guidelines for basic and comprehensive inservice...

Guidelines for In-Service Training in Basic and Comprehensive Emergency Obstetric and Newborn Care Prepared by: Blami Dao

Jhpiego Corporation is an international, non-profit health organization affiliated with The Johns Hopkins University. For more than 36 years, Jhpiego has empowered front-line health workers by designing and implementing effective, low-cost, hands-on solutions to strengthen the delivery of health care services for women and their families. By putting evidence-based health innovations into everyday practice, Jhpiego works to break down barriers to high-quality health care for the world’s most vulnerable populations. Published by: Jhpiego Brown’s Wharf 1615 Thames Street Baltimore, Maryland 21231-3492, USA www.jhpiego.org Copyright 2012 by Jhpiego. All rights reserved. The following reviewers contributed to the development of these guidelines: Julia Bluestone Catherine Carr Sheena Currie Barbara Deller Patricia Gomez Yolande Hyjazi Rosemary Kamunya Jean Pierre Rakotovao Kusum Thapa

Guidelines for EmONC In-Service Training iii

TABLE OF CONTENTS ABBREVIATIONS AND ACRONYMS ........................................................................................ iv

1. RATIONALE FOR THE GUIDELINES ..................................................................................... 1

2. TRAINING GOAL AND OBJECTIVES ..................................................................................... 2

3. PRE-TRAINING PREPARATION ............................................................................................. 3

4. COMPONENTS AND CONTENT OF TRAINING IN EMONC .................................................. 5

5. TRAINING DURATION AND SCHEDULES ........................................................................... 11

6. COURSE MATERIALS ........................................................................................................... 20

7. ANATOMIC MODELS ............................................................................................................ 22

8. VIDEOS AND PRESENTATIONS .......................................................................................... 23

9. JOB AIDS ............................................................................................................................... 24

10. DOCUMENTATION OF ACTIVITIES ................................................................................... 24

APPENDIXES APPENDIX A: ORGANIZATION OF MATERNITY SERVICES ................................................. 25

APPENDIX B: EQUIPMENT AND SUPPLIES LIST .................................................................. 27

APPENDIX C: PRACTICUM LOGBOOKS FOR DOCUMENTING SKILLS PERFORMED WITH CLIENTS .......................................................................................................................... 30

APPENDIX D: SAMPLE ACTION PLAN FOR LEARNERS ...................................................... 32

APPENDIX E: TRAINING EVALUATION QUESTIONNAIRE ................................................... 33

APPENDIX F: TRAINING INFORMATION SYSTEM: DATA RECORDING FORM .................. 34

iv Guidelines for EmONC In-Service Training

ABBREVIATIONS AND ACRONYMS AMTSL Active management of the third stage of labor

BEmONC Basic emergency obstetric and newborn care

CEmONC Comprehensive emergency obstetric and newborn care

CPR Cardiopulmonary resuscitation

CTS Clinical Training Skills

EmONC Emergency obstetric and newborn care

EONC Essential obstetric and newborn care

ETT Endotracheal intubation

HBB Helping Babies Breathe

IP Infection prevention

LRP Learning resource package

MgSO4 Magnesium sulfate

MNH Maternal and newborn health

MVA Manual vacuum aspiration

OR Operating room

PAC Postabortion care

PPH Postpartum hemorrhage

SBM-R Standards-Based Management and Recognition

TIMS Training Information Monitoring System

Guidelines for EmONC In-Service Training 1

1. RATIONALE FOR THE GUIDELINES Few developing countries will meet their targets for Millennium Development Goals 4 and 5 by 2015.1 One reason they will fall short is that only about 61% of women globally give birth with a skilled attendant. In some countries in sub-Saharan Africa and South Asia the rate is closer to 50%, with even lower rates in rural areas.2 A compounding problem is that many skilled attendants (doctors, nurses and midwives) do not have the knowledge and skills needed to prevent, recognize and manage the major causes of maternal and newborn deaths: hemorrhage, infection, pre-eclampsia/eclampsia, obstructed labor and newborn asphyxia. The components of emergency obstetric and newborn care (EmONC) were delineated in the early 1990s by WHO, UNICEF and UNFPA.3 These “signal functions” are interventions that must be available to all women at the time of birth in order to address the common but unpredictable causes of maternal and newborn mortality. In outlining the EmONC interventions, WHO, UNICEF and UNFPA recommended that all providers become capable of managing these common complications in order to decrease need for referral and improve outcomes. The signal functions for EmONC are listed below:

SIGNAL FUNCTIONS FOR EMERGENCY OBSTETRIC AND NEWBORN CARE

Basic Emergency Obstetric and Newborn Care (BEmONC): • Parenteral treatment of infection (antibiotics) • Parental treatment of pre-eclampsia/eclampsia

(anticonvulsants) • Parental treatment of postpartum hemorrhage

(uterotonics) • Manual vacuum aspiration of retained products of

conception • Vacuum-assisted delivery • Manual removal of the placenta • Newborn resuscitation

Comprehensive Emergency Obstetric and Newborn Care (CEmONC): • All components of BEmONC • Surgical capability • Blood transfusion

Many countries are working to train more skilled providers in emergency obstetric and newborn care to increase access to these services. However, few countries have the funds or human resources that are needed to implement quality in-service training. Training that does not translate into the improvement of patient care wastes those scarce resources and can cost lives. Quality training in EmONC (and in any health-related field) goes beyond bringing together providers for classroom and clinical practice for several days. Evidence suggests that training works when it is competency-based and quality-focused and when it addresses transfer of learning to

1 Hogan MC et al. 2010. Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards Millennium Development Goal 5. Lancet (375): 1609–1623. 2 Crow S, Utley M, Costello A and Pagel C. 2012. How many births in sub-Saharan Africa and South Asia will not be attended by a skilled birth attendant between 2011 and 2015? BMC Pregnancy and Childbirth (12): 4. 3 Penny S and Murray S. Training initiatives for essential obstetric care in developing countries: A “state of the art” review. Health Policy and Planning 15(4): 386–393.

2 Guidelines for EmONC In-Service Training

practice through post-training follow-up.4 Clinical practice and feedback must be sufficient for the development of clinical decision-making and psychomotor skills.5 Evidence also reinforces the importance of clinically integrated learning interventions, as they have been found to be superior to classroom-only instruction for generating positive learning outcomes.6 This type of training ensures that learners—practicing clinicians and pre-service educators—are trained by qualified facilitators in appropriate classroom and clinical settings for an adequate amount of time, using evidence-based training materials and approaches. And it emphasizes timely follow-up of the learners in their workplace, where facilitators can assess how the learners have incorporated their new skills and knowledge into their management of actual clients. These guidelines provide the information and guidance needed to implement effective BEmONC and CEmONC training. Recommendations are made for selecting participants and clinical sites, training schedules, and where to find the materials and resources needed for effective clinical skills practice. Use of these guidelines will enable facilitators to train providers who are competent in evidence-based practices and who will ensure that their facilities offer quality EmONC services.

2. TRAINING GOAL AND OBJECTIVES The goal of EmONC training is to ensure that health facilities have competent providers who can offer quality EmONC services. By the end of their training, learners achieve the following specific objectives and competencies:

1. Identify the evidence basis for EmONC interventions.

2. Demonstrate understanding of clients’ rights through provision of respectful care to clients and their families.

3. Utilize positive interpersonal communication techniques with clients and their families.

4. Demonstrate competency (first on anatomic models; then with clients) in EmONC signal functions.

5. Demonstrate understanding and use of the clinical decision-making process.

6. Formulate action plans describing how they will act as role models and work to institutionalize evidence-based EmONC knowledge and skills in their own health facilities.

4 Kongnyuy E, Hofman J and van den Broek N. 2009. Ensuring effective Essential Obstetric Care in resource poor settings. BJOG 116(Suppl. 1): 41–47. 5 McGaghie WC et al. 2009. Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: Effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest 135(3 Suppl): 62S–68S. 6 Coomarasamy A and Khan KS. 2004. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ (Clinical Research Ed.) 329(7473): 1017–1022.


3. PRE-TRAINING PREPARATION Failure to prepare is the worst enemy of quality in any training program. Preparation should start at least three to six months before the training and should include several activities:

1. Selecting clinical sites This task is of paramount importance because it will ultimately determine the skills and attitudes learners will see modeled during the training. The following criteria can be used to select clinical sites:

Buy-in by the clinical site’s staff is needed to ensure smooth training.

Clinical site staff must be willing to go through targeted on-the-job technical and skills updates to be able to model best practices.

