To our knowledge, this is the first time an inter-professional HIV training curriculum has been adopted at scale across African pre-service institutions. Furthermore, it is unique in its focus on learners that are in transition between pre-service and independent professional practice. This inter-professional approach to curriculum development and pre-service learning offers a model that can be used to enhance training in other areas, topics, or disciplines of pre-service training in Sub-Saharan Africa.
Focus on transitional training
While transitional training has been increasingly adopted in diverse health disciplines, the vast majority of transition courses have focused narrowly on surgical or other procedural skills. Furthermore, while curricula have been implemented to address the transition from student to resident physician in the US and Europe, this is the first time that a training resource like this has been developed for trainees from different cadres and in an African setting. In many settings in SSA, there are limited systems in place to support health professionals once they leave full time education. Moreover, the licensure requirements of different cadres in different countries are variable, such that newly graduated health care professionals in various settings practice HIV care with sub-optimal oversight, support, or continuing professional development opportunities. In such contexts, transition-specific education interventions can be an effective means of enhancing clinical practice by targeting learners at a critical time in their professional development.
Emphasizing inter-professional education
Recent reports have called for renewed emphasis on inter-professional education as an effective means of enhancing health professions education. However, to our knowledge, there has been limited research exploring how to implement inter-professional training in African settings. We assert that inter-professional training is the kind of transformative educational resource that can break down professional silos while also enhancing collaborative and non-hierarchical relationships that have undermined HIV care in many high burden settings. We recognize that implementing effective inter-professional education can only occur with the buy-in of institutional leadership and with sufficient funding, and we were fortunate to have financial support from HRSA and enthusiastic endorsement of deans of nursing and medical schools across all participating countries. Nonetheless, with institutional support and strong local leadership, this approach to learning can be adapted and implemented at minimal cost and is well suited to resource-constrained settings.
Implementing effective IPE also demands availability of faculty competent to lead inter-professional trainings, appropriate ratios of teachers to students, and coordination across professional training programs and academic calendars. Nonetheless, the necessity of this kind of instructional approach cannot be overstated. Not only is IPE important to ensuring high quality team-based HIV care, it is essential to the clinical practice of most major diseases in increasingly complex health settings in SSA. Given the scarcity of pedagogical resources for HP in Africa, IPE training modalities offer an efficient way to teach key domains of clinical practice to learners from across different cadres. Moreover, this kind of approach to education for health professions, matching competencies that correspond to local needs, offers a template for how elements of clinical training can be delivered sustainably.
Tools for Quality Improvement
Over the last two decades, there has been increasing recognition of the importance of quality improvement modalities to enhance HIV service delivery in SSA. Simultaneously, quality management systems are being hardwired into health systems across the continent in order to optimize services, especially where services are constrained. Unfortunately, as one recent report highlighted, low quality care in Africa has a profound, deleterious impact and responsible for millions of deaths each year. In addition, our own needs assessment illustrated how few pre-service institutions taught QI modalities to health professions students. Our curricular intervention provides learners with an introduction to a variety of QI tools, but there is a pressing need to weave this kind of QI training into a more comprehensive approach to quality in health professions training in SSA. Furthermore, greater health professions education research in SSA is warranted to demonstrate how equipping learners with QI skills can be an effective catalyst to address inequities in access and quality of care. A key limitation of the intervention relates to the fact that it will be challenging to link its impact on clinical outcomes; feedback on the training, and knowledge gained and retained are at best surrogate markers for clinical outcome measures. In the next phase of the project, an explicit goal is to determine the extent to which QI training leads to use of QI modalities in clinical practice, that can lead to improvements in clinical outcomes. Last, in the next phase of the project, we intend to rigorously assess the impact of training on both learners and educators, as well collect qualitative and quantitative feedback from partner institutions to identify gaps in the original curriculum, and used evidence-based educational strategies to address them.