.
TRAINING OF SECOND MODULE ON CLINICAL LEADERSHIP AT
MALAWI INSTITUTE OF MANAGEMENT, LILONGWE.
Visit Report
23rd June , 2012
Dr S.S. Ndeki
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1.INTRODUCTION
The visit to the Malawi Institute of Management (MIM) took place from 4th to 8th June,2012.
The aim of the visit was to observe and learn from the training of the 2nd Module on Clinical
Leadership to COs pursuing a BSc course conducted at MIM by the Warwick Medical School
faculty. The idea of the visit was conceived because there is a similar one week module on
Leadership conducted to Assistant Medical Officers undertaking a short course on Emergency
Obstetrics Care (EmOC) in Tanzania. Given the similarity of training in Leadership to similar type
of participants in Malawi and Tanzania, it was suggested that Sidney Ndeki, who is responsible
for the leadership training in Tanzania, takes an opportunity to visit, observe and learn from the
experience from the training taking place in Malawi. Lessons learned from the visit would be
used to improve the training in Tanzania.
2.THE TRAINING IN MALAWI
The Bsc training for COs comprises 8 modules as indicated in table 1. The focus of the visit was
on the second module on Clinical service improvement and leadership which takes one week.
Table 1. Clinical services improvement and leadership course
College of Health Sciences diploma & clinical experience
Emergency
obstetrics &
neonatal care
Clinical service
improvement
& leadership
Advanced
surgical &
obstetric skills
Audit into
practice
professional
project
Understanding
research &
critical
appraisal
Science, sepsis
& surgical
intervention
Pre-term
labour &
managing preterm infant
Professional
project
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The content
The training of the module is conducted using five components as shown in Figure 1
Figure 1: Leadership in Malawi is about delivering high quality services to patients
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The five components were trained in five days following the time table shown in Table 2
Table 2 Outline timetable of the course in Malawi
Time
4th June
5th June
6th June
7th June
8th June
8-10:15
Welcome
introduction
Value based
practice
Service
improvement
and audit cycle7
implementing
clinical
guidelines
Quality
improvement in
Obstetrics –
expert panel
Shared leadership
& Clinical
leadership
competency
Framework
Audit feedback
10:15- 10:30
Break
Break
Break
Break
Break
10:30 – 12:00
Working with
audits
Value based
practice
Evidence based
practice and
research
Team working ,
managing change
&VSM
Behaviours &
skills for
leadership &
VSM
12:00- 1: 00
Lunch
Lunch
Lunch
Lunch
Lunch
1:00- 2: 30
Working with
audits
Value case studies
Service
improvement
scenario
Neonatal scenario
OSCE assessment
2:30- 2: 45
Break
Break
Break
Break
Break
2:45- 4:30
Introduction to
values-based
practice and
service
improvement
Value stream
mapping (VSM)
Service
improvement
scenario and
VSM
Neonatal scenario
Closure
The focus of training content was on service competences on the module called - Clinical service
improvement and leadership.
From day one, clinical audit was an area of focus and the
leadership implications were addressed. Also throughout the training there were examples in
clinical competences and the leadership aspects were applied to them.
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The process: Training methods
Team teaching – the training was conducted by a faculty including David Davies, Vinod Patel,
Saliya Chipwete, and Chisale Mhango. This collaborative training made the training interesting
and provided participants varied inputs from the faculty with extensive experience in both
clinical and leadership skills. This approach gave trainers an opportunity to fully prepare their
area of interest and expertise. Also this academic experience provided a teaching situation in
which the trainers worked together in designing the course. Also they taught the material not
by the usual monologue, but rather by exchanging and discussing ideas and theories in front of
the learners.
Graup work and plenary. This a was a common techniques used in training which often
followed a short trainer’s presentation. This method made students participate fully as
individuals and group interaction ensured. Following each group work participants were
provided an opportunity to present their work in plenary which involved class discussions. In
this context, working in groups presented a good way of dividing work and increasing
productivity. This method allowed for the utilization of the different participants skills,
knowledge and experiences. In addition working in groups enhanced effective leadership to
manage the process and helped the group decide how to work efficiently, and monitor the
group’s progress in relation to the intended plan. As such students practised good leadership by
not merely leading the group toward their own desired outcome. Instead they practised
listening and also re-evaluated their own opinion on a topic.
Panel discussion method – There was one occasion where participants were given an
opportunity to ask questions related to challenges they came across in their workplaces. In this
session there was a good discussion of various experiences from participants and the faculty
was able to respond to questions posed by participants. Panel discussion was more interesting
to the audience compared to a single-speaker forum. Although this method was not conducted
as a typical panel discussion the faculty panel provided sufficiently varied opinions and
presentation of facts.
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Multipurpose objectives - The training was planned in such a way that multiple purposes were
achieved at the same time. For example group discussion was able to develop interactive skills
while students were learning new knowledge or skill. Also participants were asked to train
other a skill such as resuscitation of a new born whereby training and new clinical skills were
learnt at the sametime.