Evidence-based clinical standards should be in place at the site (e.g., respectful care, use of infection prevention practices, use of a partograph and active management of third stage of labor).

Adequate caseloads that are appropriate to the training (especially surgical cases for CEmONC) are needed because obstetric emergencies are relatively rare and learners need to be exposed to as many cases as possible. BEmONC training sites should have at least 10–15 deliveries per day, and CEmONC sites should have at least 10 deliveries and two to three cesarean sections per day. When the caseload is lower than this, night shifts can be organized or the length of the practicum can be extended so that all learners have the opportunity to achieve competency. The reality is that in developing countries there are many clinical sites with a high volume of cases but with poor quality of care, so strengthening of the site will be needed before training.

Please see Appendix A for a description of key elements in the organization of quality maternity services.

2. Strengthening and preparing clinical sites Every facilitator’s nightmare is that they bring learners to a facility where clinical practices are below standard or where there are frequent stock-outs of supplies. So, at least two weeks before the training, the facilitators should work with the clinical site staff on the following tasks:

Ensure that written evidence-based guidelines describing best practices in maternal and newborn health (MNH) (i.e., infection prevention, use of the partograph, active management of third stage of labor, and so on) are in place.

Determine whether the facility is woman- and baby-friendly (i.e., the rights of women and families to respectful care, privacy, confidentiality, the presence of a companion and autonomy are recognized; mothers and babies are not separated; early and exclusive breastfeeding is practiced; and so on).

Ensure that training will not unduly disrupt the facility’s work.

Make sure that sufficient supplies and medications such as infection prevention (IP) equipment (training necessitates an increased number of gloves), delivery sets, suture kits, oxytocin, magnesium sulfate (MgSO4) are available at the site. The training facilitators may


need to bring some of these medications and supplies to the site to ensure that learners will be able to manage cases in a timely manner instead of waiting for patients to purchase them before receiving care.

Refer to the Jhpiego publication Site Assessment and Strengthening for Maternal and Newborn Health Programs, available at www.accesstohealth.org, for a complete description of effective strengthening of clinical sites prior to training.

3. Selecting learners Selection of participants for training should be based on the following criteria:

Qualification as an obstetrician (or general practitioner), nurse and/or midwife, or anesthetist

Work experience as a provider in a facility delivering EmONC services and/or as a faculty member/tutor in a school of medicine or midwifery

Supervisor’s written commitment to enable the learner to utilize the knowledge and skills gained in the course in his/her clinical site and a commitment that the participant will be deployed in the maternity unit for at least 12 months after training

The best way to select learners is to form a three- to four-person team of providers from each facility. The suggested composition of the team is as follows:

For BEmONC courses:

– An obstetrician, general practitioner, or clinical officer

– Two midwives (or nurses/midwives)

The ideal number of learners for the BEmONC course is 16–24, depending on the number of clinical sites available as well as the caseload in each site.

For CEmONC courses:

– An obstetrician, general practitioner, or clinical officer with surgical skills

– Two midwives (or nurses/midwives)

– An anesthetist or a nurse anesthetist

The ideal number of learners is between 16 and 20, depending on the number of clinical sites available and the caseload at each site.

4. Selecting facilitators

Being a proficient obstetrician, midwife, or anesthetist is not enough to qualify as an EmONC facilitator. EmONC facilitators must meet the following requirements:

– Qualification as a midwife, doctor, or anesthetist trained in EmONC

– Qualification as a trainer through a Clinical Training Skills (CTS) course or ModCAL/CTS

– Currently working in a facility that delivers EmONC services or has regular opportunities to maintain clinical skills


One often-asked question is how many facilitators are needed for EmONC training.

For a BEmONC training with 16–24 learners, a minimum of three facilitators (two obstetricians plus one midwife, or one obstetrician plus two midwives) is needed for the knowledge update component. Since each team of three to four learners should be supervised by a facilitator during the clinical skills standardization portion of the course (including work with anatomic models), an additional two or three facilitators (either two to three midwives or one obstetrician and one or two midwives) will be needed. These facilitators will remain with the teams throughout the clinical portion of the course. These facilitators become critically important if the practicum takes place in a very busy facility where a few facilitators cannot adequately supervise all the learner teams when they are working with clients.

For a CEmONC training, an additional obstetrician is recommended for sites with many surgical cases; the number of midwives is the same as for BEmONC. In addition, two anesthetists (an anesthesiologist and/or a nurse anesthetist) will be needed.

5. Gathering equipment needed for training (see Appendix B)

6. Developing job aids Simple job aids that remind the learner of key information can be extremely valuable in helping the learner apply skills on the job. Posters, pocket guides and simple guidelines assist learners with quick recall and the application of complex skills. For more information, see section 9.

4. COMPONENTS AND CONTENT OF TRAINING IN EMONC Any complete EmONC training (and by extension any good clinical training) should include the following three components:

Knowledge update

Clinical skills standardization, resulting in the acquisition of competencies in specific skills (a list of competencies is included below)

Follow-up of learners in their sites within three months of the training, ideally by the facilitators who conducted the course

Jhpiego has applied evidence from a recent integrative review of the literature regarding the techniques, timing, setting and media used for the delivery of instruction to its EmONC training approach. The blended approach uses spaced, repetitive questions delivered via mobile phone text messaging (SMS) or the internet to address key knowledge objectives, followed by clinical practice in simulation and with clients, and continued follow-up and support after training. The knowledge component of the course via the internet can be accessed at: http://app.qstream.com/Jhpiego/courses/2042-Basic-Emergency-Obstetrical-Skills.


Effective blended learning approaches require each component of training to be dependent on another component.7 Each piece is linked so that a learner cannot successfully complete the course and master the content without completing each component in succession. Jhpiego applies this approach by delivering questions that are repeated over time, confirming completion and knowledge mastery during the clinical practice and live sessions, linking the follow-up to the use of skills in the workplace, and recording the use of the skills in a logbook. This ensures that funds invested to train providers result in skills being applied during service delivery and ultimately in improved maternal and newborn health outcomes. Jhpiego’s three training components are discussed in further detail below.

KNOWLEDGE UPDATE This component is computer- and/or classroom-based and includes the evidence basis for best practices in the management of normal labor and birth as well as the signal functions of EmONC, demonstrations of key interventions on anatomic models (via video or real-time if in the classroom), case studies and role plays. The following topics should be reviewed and knowledge assessed before advancing to the clinical site:

Basic Emergency Obstetric and Newborn Care (BEmONC) Topics for midwives, doctors and nurses:

Maternal and newborn mortality reduction

Evidence-based practices in maternal and newborn health

Human rights; respectful care of women and their families

Clinical decision-making

Infection prevention practices

Best practices during normal labor and childbirth, including partograph use, active management of the third stage of labor (AMTSL) and essential newborn care

Care of the mother and baby during the immediate postpartum period

Rapid initial assessment

Management of shock

Vaginal bleeding in early pregnancy and postabortion care (PAC)

Vaginal bleeding in late pregnancy

Headache, blurred vision, loss of consciousness and elevated blood pressure

Management of cord prolapse, breech delivery and shoulder dystocia (optional)

Vacuum-assisted delivery

7 Hoffman J and Miner N. 2008. Real blended learning stands up. American Society of Training and Development. Accessed on February 21, 2012, at: http://www.astd.org/LC/2008/1008_hofmann.htm


Vaginal bleeding after childbirth

Fever during and after childbirth

Newborn resuscitation

Newborn sepsis

Improving EmONC through criterion-based audit or other quality improvement approaches such as Standards-Based Management and Recognition (SBM-R)

Comprehensive Emergency Obstetric and Newborn Care (CEmONC) Topics for doctors (and midwives in some settings):

All BEmONC topics

Pre-, intra- and postoperative care of obstetric patients

Cesarean section (Misgav Ladach method); surgical treatment of ectopic pregnancy

B-Lynch suture

Blood transfusion

Anesthesia and analgesia in obstetrics

Craniotomy (optional)

Tubal ligation (optional) Topics for anesthetists:

Maternal and newborn mortality

Evidence-based medicine in maternal and newborn health

Infection prevention

Setup of operating theater

Rapid initial assessment

Management of shock

Review anatomy of respiratory and cardiovascular systems

Review of anatomy of vertebral column and spinal cord

Headaches, blurred vision, convulsions, loss of consciousness or elevated blood pressure

Cardiopulmonary resuscitation (CPR)

Control of the airway; endotracheal intubation

Intravenous fluid therapy, oxygen therapy, drugs used in resuscitation

Normal newborn care and newborn resuscitation

Pre-operative, intraoperative and postoperative evaluation and care


Selecting the correct anesthetic technique, including ketamine and spinal anesthesia

