“I Need to Be the First One with a Different Approach and to Make a Difference to the People”: A Mixed Methods Pilot Study on Non-Physician Clinicians Training in Malawi

Abstract

Purpose

To improve child health care depends on the availability of sufficient numbers of skilled healthcare workers. To achieve this, the German Society of Tropical Paediatrics & International Child Health supported the existing three-year Bachelor of Science in Paediatrics and Child Health training for Clinical Officers, a non-physician clinician cadre, from 09/2017 to 08/2019. This study aims to evaluate the project to inform forthcoming training.

Methods

All 17 students who were in training took part in this study. Quantitative data collection took place between 01/2018 to 06/2019 using the post-self-assessment bloc course survey, Research Self-Efficacy Scale (RSES), and Stages of Change (SOC) model. Students and key informants participated in three focus group discussions and five in-depth interviews during April 1–10, 2019.

Results

Students mostly perceived bloc course contents “At their level” (92%) and “Very important/relevant” (61%) with “Good quality” teaching (70.5%). The mean (SD) score for RSES (10-point scale) was 9.10 (0.91). The SOC (4-point scale) scores were higher for “Attitude” and “Intention” statements than “Action”. Students found the program well-paced, felt that their clinical knowledge and skills had improved, and valued the acquired holistic disease management approach. They reported increased confidence and being more prepared for leadership roles in their future work. The involvement of international teachers and supervisors enriched their global perspectives.

Conclusion

Students improved their clinical and non-clinical skills, developed self-efficacy and attitudes toward research, and were confident to build and utilize their networks. These transformative experiences could facilitate the development of change agents among current and future trainees.

Keywords:

• clinical officer
• health partnership
• child health
• transformative learning
• interdependence in education
• change agent
• non-physician clinician

Abbreviation

BSc, Bachelor of Science; BT, Blantyre; CoM, College of Medicine; CO, Clinical Officer; CPD, Continuous Professional Development; DH, District Hospital; FGD, Focus Group Discussion; GTP, German Society of Tropical Paediatrics & International Child Health; IDI, In-depth Interview; KCH, Kamuzu Central Hospital; LG, Lilongwe; MJ, Mchinji; MoH, Ministry of Health; NPC, Non-physician Clinician; PCH, Paediatrics and Child Health; RSES, Research Self-Efficacy Scale; RMNCAH, Reproductive, maternal, neonatal, child and adolescent health; SD, Standard Deviation; SL, Salima; SOC, Stages of Change.

Data Sharing Statement

Data will be available on request. Farzana Yasmin is responsible for data access.

Ethical Approval

Ethical approval was granted from the Ethics Commission of the Witten/Herdecke University, Germany (Application No. 94/2018) and the College of Medicine, Malawi (P.06/18/2428).

Acknowledgment

We thank the BSc PCH CO program students, College of Medicine, Malawi, for contributing to the study.

Author Contributions

Farzana Yasmin (FY): Made a significant contribution to the work reported -in the conception, study design, execution, acquisition of data, analysis, and interpretation. She drafted the article.

Andreas Schultz (AS): Made a significant contribution to the work reported - in the conception, study design, execution, acquisition of data, analysis, and interpretation. He partly drafted and substantially revised the article.

Ajib Phiri (AP): Made a significant contribution to the work reported - in the conception, study design, and execution. He critically reviewed the article.

Ralf Weigel (RW): Made a significant contribution to the work reported - in the conception, study design, and interpretation. He critically reviewed the article.

All authors (FY, AS, AP, RW) have agreed on the journal (Advances in Medical Education and Practice) to which the article will be submitted.

All authors reviewed and agreed on the version of the article for submission and agreed to take responsibility and be accountable for the article’s contents.

Disclosure

All authors declare no competing interest. The funding bodies played no role in study design, data collection, analysis, interpretation, or manuscript writing.

Additional information

Funding

The Federal Ministry for Economic Cooperation and Development (BMZ) and the Else Kröner-Fresenius-Stiftung (EKFS) funded the project and the study and Friede Springer endowed professorship for global child health, Witten/Herdecke University Germany, provided the publication fee.