Lecture discussion lecture- Lectures were short and facilitators used most of the time asking
questions. Through answering questions the subject matter was unveiled mostly by students.
This made the presentation more interesting and only aspects that were new would be given by
the faculty. Most times the presenter would be writing on the flip chart students input. This
method reinforced the learning.
Home work There was a common home work which was given to students which was a self
assessment. Also from the second day students were asked to be thinking about a service
improvement scenario. Homework served a clear purpose as it matched both the skills of each
individual student to the current topics being taught in class. Feedback improved the
effectiveness of homework.
Assessment methods
Self assessment on daily basis was prepared to make students assess themselves on selected
issues that were taught. Also OSCE was used to assess students on the final day. This was a
method whereby there were five stations through which students would visit. At each station
students were asked questions by a facilitator on practical issues such as hand washing,
resuscitation of a newborn, discussion with a DMO about the shortage of drugs etc. This
assessment method is practical, provides a student to express various skills, knowledge and
behaviours. This method also takes short time and feedback is prompt.
An OSCE usually comprises a circuit of short duration stations, in which each candidate is
examined on a one-to-one basis with one examiner and either real or simulated actors. Each
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station had a different examiner, as opposed to the traditional method of clinical examinations
where a candidate would be assigned to an examiner for the entire examination. Candidates
rotated through the stations, completing all the stations on their circuit. In this way, all
candidates take the same stations. It is considered to be an improvement over traditional
examination methods because the stations can be standardized enabling fairer peer
comparison
Training environment
The training room arrangement accommodated the number of participants and small group
activities. Readily accessible restrooms, snacks, lunch and accommodations helped ensured
that participants returned to the class sessions on time following breaks or lunch.
3. WHAT WAS LEARNT AND RECOMMENDATIONS FOR TRAINING IN TANZANIA
Training content
In Malawi the module is part of a long course on maternal and newborn health. On the other
hand in Tanzania the leadership course is part of a short course on EmOC to AMOs and nurses.
The training in Malawi provides various aspects of training for the Tanzania course in the areas
indicated in Table
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Table Leadership training aspects that Malawi course provides for Leadership training in Tanzania
EmOC
Leadership skills from Malawi cource
Aspects
Personal qualities
Working with others
Managing services
Improving
services
Setting direction
Competent care
X
X
X
X
X
;
X
X
X
X
X
Supervision and
Management
X
X
Training and
Development
X
X
Supplies,
equipment and
infrastructure
X
X
Access and continuity
Privacy,
confidentiality,
dignity, comfort &
expression of opinion
Recommendation 1: The materials for training especially in competent patient care and patient
centred care be incorporated into the training in Tanzania. However the focus of training in
Tanzania should continue to be broad including the clinical practice.
Team teaching
Team training provides a lead trainer to get support from other faculty to complete the training
of various related subjects to the topic. In this case, the teachers actively share the instruction
of content and skills to all students. Also when one teacher presents the new material to the
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students the other trainer constructs a concept map on the butcher paper as the students listen
to the presenting teacher.
Recommendation 2: The training in Tanzania should include other trainers to make training
richer and more interesting to students. At the moment there is only one trainer for the
leadership course.
Self assessment
There is a structured self assessment document prepared for students on respective leadership
areas that students use on a daily basis throughout the course.
Recommendation 3. The self assessment document should be used in the training of EmOc
students in Tanzania as well as to other health workers at workplaces to develop self
assessment practice.
OSCE
OSCE was used in the final assessment of students in Malawi. It was noted that the assessment
method was objective in that all candidates are assessed using exactly the same stations with the
same marking scheme. In an OSCE, candidates got marks for each step on the mark scheme that
they perform correctly, which makes the assessment of clinical skills more objective, rather than
subjective, which is where the examiners decide whether or not the candidate fails based on their
subjective assessment of their skills
Also the method is structured. Stations in OSCE have a very specific task. Instructions are
carefully written to ensure that the candidate is given a very specific task to complete. The OSCE
is carefully structured to include parts from all elements of the curriculum as well as a wide
range of skills. Finally the questions are standardized and the candidate is only asked questions
that are on the mark sheet.
Recommendation 4. OSCE should be introduced in the assessment of participants in leadership
courses in Tanzania. This method will offer the assessment which is objective, structured and
fair to participants. However the need for more trainers for the course in mandatory if OSCE is to
be introduced.
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Multipurpose objectives
The Malawi training used training methods that would achieve multiple goals. For example
students had an exercise to train others a particular clinical skill. In so doing they would learn
both training and clinical skills. This approach saves time and re-enforces learning.
Recommendation 5 The Leadership course in Tanzania should include training methods that are
multipurpose in order to efficiently develop students’ competences in Training, Leadership and
Clinical skills.
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