Deciding which cases to refer

Blood transfusion

Improving emergency obstetric care through criterion-based audits

CLINICAL SKILLS STANDARDIZATION Classroom Practice Clinical skills standardization begins in the classroom/skills lab as learners use evidence-based, standardized checklists to become competent in specific skills using anatomic models. Learners must be judged competent in all skills before proceeding to the clinical setting to care for clients. Depending on the number of learners and the level of skills they bring to the training, clinical skills standardization may require up to two days to complete for all learners. “Stations” are set up for each skill that learners will master (e.g., newborn resuscitation, normal birth, AMTSL, immediate newborn care, suturing, and so on). After each skill is demonstrated by facilitators, learners practice in pairs at the station using checklists. Each learner is then assessed by the facilitators for competency in the skill using models. Anyone who does not attain mastery of the skill in simulation continues to practice until competent. Stations for BEmONC skills assessment and mastery (for midwives, doctors and nurses) in the classroom:

Normal delivery, including AMTSL and immediate newborn care

Management of severe pre-eclampsia and eclampsia using MgSO4

Repair of episiotomy and vaginal and cervical lacerations

Postabortion care and manual vacuum aspiration (MVA)


Management of postpartum hemorrhage (PPH), including manual removal of the placenta, bimanual compression of the uterus, compression of the abdominal aorta, and condom tamponade

Normal newborn exam


Breech delivery (Mauriceau-Smellie-Veit and Loveset maneuvers) (optional) Facilitators must make sure that all learners have mastered these skills in simulation before they move to the practicum at the clinical site(s). Stations for CEmONC skills assessment (for providers who perform surgery) in the classroom:

All skills stations listed for BEmONC

Cesarean section


Laparotomy

Tubal ligation (optional)

Craniotomy (optional) Facilitators must make sure that all learners have mastered these skills in simulation before they move to the practicum at the clinical site(s). Stations for CEmONC skills assessment (for anesthetists) in the classroom:

Adult resuscitation and intubation

Cardiopulmonary resuscitation

Spinal anesthesia

Newborn resuscitation Facilitators must make sure that all learners have mastered these skills before moving to the practicum at the clinical sites.

Clinical Practicum During the practicum facilitators divide learners into groups of three or four, with no more than four learners per facilitator, and develop rotation schedules in ANC, maternity (triage/admission, labor, and birth areas, if separate), inpatient antepartum, and immediate postpartum/newborn. It is important to have a room where anatomic models and supplies can be available for continued practice and where case studies, “partograph rounds,” and role plays can be carried out at times when the service is not busy. Each learner must have a logbook for recording daily activities (Appendix C). Continual assessment of learners during their clinical work is essential to ensure that each one has an opportunity to practice various skills with clients. Facilitators should meet daily with each learner to assess their progress and challenges and to ensure that each has adequate clinical experience and coaching to become competent in as many skills as possible. The meetings usually take place at the end of the day. Facilitators should also meet daily as a group to discuss the general progress of learners and any specific issues that arise during the training.

Last Day of Training On the last day of the training, learners and facilitators meet again in the classroom. Some important activities take place during the day: Learners complete a written knowledge assessment covering the best practices addressed during the

training. They should score at least 85%; if they do not, they should be coached and then take the assessment again. They should continue to retake the assessment until they reach the required score.

Depending on the setting, learners may need to participate in clinical simulations with models so that their competency in key skills can be assessed. They should be coached until they reach a minimum score of 85% for each skill.


Each team of learners (if possible) or each individual learner (if the team members come from different facilities) will develop an action plan to implement in the three months following the trainings. Action plans ensure that learners continue to use their new skills and teach them to colleagues, thereby improving the quality of services at their facilities. Usually, learners are asked to select up to three clinical practices that they want to improve at their facility and delineate the steps they will take to achieve the improvements. See Appendix D for a sample action plan.

Facilitators and learners discuss next steps, and facilitators share information about:

The use of the logbooks to record all the skills performed by the learners after the training and before the follow-up visit;

The implementation of the action plans;

The follow-up visit (including, if possible, dates and process); and

Evaluation of the training.

Learners share their feelings and feedback about the training. Each learner fills out an anonymous questionnaire assessing several components of the training, including the objectives, methodology, content, logistics, and so on. Appendix E provides an example of a training evaluation questionnaire.

FOLLOW-UP OF THE TRAINING Follow-up and supportive supervision are key to helping providers solve problems and apply new practices on the job. Using performance standards (harmonized and standardized with training materials) within a post-training follow-up approach or supportive supervision system can also support performance improvement.8 Before leaving the training site learners will develop action plans in which they will select three or four skills they have acquired and put them into practice in their workplaces. Follow-up takes place from six weeks to three months after the training, so learners will have had time to practice their new knowledge and skills and put their action plans into effect. They will then have the opportunity to discuss their successes and challenges with a facilitator. If the caseloads in the learners’ health facilities are low, it may be better to regroup all learners in a busy health facility for two to three days to conduct the follow-up visit. An innovative way to follow up learners, either before or after the first visit, is by using mobile phone technology in a structured way. Options include sending regular SMS messages to remind learners to use key best practices; texting questions for them to answer to test their retention of knowledge; and scheduling short phone calls to each team every few weeks to ascertain successes and challenges and provide coaching even before the actual visit. This form of early and ongoing communication is being used successfully in many countries; it helps to ensure that the follow-up visit is used to address the most important issues raised during the mobile phone activities. 8 Examples of EmONC performance standards are available in the EONC Toolkit (forthcoming at www.k4h.org).


When conducting a follow-up visit, you should organize your activities as follows:

1. Assessment of the learners’ action plan implementation, including successes and challenges encountered

2. Knowledge assessment for each learner using questions similar to those used in the training

3. Case studies on the partograph and PPH

4. Assessment of skills and attitudes with clients (ideally) or anatomic models (if there are no clients) using checklists

5. Review of each learner’s clinical experiences logbook

6. Debriefing with the facility management team

7. Discussion of next steps to ensure that as many elements as possible of BEmONC and/or CEmONC continue to be practiced in the facility

For more detailed information on how to conduct follow-up of providers, you may wish to consult Jhpiego’s Guidelines for Assessment of Skilled Providers after Training in Maternal and Newborn Health, available at: www.jhpiego.org/files/GdlnsSkillProvEN.pdf

5. TRAINING DURATION AND SCHEDULES There is a debate in the EmONC community about the appropriate duration of EmONC trainings. EmONC training curricula generally range in length from three days to three weeks. It is important to keep in mind that EmONC training is based on mastery of the EmONC signal functions, and every training course should result in competent providers. The evidence is clear that sufficient practice and feedback is essential to the development of the critical thinking and psychomotor skills required to perform these functions.9 The knowledge update alone may have little to no impact on learners’ clinical practice skills and behaviors. In countries with scarce human resources, taking any health worker away for training can compromise the provision of services during the training. To reduce training time and increase efficiency, Jhpiego now uses an internet-based course built upon repeated questions and feedback (see section 4). Three options for training schedules are included here: a 12-day BEmONC training schedule for midwives and obstetricians; an 18-day CEmONC training schedule for midwives and obstetricians; and an 18-day CEmONC training schedule for anesthetists. The schedules assume that a blended learning approach will be taken to reduce training time and increase the effectiveness of training.

9 McGaghie, WC et al. 2009. Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: Effectiveness of continuing medical education: American College of Chest Physicians, evidence-based educational guidelines. Chest 135 (3 Suppl) (Mar): 62S–68S.

