Retention of knowledge and skills after Emergency Obstetric Care training: A multi-country longitudinal study

Abstract

ObjectiveTo determine retention of knowledge and skills after standardised “skills and drills” training in Emergency Obstetric Care.DesignLongitudinal cohort study.SettingGhana, Malawi, Nigeria, Kenya, Tanzania and Sierra Leone.Population609 maternity care providers, of whom 455 were nurse/midwives (NMWs)MethodsKnowledge and skills assessed before and after training, and, at 3, 6, 9 and 12 months. Analysis of variance to explore differences in scores by country and level of healthcare facility for each cadre. Mixed effects regression analysis to account for potential explanatory factors including; facility type, years of experience providing maternity care, months since training and number of repeat assessments.Main outcome measuresChange in knowledge and skills.ResultsBefore training the overall mean (SD) score for skills was 48.8% (11.6%) and 65.6% (10.7%). for knowledge. After training the mean (95% CI) relative improvement in knowledge was 30.8% (29.1% - 32.6%) and 59.8% (58.6%– 60.9%) for skills. Mean scores for knowledge and skills at each subsequent assessment remained between those immediately post-training and those at 3 months. NMWs who attended all four assessments demonstrated statistically better retention of skills (14.9%, 95% CI 7.8%, 22.0% p<0.001) but not knowledge (8.6%, 95% CI -0.3%, 17.4%. p = 0.06) compared to those who attended one or two assessments only. Health care facility level or experience were not determinants of retention.ConclusionsAfter training, healthcare providers retain knowledge and skills for up to 12 months. This effect can likely be enhanced by short repeat skills-training sessions, or, ‘fire drills’.

Training in obstetric and neonatal emergencies in Mexico: effect on knowledge and self-efficacy by gender, age, shift, and profession

“…The PRONTO program increased knowledge and self-efficacy in obstetric and neonatal emergencies among healthcare providers. This is consistent with results obtained in previous studies [20,21,25]. Our analysis showed a significant increase in knowledge and self-efficacy in every course topic; this is a relevant result given that these complications are among the main causes of maternal and neonatal mortality in Mexico [26].…”

“…Previous authors [29] noted that the most necessary elements for successful medical trainings are simulations and repeated training periods. We recommend ongoing interprofessional training in all medical units to maintain the required knowledge and skills as the literature suggests that knowledge in adults might be diluted 3-6 months after training [36] although recent research on obstetric care puts this figure up to 12 months [25], suggesting repeated drills might be beneficial to ensure retention.…”

Social return on investment of emergency obstetric care training in Kenya

“…Training in EmOC has been shown to lead to increased knowledge and skills among healthcare providers and improved pregnancy outcomes for women who receive care from them 8–10. Thus, while a strong case can be made for continued investments based on evidenced effectiveness,9–11 there is a need for, and a growing interest in, evidence to demonstrate if EmOC training is a cost-effective intervention and, more broadly, if investments made in implementing such training can be considered value-for-money (VfM) 12 13. Traditionally, cost-effectiveness, cost-utility and cost-benefit analyses have been used to assess VfM of public health interventions 13.…”

Health Facility Capacity to Provide Postabortion Care in Afghanistan: A Cross-Sectional Study

“…After training, health care providers retain knowledge and skills only for up to 12 months. 25 Although most facilities had supplies, equipment, and drugs needed for PAC, there were gaps in availability of supplies, equipment, and drugs in different HFs. More than two-thirds of HFs, both public and private, had a D&C kit, indicating that this procedure is still widely practiced in Afghanistan.…”

“…9 Providers' knowledge and counseling skills could be improved through evidence-based, short, repeated learning sessions. 25,32 Respectful care is a key component of quality of care within a rights-based framework and should be considered while providing family planning counseling and services. 33 It is paramount to consider values clarification exercises while developing the capacity of health care providers to ensure that women are treated with respect and to prevent negligence.…”