Category: Blog

NICHE International wants to ensure that the learning which candidates acquire when they attend a Neonatal Care Course, is put into practice in their workplaces.  

One way of doing this is to encourage peer to peer learning, which can be led by the health workers that have qualified as Neonatal Care Course Instructors and carried out in the health clinics and hospitals where they work.

There is evidence that short informal teaching sessions can embed good practice and reduce skills decay.

An award from BMA Giving is enabling us to buy new neonatal manikins to distribute to hospitals and clinics in Cameroon, to help midwives, nurses and doctors to practise neonatal resuscitation which saves babies lives.

On 31st July we ran our first Information Webinar for potential volunteers. We were delighted to see many keen people and some Cameroonian colleagues in attendance.

The best questions in the webinar were ‘How do we maintain the standards of the Instructors?” and ‘how do we know that what is taught on the course is incorporated into practice?”.  Both of these issues remain a challenge, and are linked to the Holy Grail of skills retention.

Dr Jarlath O’Donohoe muses on this further:

NICHE has a well developed structure of training, based on educational approaches that are used in resource rich countries for clinical training. However it is clear that there is a significant loss of skill and knowledge in the few months following a training course, wherever in the world that course is delivered. To help trainers keep up to date and to develop, NICHE has recently begun facilitating Instructor Development days for established overseas faculty members.

In high income countries attempts to overcome the loss of skills by practitioners principally revolve around repeat attendance at the training course, usually at an interval of years (often 4 years). The 4 year gap is for financial reasons principally because the forgetting curve (see diagram above) is pretty much at the bottom of the graph by the time people redo their provider courses. For practical and educational reasons, it may be worth trying to identify other techniques that practitioners could use to retain skills.

Various modifications of training technique have been suggested to help with skill retention and programme scale-up. These include discussing things with an inanimate object (a rubber duck is the example given) which has been recommended in the world of computer learning. “Simply talking about it will lead to enlightenment” Thomas D and Hunt A wrote in The Pragmatic Programming. Pearson Education Inc. 20^th Anniversary Edition.

For those not keen on talking to inanimate objects a closely related technique is the Feynman technique which has 4 stages. Imagine you are trying to teach something to an 10 year old child. Write down your description of what you are trying to learn. Identify the gaps and lastly find ways of filling in those gaps. This is Lernen durch Lehren, German for Learning by Teaching.

Mental imaging and rehearsal: athletes and surgeons often mentally rehearse their technique before implementing it. Instructors of life support courses practice exactly what they are going to demonstrate before teaching it. Results indicate that the more complex the teaching activity is, the more opportunities there are to learn by teaching. NICHE encourages the incorporation and extension of practices that provide opportunities for instructors to continue to learn by teaching their peers, peer tutoring and/or peer assessment (Duran, D. (2016). Learning-by-teaching. Evidence and implications as a pedagogical mechanism. Innovations in Education and Teaching International, 54(5), 476–484. https://doi.org/10.1080/14703297.2016.1156011). We have recently successfully fund raised for extra manikins to be sent to Cameroon faculty members for on-going microteaching sessions in instructors’ own healthcare facilities.

The forgetting curve and prevention of skills decay could be one of the discussion topics in the next Instructor Development Days.

Health centres run by the Cameroon Baptist Health Convention, our partners in Cameroon, share their maternal and neonatal mortality data with their Health Districts. They aim to learn from incidents. Grace and her colleagues were invited to Nkoabang Baptist Health Centre, Nkoabang Village on the Eastern edge of Yaoundé this week to deliver 2 days of training to the staff as one of the outcomes of a neonatal death review.

The topics covered are resuscitation at birth, new born infections, convulsions, and fluid and electrolyte balance.

Three experienced nurses who have trained as trainers with NICHE are leading the training.

This is a good way of learning from incidents and sharing the knowledge, and is vital to saving babies’ lives in Cameroon.

Health workers who have done the Neonatal Care Course, use a confidential WhatsApp group to seek advice about clinical problems of babies they are caring for, and also to talk about neonatal deaths that have occurred in their own health facilities.

This information enables midwives and nurses to support each other in their work, and is valuable in indicating where further training might be useful.