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orm

al la

bor

• U

nsat

isfa

ctor

y pr

ogre

ss in

labo

r

• P

rolo

nged

act

ive

phas

e

• O

bstr

ucte

d la

bor

Exe

rcis

e: P

lotti

ng a

nd

inte

rpre

ting

the

part

ogra

ph

Age

nda

of th

e da

y

War

m-u

p

Pre

sen

tati

on

an

d

Dis

cuss

ion

: C

are

of th

e m

othe

r in

the

post

part

um

perio

d

Ski

ll D

emon

stra

tion:

E

pisi

otom

y an

d re

pair

of

cerv

ical

tear

s us

ing

chec

klis

t

Pre

sen

tati

on

, Dis

cuss

ion

an

d V

ideo

tap

e: B

reec

h de

liver

y (o

ptio

nal)

Ski

ll D

emo

nst

rati

on

: B

reec

h de

liver

y us

ing

mod

el (

optio

nal)

Pre

sen

tatio

n, D

iscu

ssio

n

and

Vid

eota

pe:

Vac

uum

ex

trac

tion

Ski

ll D

emo

nst

rati

on

: V

acuu

m e

xtra

ctio

n us

ing

mod

el

Age

nda

of th

e da

y

War

m-u

p

Pre

sen

tati

on

an

d

Dis

cuss

ion

: F

ever

dur

ing

and

afte

r ch

ildbi

rth

Cas

e S

tud

ies:

Fev

er a

fter

child

birt

h

Pre

sen

tati

on

an

d

Dis

cuss

ion

: B

asic

ne

wbo

rn r

esus

cita

tion

Ski

ll D

emo

nst

rati

on

: N

ewbo

rn r

esus

cita

tion

usin

g m

odel

Ski

lls P

ract

ice

wit

h

Mo

del

s: L

earn

ers

prac

tice

in p

airs

usi

ng m

odel

LU

NC

H

LU

NC

H

LU

NC

HL

UN

CH

L

UN

CH

LU

NC

H

Pre

sen

tati

on

an

d

Dis

cuss

ion

: W

oman

-fr

iend

ly c

are

Pre

sen

tati

on

an

d

Dis

cuss

ion

: In

fect

ion

prev

entio

n pr

actic

es

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Pre

sen

tati

on

an

d

Dis

cuss

ion

: P

osta

bort

ion

care

Ski

ll D

emo

nst

rati

on:

M

VA

usi

ng m

odel

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Pre

sen

tati

on

an

d

Dis

cuss

ion

: M

anag

ing

prol

apse

d co

rd (

optio

nal)

Pre

sen

tati

on

an

d

Dis

cuss

ion

: A

MT

SL

Pre

sen

tati

on

an

d

Dis

cuss

ion

: Im

med

iate

ne

wbo

rn c

are

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Ski

ll D

emo

nst

rati

on

: C

lean

and

saf

e ch

ildbi

rth

usin

g m

odel

(in

clud

es

AM

TS

L an

d im

med

iate

ne

wbo

rn c

are)

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Pre

sen

tati

on

an

d

Dis

cuss

ion

: V

agin

al

blee

ding

afte

r ch

ildbi

rth

Ski

ll D

emon

stra

tion:

M

anua

l rem

oval

of

plac

enta

, bim

anua

l co

mpr

essi

on o

f the

ute

rus,

ab

dom

inal

aor

tic

com

pres

sion

, con

dom

ta

mpo

nade

usi

ng m

odel

s

Cas

e S

tud

ies:

Vag

inal

bl

eedi

ng a

fter

child

birt

h

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Ski

lls P

ract

ice

wit

h

Mo

del

s: L

earn

ers

prac

tice

in p

airs

usi

ng m

odel

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Rea

din

g A

ssig

nm

ent

Rea

din

g A

ssig

nm

ent

Rea

din

g A

ssig

nm

ent

Rea

din

g A

ssig

nm

ent

Rea

din

g A

ssig

nm

ent

13

G

uid

elin

es f

or

Em

ON

C In

-Ser

vice

Tra

inin

g

BE

MO

NC

FO

R M

IDW

IVE

S A

ND

OB

ST

ET

RIC

IAN

S:

12-D

AY

CO

UR

SE

SC

HE

DU

LE

DA

Y 7

D

AY

8

DA

Y 9

D

AY

10

DA

Y 1

1 D

AY

12

Age

nda

and

open

ing

activ

ity

Mid

cou

rse

Kn

ow

led

ge

Qu

esti

on

nai

re

Ski

lls P

ract

ice

wit

h

Mo

del

s: L

earn

ers

prac

tice

in p

airs

usi

ng m

odel

Clin

ical

Pra

ctic

e C

linic

al P

ract

ice

Clin

ical

Pra

ctic

e C

linic

al P

ract

ice

Age

nda

and

open

ing

activ

ity

Gro

up

Wo

rk:

Dev

elop

ac

tion

plan

s

Nex

t S

tep

s: D

iscu

ssio

n

of

use

of

logb

ook;

follo

w-

up v

ia m

obile

pho

ne a

nd

visi

ts

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

Ski

lls M

aste

ry w

ith

M

od

els:

Lea

rner

s de

mon

stra

te m

aste

ry o

f sk

ills

usin

g m

odel

Inst

ruct

ion

s fo

r C

linic

al

Pra

ctic

e

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Clin

ical

Pra

ctic

e

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Clin

ical

Pra

ctic

e

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Clin

ical

Pra

ctic

e

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Clin

ical

Pra

ctic

e

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Co

urs

e S

um

mar

y

Co

urs

e E

valu

atio

n

Clo

sin

g C

erem

on

y

14

Gu

idel

ines

fo

r E

mO

NC

In-S

ervi

ce T

rain

ing

CO

UR

SE

SC

HE

DU

LE

FO

R 1

8-D

AY

CL

AS

SR

OO

M/C

LIN

ICA

L C

EM

ON

C W

OR

KS

HO

P:

MID

WIV

ES

AN

D O

BS

TE

TR

ICIA

NS

K

NO

WL

ED

GE

UP

DA

TE

AN

D C

LIN

ICA

L S

KIL

LS

ST

AN

DA

RD

IZA

TIO

N

CE

MO

NC

FO

R M

IDW

IVE

S A

ND

OB

ST

ET

RIC

IAN

S:

18-D

AY

CO

UR

SE

SC

HE

DU

LE

DA

Y 1

D

AY

2

DA

Y 3

D

AY

4

DA

Y 5

D

AY

6

Op

enin

g:

Wel

com

e an

d in

trod

uctio

ns

Ove

rvie

w o

f the

cou

rse

(goa

ls, o

bjec

tives

, sch

edul

e)

Rev

iew

cou

rse

mat

eria

ls

Iden

tify

lear

ners

’ exp

ecta

tions

Pre

cou

rse

Kn

ow

led

ge

Qu

esti

on

nai

re

Rev

iew

clin

ical

exp

erie

nce

Iden

tify

indi

vidu

al a

nd g

roup

le

arni

ng n

eeds

Rev

iew

an

d D

iscu

ssio

n:

Rev

iew

site

ass

essm

ent

findi

ngs

and

disc

uss

impr

ovin

g pr

ovid

er

perf

orm

ance

, qua

lity

of c

are

and

team

app

roac

h to

E

mO

NC

Pre

sent

atio

n an

d D

iscu

ssio

n: A

verti

ng m

ater

nal

deat

h an

d di

sabi

lity;

bas

ic a

nd

com

preh

ensi

ve E

mO

NC

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: IP

pra

ctic

es

Dem

on

stra

tio

ns:

•

Han

dwas

hing

•

Dec

onta

min

atio

n •

Sha

rps

hand

ling

• W

aste

dis

posa

l •

Inst

rum

ent h

andl

ing

and

prep

arat

ion

Pre

sen

tati

on

s an

d

Dis

cuss

ion

: R

apid

initi

al

asse

ssm

ent,

reco

gniz

ing

and

man

agin

g sh

ock,

adu

lt re

susc

itatio

n, m

onito

ring

bloo

d tr

ansf

usio

n

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

s an

d

Dis

cuss

ion

: V

agin

al

blee

ding

in e

arly

and

late

pr

egna

ncy

and

labo

r

Cas

e S

tud

ies:

Vag

inal

bl

eedi

ng in

ear

ly

preg

nanc

y

Pre

sen

tati

on

an

d

Dis

cuss

ion

: P

osta

bort

ion

care

Ski

ll D

emo

nst

rati

on

: M

VA

us

ing

mod

el

Vid

eota

pe:

Pos

tabo

rtio

n ca

re p

hoto

set

Ski

ll P

ract

ice:

MV

A;

lear

ners

pra

ctic

e in

pai

rs

usin

g m

odel

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: N

orm

al la

bor

and

child

birt

h

• A

mbu

latio

n •

Nut

ritio

n •

Sup

port

per

son

Pre

sen

tati

on

an

d

Dis

cuss

ion

: P

lotti

ng a

nd

inte

rpre

ting

the

part

ogra

ph

• N

orm

al la

bor

• U

nsat

isfa

ctor

y pr

ogre

ss

in la

bor

• P

rolo

nged

act

ive

phas

e •

Obs

truc

ted

labo

r

Exe

rcis

e: P

lotti

ng a

nd

inte

rpre

ting

the

part

ogra

ph

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: C

are

of th

e w

oman

and

new

born

in th

e po

stpa

rtum

per

iod

Ski

ll D

emo

nst

rati

on

: E

pisi

otom

y an

d re

pair

and

repa

ir of

cer

vica

l tea

rs

usin

g le

arni

ng a

id

Ski

ll P

ract

ice:

