Discussions between GPHC & UH• Start mandatory compliance training for all

midwifery/ obstetric nursing staff at GPHC– 6 months program covering core topics/ to be repeated,

ongoing– Opportunity for all staff to be exposed to teaching and

build some rapport with UH midwifery staff– Opportunity to identify leaders & faculty for new

midwifery program• Intensive faculty development 3-6 months• After curriculum & assessment review role out new

Midwifery training for Guyana (consider pilot at GPHC)

In-service training plan developed• supported by GPHC• UH identified an educator (but not a UH employee)• List of topics & teaching schedule established• 6 broad categories covered each month• Pre Readings to be identified & distributed to all staff– Textbook recommended & purchased by GPHC

• Weekly teaching times- 2 live, 2 recorded• Pre & post tests• Record of attendance at a session & submitting the post test

mandatory for all staff• Staff rostered to all access the teaching

Why didn’t it happen?• IT issues- needed a internet based platform for uploading

slides & recording lectures• PAHO donated space on their virtual classroom-

Elluminate• Educator in Cleveland unable to make it work, no IT

support• Slow progress because communication & planning always

going through residency office. Need direct nursing to nursing communication & planning (UH & GPHC)

• How were we going to make it mandatory?

Where to from here?

• All stakeholders to reiterate their agreement to the process

• Identify solutions to proposed bottlenecks• Commit to delivering on these solutions

The proposal: A stepwise strategy1. Mandatory in-service training developed & piloted at GPHC (6

month pilot but ongoing)2. Local midwifery faculty development

– Identified through in-service training– Selected through application & interview process

3. Review of Midwifery certificate curriculum, delivery process and assessment tools– Perhaps in collaboration with the identified faculty

4. Pilot the new midwifery program at GPHC5. Role out new midwifery program nationwide6. Consider – UG degree in Obstetric Nursing– Consider mandatory CME/CPD for ongoing midwifery registration

Mandatory In-service training at GPHC

• Need UH Nursing educator with IT support• Need reliable internet & teaching space at GPHC• Need to identify 2 Nurse Educators at GPHC– IT savvy – To communicate & liaise with UH– To organise local logistics of the training, as well as other

MW educational activities, simulations, protocol training etc

– Need to be given protected time/ reduced clinical load• Need to identify process to make it mandatory– Incentives for participating? Disincentives for not?

Local Faculty Development

• Confirm selection criteria & process• Need reliable internet & training space• Need to fund participants travel to the US for (2-4

week observership & training)• What will be their incentives?• Will they be bonded?• Need faculty from other regional hospitals/ MW

traning sites if program is to role out nationally• What can we learn from NICU program?

Midwifery Curriculum review

• UH Midwifery education experts to be identified & enabled to complete task– Protected time, compensation

• Committee from Guyana to be identified for UH to liaise with. Who will be the lead?

• Reliable internet and computer access• What is the process for accreditation with the

GNC

New Midwifery program

• Budget for 15 visits per year from visiting faculty for teaching and evaluation procedures

• Incentives for local faculty• Need to ensure regular supply of necessary

equipment eg fetal monitors at all training sites

Now to open the floor…

• What are the stakeholder opinions?• Is there anyone missing?• Are the other initiatives to improve midwifery

or nursing education?

• What is the new time line?• Who are the leaders & champions?• Who is contributing what?