Epi

siot

omy

and

repa

ir an

d re

pair

of

cerv

ical

tear

s; le

arne

rs

prac

tice

in p

airs

usi

ng

lear

ning

aid

Pre

sen

tati

on

an

d

Dis

cuss

ion

an

d

Vid

eota

pe: B

reec

h de

liver

y

Ski

ll D

emon

stra

tion:

B

reec

h de

liver

y us

ing

mod

el

Ski

ll P

ract

ice:

Bre

ech

deliv

ery;

lear

ners

pra

ctic

e in

pai

rs u

sing

mod

el

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: V

agin

al

blee

ding

afte

r ch

ildbi

rth

Ski

ll D

emo

nst

rati

on

: M

anua

l rem

oval

of

plac

enta

, bim

anua

l co

mpr

essi

on o

f the

ut

erus

, abd

omin

al

aort

ic c

ompr

essi

on,

cond

om ta

mpo

nade

Ski

ll P

ract

ice:

Man

ual

rem

oval

of p

lace

nta;

bi

man

ual c

ompr

essi

on

of th

e ut

erus

, abd

omin

al

aort

ic c

ompr

essi

on,

lear

ners

pra

ctic

e in

pa

irs u

sing

mod

el

Cas

e S

tud

ies:

Vag

inal

bl

eedi

ng a

fter

child

birt

h

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

15

G

uid

elin

es f

or

Em

ON

C In

-Ser

vice

Tra

inin

g

CE

MO

NC

FO

R M

IDW

IVE

S A

ND

OB

ST

ET

RIC

IAN

S:

18-D

AY

CO

UR

SE

SC

HE

DU

LE

Pre

sen

tati

on

an

d

Dis

cuss

ion

: C

hang

ing

obst

etric

and

mid

wife

ry

prac

tice

Pre

sen

tati

on

an

d

Dis

cuss

ion

: H

uman

rig

hts

and

Em

ON

C:

• F

eelin

g a

sens

e of

ur

genc

y •

Acc

ount

abili

ty fo

r on

e’s

actio

ns

• R

espe

ct fo

r hu

man

life

•

Rec

ogni

zing

wom

en’s

rig

ht to

life

, hea

lth,

priv

acy

and

dign

ity

Rol

e P

lay:

inte

rper

sona

l co

mm

unic

atio

n du

ring

Em

ON

C

Ski

ll D

emo

nst

rati

on

: A

dult

resu

scita

tion

usin

g m

odel

Ski

ll P

ract

ice:

Adu

lt re

susc

itatio

n; le

arne

rs

prac

tice

in p

airs

usi

ng m

odel

Clin

ical

Sim

ula

tio

n:

Em

erge

ncy

drill

•

Sel

ecte

d le

arne

rs ta

ke

part

•

Rem

aini

ng le

arne

rs

obse

rve

Dis

cuss

ion

: B

eing

pre

pare

d fo

r an

em

erge

ncy

Dis

cuss

ion

: C

hang

ing

attit

udes

tow

ard

post

ab

ortio

n ca

re s

ervi

ces

Pre

sen

tati

on

an

d

Dis

cuss

ion

: N

orm

al la

bor

and

child

birt

h •

Ass

essi

ng d

esce

nt,

dila

tatio

n, p

ositi

on

• S

econ

d st

age;

nee

d fo

r ep

isio

tom

y •

Act

ive

man

agem

ent o

f th

ird s

tage

•

Imm

edia

te n

ewbo

rn a

nd

post

part

um c

are

Ski

ll D

emon

stra

tion:

Cle

an

and

safe

chi

ldbi

rth

usin

g m

odel

Ski

ll P

ract

ice:

Cle

an a

nd s

afe

child

birt

h; le

arne

rs p

ract

ice

in

pairs

usi

ng m

odel

Rev

iew

of t

he d

ay’s

act

iviti

es

Pre

sen

tati

on

, Dis

cuss

ion

an

d V

ideo

tap

e: V

acuu

m

extr

actio

n

Ski

ll D

emo

nst

rati

on

: V

acuu

m e

xtra

ctio

n us

ing

mod

el

Ski

ll P

ract

ice:

Vac

uum

ex

trac

tion;

lear

ners

pra

ctic

e in

pai

rs u

sing

mod

el

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Pre

sen

tati

on

an

d

Dis

cuss

ion

: F

ever

du

ring

and

afte

r ch

ildbi

rth

Cas

e S

tud

y: F

ever

af

ter

child

birt

h

Ski

lls P

ract

ice

wit

h

Mo

del

s R

evie

w o

f the

day

’s

activ

ities

Pre

sen

tati

on

an

d

Dis

cuss

ion

: H

eada

ches

, bl

urre

d vi

sion

, con

vuls

ions

, lo

ss o

f con

scio

usne

ss,

elev

ated

blo

od p

ress

ure

Cas

e S

tud

y: P

regn

ancy

-in

duce

d hy

pert

ensi

on

Pre

sen

tati

on

an

d

Dis

cuss

ion

: M

anag

ing

prol

apse

d co

rd

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Rev

iew

of t

he d

ay’s

act

iviti

es

Rev

iew

of t

he d

ay’s

act

iviti

es

DA

Y 7

D

AY

8

DA

Y 9

D

AY

10

DA

Y 1

1 D

AY

12

Age

nda

and

open

ing

activ

ity

Age

nda

and

open

ing

activ

ity

Age

nda

and

open

ing

activ

ity

Ski

lls P

ract

ice

wit

h

Mo

del

s: L

earn

ers

prac

tice

in p

airs

usi

ng m

odel

Age

nda

and

open

ing

activ

ity

Mid

cou

rse

Kn

ow

led

ge

Qu

esti

on

nai

re

Ski

lls P

ract

ice

wit

h M

od

els:

Le

arne

rs p

ract

ice

in p

airs

us

ing

mod

el

Inst

ruct

ion

s fo

r C

linic

al

Pra

ctic

e

Clin

ical

Exp

erie

nce

Lo

g

Bo

ok

Clin

ical

Pra

ctic

e C

linic

al P

ract

ice

Pre

sen

tati

on

an

d

Dis

cuss

ion

: N

orm

al

new

born

car

e •

Pre

vent

ing

infe

ctio

ns

• T

herm

al p

rote

ctio

n •

Bas

ic n

ewbo

rn

resu

scita

tion

• B

reas

tfeed

ing

• B

est p

ract

ices

Ski

ll D

emo

nst

rati

on

: N

ewbo

rn r

esus

cita

tion

usin

g m

odel

Ski

ll P

ract

ice:

New

born

re

susc

itatio

n; le

arne

rs p

ract

ice

in p

airs

usi

ng m

odel

Pre

sen

tati

on

an

d

Dis

cuss

ion

: E

ndot

rach

eal

intu

batio

n

Ski

ll D

emo

nst

rati

on

: E

ndot

rach

eal i

ntub

atio

n us

ing

mod

el

Ski

ll P

ract

ice:

End

otra

chea

l in

tuba

tion;

lear

ners

pra

ctic

e in

pai

rs u

sing

mod

el

Ski

lls P

ract

ice

wit

h M

od

els:

Le

arne

rs p

ract

ice

in p

airs

us

ing

mod

el

Pre

sen

tatio

n an

d D

iscu

ssio

n: O

bste

tric

sur

gery

• C

esar

ean

sect

ion

• La

paro

tom

y •

Pos

tpar

tum

hy

ster

ecto

my

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

16

Gu

idel

ines

fo

r E

mO

NC

In-S

ervi

ce T

rain

ing

CE

MO

NC

FO

R M

IDW

IVE

S A

ND

OB

ST

ET

RIC

IAN

S:

18-D

AY

CO

UR

SE

SC

HE

DU

LE

Pre

sent

atio

n an

d D

iscu

ssio

n: P

ain

man

agem

ent a

nd a

nalg

esia

an

d an

esth

esia

in E

mO

NC

Pre

sen

tati

on

an

d

Dis

cuss

ion

: P

re-

and

post

oper

ativ

e ca

re p

rinci

ples

Pre

sen

tati

on

an

d

Dis

cuss

ion

—co

nti

nu

ed

Obs

tetr

ic s

urge

ry

• C

esar

ean

sect

ion

• La

paro

tom

y •

Pos

tpar

tum

hy

ster

ecto

my

Vid

eota

pe:

Ces

area

n se

ctio

n (M

isga

v La

dach

m

etho

d)

Pre

sen

tati

on

an

d

Dis

cuss

ion

: C

rani

otom

y

Rev

iew

of t

he d

ay’s

act

iviti

es

Ski

lls P

ract

ice

wit

h

Mo

del

s: L

earn

ers

prac

tice

in p

airs

usi

ng m

odel

To

ur

of

Clin

ical

Fac

iliti

es

Clin

ical

Pra

ctic

e C

linic

al P

ract

ice

Rev

iew

of t

he d

ay’s

act

iviti

es

DA

Y 1

3 D

AY

14

DA

Y 1

5 D

AY

16

DA

Y 1

7 D

AY

18

Clin

ical

Pra

ctic

e C

linic

al P

ract

ice

Clin

ical

Pra

ctic

e C

linic

al P

ract

ice

Clin

ical

Pra

ctic

e A

gend

a an

d op

enin

g ac

tivity

Pre

sen

tati

on

an

d

dis

cuss

ion

: E

mO

NC

in

dica

tors

Pre

sen

tati

on

an

d

dis

cuss

ion

: C

riter

ia-

base

d au

dit

Gro

up

Wo

rk:

Dev

elop

ac

tion

plan

s

Pre

sen

tati

on

s: A

ctio

n pl

ans

Nex

t Ste

ps: L

ogbo

ok;

on-th

e-jo

b le

arni

ng;

plan

ning

men

torin

g vi

sits

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

Clin

ical

Pra

ctic

e C

linic

al P

ract

ice

Clin

ical

Pra

ctic

e C

linic

al P

ract

ice

Clin

ical

Pra

ctic

e C

ou

rse

Su

mm

ary

Co

urs

e E

valu

atio

n

Clo

sin

g C

erem

on

y

Not

e: S

hade

d ar

eas

indi

cate

com

mon

mod

ules

for

obst

etric

ians

, mid

wiv

es a

nd a

nest

hetis

ts

17

G

uid

elin

es f

or

Em

ON

C In

-Ser

vice

Tra

inin

g

CO

UR

SE

SC

HE

DU

LE

FO

R 1

8-D

AY

CL

AS

SR

OO

M/C

LIN

ICA

L C

EM

ON

C W

OR

KS

HO

P:

AN

ES

TH

ET

IST

S

KN

OW

LE

DG

E U

PD

AT

E A

ND

CL

INIC

AL

SK

ILL

S S

TA

ND

AR

DIZ

AT

ION

C

EM

ON

C F

OR

AN

ES

TH

ET

IST

S:

18-D

AY

CO

UR

SE

SC

HE

DU

LE

DA

Y 1

D

AY

2

DA

Y 3

D

AY

4

DA

Y 5

D

AY

6

Op

enin

g:

Wel

com

e an

d in

trod

uctio

ns

Ove

rvie

w o

f the

cou

rse

(goa

ls, o

bjec

tives

, sc

hedu

le)

Rev

iew

cou

rse

mat

eria

ls

Iden

tify

lear

ner

expe

ctat

ions

Pre

cou

rse

Kn

ow

led

ge

Qu

esti

on

nai

re

Rev

iew

clin

ical

ex

perie

nce

Iden

tify

grou

p an

d in

divi

dual

lear

ning

nee

ds

Rev

iew

an

d

Dis

cuss

ion

:

Rev

iew

site

ass

essm

ent

findi

ngs

and

disc

uss

impr

ovin

g pr

ovid

er

perf

orm

ance

, qua

lity

of

care

and

team

app

roac

h to

Em

ON

C

Pre

sen

tatio

n a

nd

D

iscu

ssio

n: A

vert

ing

mat

erna

l dea

th a

nd

disa

bilit

y; b

asic

and

co

mpr

ehen

sive

Em

ON

C

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: In

fect

ion

prev

entio

n pr

actic

es

Dem

on

stra

tio

n:

•

Han

dwas

hing

•

Dec

onta

min

atio

n

• S

harp

s ha

ndlin

g

• W

aste

dis

posa

l •

Inst

rum

ent h

andl

ing

and

prep

arat

ion

Pre

sen

tati

on

an

d

Dis

cuss

ion

: R

apid

initi

al

asse

ssm

ent;

reco

gniz

ing

and

man

agin

g sh

ock;

adu

lt re

susc

itatio

n; a

nd m

onito

ring

bloo

d tr

ansf

usio

n

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: R

evie

w o

f an

atom

y of

res

pira

tory

an

d ca

rdio

vasc

ular

sy

stem

Pre

sen

tati

on

an

d

Dis

cuss

ion

: D

rugs

use

d in

res

usci

tatio

n:

adre

nalin

e, e

phed

rine,

at

ropi

ne

Dem

on

stra

tio

n:

Res

usci

tatio

n tr

ay

Pre

sen

tati

on

an

d

Dis

cuss

ion

: R

evie

w o

f ph

ysio

logy

of r

espi

rato

ry

and

card

iova

scul

ar

syst

em; p

hysi

olog

ical

ch

ange

s in

pre

gnan

cy

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

:

• C

PR

•

Con

trol

of a

irway

•

Prin

cipl

es o

f oxy

gen

ther

apy

•

Intr

aven

ous

fluid

th

erap

y

Dem

on

stra

tio

n a

nd

S

kills

Pra

ctic

e o

n

Mo

del

s:

• IV

can

nula

tion

•

Bag

and

mas

k ve

ntila

tion

•

CP

R

Lear

ners

pra

ctic

e in

pai

rs

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

:

• E

valu

atio

n an

d ca

re o

f pr

eope

rativ

e pa

tient

•

Sel

ectin

g th

e co

rrec

t an

esth

etic

tech

niqu

e

Cas

e S

tud

y: P

reop

erat

ive

case

stu

dies

An

esth

etic

Eva

luat

ion

: E

xerc

ise

One

:

Pre

oper

ativ

e pa

tient

Dem

on

stra

tio

n a

nd

P

ract

ice:

Eva

luat

ion

and

care

of p

reop

erat

ive

patie

nt

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: V

agin

al

blee

ding

afte

r ch

ildbi

rth

Pre

sen

tati

on

an

d

Dis

cuss

ion

: In

tra-

oper

ativ

e ev

alua

tion

and

care

Cas

e S

tud

y: In

tra-

oper

ativ

e br

eath

ing

diffi

culty

and

bra

dyca

rdia

An

esth

etic

Eva

luat

ion

: E

xerc

ise

Tw

o:

• In

tra-

oper

ativ

e pa

tient

Pre

sen

tati

on

an

d

Dis

cuss

ion

: R

evie

w o

f an

atom

y of

ver

tebr

al

colu

mn

and

spin

al c

ord

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

18

Gu

idel

ines

fo

r E

mO

NC

In-S

ervi

ce T

rain

ing

CE

MO

NC

FO

R A

NE

ST

HE

TIS

TS

: 18

-DA

Y C

OU

RS

E S

CH

ED

UL

E

Pre

sen

tati

on

an

d

Dis

cuss

ion

: C

hang

ing

obst

etric

and

mid

wife

ry

prac

tice

Pre

sen

tati

on

an

d

Dis

cuss

ion

: E

thic

al

issu

es a

nd E

mO

NC

: •

Fee

ling

a se

nse

of

urge

ncy

•

Acc

ount

abili

ty fo

r on

e’s

actio

ns

• R

espe

ct fo

r hu

man

lif

e •

Rec

ogni

zing

wom

en’s

rig

ht to

life

, hea

lth,

priv

acy

and

dign

ity

Rol

e P

lay:

Inte

rper

sona

l co

mm

unic

atio

n du

ring

Em

ON

C

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Ski

ll D

emo

nst

rati

on

: A

dult

resu

scita

tion

usin

g m

odel

Ski

ll P

ract

ice:

Adu

lt re

susc

itatio

n; le

arne

rs

prac

tice

in p

airs

usi

ng m

odel

Clin

ical

Sim

ula

tio

n:

Em

erge

ncy

drill

: •

Sel

ecte

d le

arne

rs ta

ke

part

•

Rem

aini

ng le

arne

rs

obse

rve

Dis

cuss

ion

: B

eing

pre

pare

d fo

r an

em

erge

ncy

Rev

iew

of t

he d

ay’s

act

iviti

es

Pre

sen

tati

on

an

d

Dis

cuss

ion

: H

eada

ches

, blu

rred

vi

sion

, con

vuls

ions

, los

s of

con

scio

usne

ss,

elev

ated

blo

od p

ress

ure

Cas

e S

tud

y: P

regn

ancy

-in

duce

d hy

pert

ensi

on

Dem

on

stra

tio

n:

Flu

ids

used

for

resu

scita

tion

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Pre

sen

tati

on

an

d

Dis

cuss

ion

: N

orm

al

new

born

car

e; b

asic

ne

wbo

rn r

esus

cita

tion

Ski

ll D

emo

nst

rati

on

an

d

Pra

ctic

e: N

ewbo

rn

resu

scita

tion

usin

g m

odel

s; le

arne

rs p

ract

ice

in p

airs

Ski

ll P

ract

ice

wit

h

Mo

del

s: L

earn

ers

prac

tice

in p

airs

usi

ng m

odel

s

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Pre

sen

tati

on

an

d

Dis

cuss

ion

: K

etam

ine

Ane

sthe

sia

Ski

ll D

emo

nst

rati

on

on

M

od

els:

Ket

amin

e an

esth

esia

Cas

e S

tud

y: K

etam

ine

anes

thes

ia in

obs

tetr

ic

prac

tice;

obs

truc

ted

labo

r

Rev

iew

of t

he d

ay’s

act

iviti

es

Pre

sen

tati

on

an

d

Dis

cuss

ion

:

Spi

nal a

nest

hesi

a

Ro

le P

lay:

Spi

nal

anes

thes

ia:

Com

mun

icat

ing

with

co

nsci

ous

patie

nt

Dem

on

stra

tio

n a

nd

S

kills

Pra

ctic

e: L

umba

r pu

nctu

re a

nd s

pina

l an

esth

esia

; lea

rner

s pr

actic

e in

pai

rs

Rev

iew

of t

he d

ay’s

ac

tiviti

es

DA

Y 7

D

AY

8

DA

Y 9

D

AY

10

DA

Y 1

1 D

AY

12

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: D

rugs

use

d in

ane

sthe

sia

Pre

sent

atio

n an

d D

iscu

ssio

n: E

valu

atio

n an

d ca

re o

f pos

tope

rativ

e pa

tient

Cas

e S

tud

y:

Pos

tope

rativ

e br

eath

ing

diffi

culty

Pre

sen

tati

on

an

d

Dis

cuss

ion

: D

ecid

ing

whi

ch c

ases

to r

efer

An

esth

etic

Eva

luat

ion

: E

xerc

ise

Thr

ee:

• P

osto

pera

tive

patie

nt

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: E

ndot

rach

eal

intu

batio

n (E

TT

)

Ski

ll D

emo

nst

rati

on

: E

ndot

rach

eal i

ntub

atio

n us

ing

mod

el

Ski

ll P

ract

ice:

End

otra

chea

l in

tuba

tion;

lear

ners

pra

ctic

e in

pai

rs u

sing

mod

el o

r ca

dave

r

Age

nda

and

open

ing

activ

ity

Pre

sen

tati

on

an

d

Dis

cuss

ion

: S

ettin

g up

op

erat

ing

room

Dem

on

stra

tio

n in

O

per

atin

g R

oo

m:

• R

esus

cita

tion

equi

pmen

t •

Ket

amin

e an

esth

esia

•

Spi

nal a

nest

hesi

a •

Intr

a-op

erat

ive

care

Clin

ical

Pra

ctic

e:

Intr

a-op

erat

ive

eval

uatio

n, m

onito

ring

and

care

Age

nda

and

open

ing

activ

ity

Mid

cou

rse

Qu

estio

nn

aire

D

iscu

ssio

n a

nd

Ski

lls

Pra

ctic

e: D

iffic

ult E

TT

and

sp

inal

ane

sthe

sia

Inst

ruct

ion

on

Clin

ical

E

xper

ien

ce L

og

bo

ok

Inst

ruct

ion

s o

n C

linic

al

Pra

ctic

e

Rev

iew

th

e R

esu

lts

of

the

Mid

cou

rse

Qu

esti

on

nai

re

Age

nda

and

open

ing

activ

ity

To

ur

of

Mo

del

Dis

tric

t E

mO

NC

Fac

ility

: •

Em

erge

ncy

rece

ptio

n ar

ea:

– R

apid

ass

essm

ent

– M

anag

emen

t of

shoc

k •

Labo

r ro

om a

nd p

ost-

deliv

ery

war

d:

– P

reop

erat

ive

eval

uatio

n an

d ca

re

– P

osto

pera

tive

care

•

Ope

ratin

g ro

om:

– S

ettin

g up

OR

–

Intr

a-op

erat

ive

eval

uatio

n an

d ca

re

– Im

med

iate

po

stop

erat

ive

care

Age

nda

and

open

ing

activ

ity

Clin

ical

Pra

ctic

e in

OR

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

LU

NC

H

19

G

uid

elin

es f

or

Em

ON

C In

-Ser

vice

Tra

inin

g

CE

MO

NC

FO

R A

NE

ST

HE

TIS

TS

: 18

-DA

Y C

OU

RS

E S

CH

ED

UL

E

Clin

ical

Sim

ula

tio

n

(em

erg

ency

d

rill/

clin

ical

si

mu

lati

on

):

Man

agem

ent o

f sev

ere

pre-

ecla

mps

ia a

nd

colla

pse

Ski

ll P

ract

ice

on

M

od

els:

CP

R, n

ewbo

rn

resu

scita

tion,

ven

tilat

ion

Rev

iew

of t

he d

ay’s

ac

tiviti

es

Pre

sen

tati

on

an

d

Dis

cuss

ion

: O

bste

tric

su

rger

y:

• C

esar

ean

sect

ion

• La

paro

tom

y •

Hys

tere

ctom

y •

Sal

ping

ecto

my

Vid

eo F

ilms:

Ces

area

n se

ctio

n

Rev

iew

of t

he d

ay’s

act

iviti

es

Clin

ical

Pra

ctic

e (c

on

tin

ued

): In

tra-

oper

ativ

e ev

alua

tion,

m

onito

ring

and

care

Dem

on

stra

tio

n:

Infe

ctio

n pr

even

tion:

•

Inst

rum

ent a

nd li

nen

prep

arat

ion

• H

igh-

leve

l di

sinf

ectio

n •

Ste

riliz

atio

n

Dis

cuss

ion:

Mai

ntai

ning

op

erat

ing

room

(OR

) re

adin

ess

Rev

iew

of t

he d

ay’s

ac

tiviti

es

To

ur

of

the

Ho

spit

al

Em

ON

C F

acili

ty

• E

mer

genc

y re

cept

ion

area

•

Labo

r ro

om/w

ard

• A

nten

atal

and

pos

t-de

liver

y ar

ea

Rev

iew

of t

he d

ay’s

ac

tiviti

es

To

ur

of

Mo

del

Dis

tric

t E

mO

NC

Fac

ility

(c

on

tin

ued

)

Dis

cuss

ion

: S

ettin

g up

di

stric

t OR

and

ane

sthe

sia

serv

ices

and

faci

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6. COURSE MATERIALS Since the goal of EmONC training is to teach providers evidence-based best practices, training must be based on the most up-to-date teaching materials and manuals. This section contains links to the learning resource packages (LRPs) that facilitators will need in order to organize the BEmONC and CEmONC courses in a logical way. The LRPs contain schedules, session outlines, knowledge questionnaires, case studies, role plays, skills checklists and PowerPoint presentations. In addition, links are provided to several reference manuals that contain global evidence-based guidelines for emergency obstetric and newborn care. The LRPs are formulated to reflect the information in these manuals.

MATERIALS FOR THE BEMONC COURSE

DOCUMENTS TO PREPARE IN ADVANCE

For each learner: For each facilitator:

• Course schedule • Course schedule and course outline

• Precourse questionnaire • Precourse questionnaire and answer key

• Midcourse questionnaire • Midcourse questionnaire and answer key

• Action plan • Copy of learners’ action plan

TRAINING MATERIALS TO DOWNLOAD

For each learner For each facilitator

• Best Practices in Maternal and Newborn Care: A Learning Resource Package for Essential and Basic Emergency Obstetric and Newborn Care. Learner’s Notebook. http://www.accesstohealth.org/toolres/pdfs/ACCESS_BPmnclrpPart.pdf

• Best Practices in Maternal and Newborn Care: A Learning Resource Package for Essential and Basic Emergency Obstetric and Newborn Care. Facilitator’s Guide. http://www.accesstohealth.org/toolres/pdfs/ACCESS_BPmncrlpFacil.pdf

• Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. World Health Organization, 2003. http://whqlibdoc.who.int/hq/2000/WHO_RHR_00.7.pdf

• Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice. WHO, 2006. http://www.who.int/reproductivehealth/publications/en/



• Emergency Obstetric Care: Quick Reference Guide for Frontline Providers. Jhpiego, 2003. http://www.jhpiego.org/en/node/477

• Emergency Obstetric Care: Quick Reference Guide for Frontline Providers. Jhpiego, 2003. http://www.jhpiego.org/en/node/477


MATERIALS FOR THE CEMONC COURSE

DOCUMENTS TO PREPARE IN ADVANCE


• Course schedule for midwives, doctors and/or other clinicians performing surgery

• Course schedule and course outline for midwives, doctors and/or other clinicians performing surgery

• Precourse questionnaire for midwives, doctors and/or other clinicians performing surgery

• Precourse questionnaire for midwives, doctors and/or other clinicians performing surgery, and answer key

• Midcourse questionnaire for midwives and doctors

• Midcourse questionnaire for midwives and doctors, and answer key

• Action plan • Copy of learners’ action plans

For each anesthetist: For each facilitator anesthetist:

• Course schedule for anesthetists • Course schedule for anesthetists

• Precourse questionnaire for anesthetists • Precourse questionnaire for anesthetists

• Midcourse questionnaire for anesthetists • Midcourse questionnaire for anesthetists, and answer key

• Action plan • Copy of learners’ action plans

TRAINING MATERIALS TO DOWNLOAD


• Emergency Obstetric Care for Doctors and Midwives. Learner’s Guide. Jhpiego/MNH Program and AMDD, 2003. http://www.jhpiego.org/pt-br/node/445

• Emergency Obstetric Care for Doctors and Midwives. Teacher’s Notebook Guide. Jhpiego/MNH Program and AMDD, 2003. http://www.jhpiego.org/pt-br/node/445





For each learner anesthetist: For each facilitator anesthetist:

• Anesthesia for Emergency Obstetric Care. Learner’s Guide. Jhpiego/MNH Program and AMDD Program, 2003. http://www.jhpiego.org/en/node/444

• Anesthesia for Emergency Obstetric Care. Teacher’s Notebook. Jhpiego/MNH Program and AMDD Program, 2003. http://www.jhpiego.org/en/node/444

• Anaesthesia at the District Hospital (2d ed.), by Michael B. Dobson. WHO, 2000. http://whqlibdoc.who.int/publications/9241545275

• Anaesthesia at the District Hospital (2d ed.), by Michael B. Dobson. WHO, 2000. http://whqlibdoc.who.int/publications/9241545275




MATERIALS FOR FOLLOW-UP OF LEARNERS

For each midwife and doctor: For each anesthetist:

• Clinical experience logbook • Anesthesia for EmONC clinical experience logbook

• Guidelines for Assessment of Skilled Providers after Training in Maternal and Newborn Health. Jhpiego, 2004. www.jhpiego.org/files/GdlnsSkillProvEN.pdf

• Materials for follow-up of health care providers trained in anesthesia for EmONC can be found in the EONC Toolkit (forthcoming in 2012; visit www.k4health.org)

• Action plan • Action plan

• Related standards • Related standards

7. ANATOMIC MODELS Listed below are descriptions and ordering information for anatomic models and other equipment needed for EmONC trainings. At a minimum, models for childbirth (for practicing AMTSL, immediate newborn care, and PPH treatment) and newborn resuscitation should be made available for BEmONC training. Models for lumbar puncture and airway management can be added for CEmONC training.

DESCRIPTION SOURCE

Childbirth simulator BUYAMAG INC.www.buyamag.com GAUMARD SCIENTIFIC Tel: 001305-971-3790 www.gaumard.com

MamaNatalie (normal birth & vacuum) LAERDALwww.laerdal.com/mamaNatalie

Pelvic model for breech delivery SUPERIOR MEDICALsuperiormedical.com/l_models.html

Model and equipment for MVA IPASwww.ipas.org

Fetus model for vacuum extraction PELICAN HEALTHCARE LTD. www.pelicanhealthcare.co.uk Tel: 029 2074 7000 Fax: 029 2074 7001 Email: [email protected]

Model for Cesarean section OPERATIVE EXPERIENCE www.operativeexperience.com

Model for PPH management: MamaNatalie LAERDALwww.laerdal.com

Model and equipment for newborn resuscitation: Helping Babies Breathe (HBB) model NeoNatalie

LAERDAL GLOBAL HEALTH www.laerdalglobalhealth.com/neonatalie.html


DESCRIPTION SOURCE

Lumbar puncture trainer/simulator for spinal anesthesia

GAUMARD SCIENTIFICTel: 001305-971-3790 www.gaumard.com KYOTO KAGAKU www.kyotokagaku.com

Airway management trainer with stand SIMULAIDSwww.simulaids.com Tel: 800-431-4310 Fax: 001845-679-8996 E-mail: [email protected]

8. VIDEOS AND PRESENTATIONS The following videos and presentations are useful in EmONC training to reinforce the key components of each skill being taught. Learners can view them at their own convenience during and following training as needed to refresh their knowledge.

DESCRIPTION SOURCES

Active Management of the Third Stage of Labor: A Demonstration

ACCESS Programwww.accesstohealth.org/toolres/amtslweb/amtsl.html

Vaginal Breech Delivery and Symphysiotomy

WHO Reproductive Health Libraryhttp://apps.who.int/rhl/videos/en/index.html

Manual Vacuum Aspiration IPASwww.ipas.org View video at http://youtu.be/I0daZ8dLXdY

Vacuum Extraction WHO Reproductive Health Libraryhttp://apps.who.int/rhl/videos/en/index.html

Vacuum-Assisted Delivery: A Brief Summary of Key Principles

Clinical Innovations, Inc. http://www.clinicalinnovations.com/kiwi_video_vad.htm Tel: 888-268-6222 or 801-268-8200 To order video, go to: http://www.clinicalinnovations.com/vacca.htm#dvd

Steps to Overcome Shoulder Dystocia


Caesarean Section Evidence-Based Surgical Techniques


Spinal Anesthesia www.operationalmedicine.org/ed2/video/spinal.mpg

Labour Companionship: Every Woman’s Choice



9. JOB AIDS A full list of resources, including job aids, can be found in the Essential Obstetric and Newborn Care (EONC) Toolkit, forthcoming in 2012 on the Knowledge for Health website (visit http://www.k4health.org/publications-and-resources). The following job aids are especially useful during training. If possible, each facility represented at the training should have copies of them. Job Aids in the EONC Toolkit (forthcoming at www.k4health.org):

Positions for Labor (drawings of positions in labor and squatting position for birth), by Victor Okello (artist); from GOAL, Uganda

Steps to Perform AMTSL (poster)

Steps to Perform MVA (poster)

Algorithm for Management of Preeclampsia/Eclampsia (poster)

Dilution and Mixing of MgSO4 (poster)

Algorithm for Management of PPH (poster) Other Job Aids:

Positions for Laboring Out of Bed Tear Pad Cascade Healthcare Products www.1cascade.com/ProductInfo.aspx?productid=2937

Action Plan Poster Helping Babies Breathe Action Plan www.helpingbabiesbreathe.org/docs/ActionPlan.pdf

Large laminated WHO Modified Partograph (Facilitators can make this by enlarging a printed partograph to about 1 meter x 1 meter and laminating it.)

Wall chart to demonstrate cervical dilatation (Facilitators can make this on flipchart paper by drawing circles from 1 cm to 10 cm in diameter.)

10. DOCUMENTATION OF ACTIVITIES Training in EmONC is an important component of many maternal mortality reduction programs, and documentation of activities is needed to monitor the impact of training. You will need a system for collecting data on facilitators, learners and training events so that you can report on activities and evaluate the program. The system can be solely paper-based or web-based or a combination of both. Appendix F shows the Training Information Monitoring System (TIMS) Data Recording Form, the paper-based reporting system developed by Jhpiego for tracking training activities. The data collected can be entered in a simple Excel spreadsheet.


APPENDIX A: ORGANIZATION OF MATERNITY SERVICES Listed below are the components of maternity services that should be assessed and targeted for improvement in the clinical sites that are used for EmONC training. Included are points that should be highlighted during the discussion of woman-friendly services on the first day of training and throughout the training.

1. Staffing

Services should be available 24 hours/day, seven days/week.

Staff with BEmONC skills should stay at the site during their assigned shifts. Staff with CEmONC skills should be easily available by phone or other means, and able to be at the site within 20 minutes of being called.

2. Woman-friendly and family-friendly care

Women and their families should always be greeted kindly and with respect, no matter how busy the service is. Every woman should feel as though she is receiving the highest quality care, even if labor and birth proceed normally.

Women who present for care should undergo immediate rapid assessment and be triaged according to the findings of the assessment.

Women have a right to (1) privacy (curtains, if not a separate room); (2) know who is taking care of them (i.e., the provider’s name and qualification); (3) consent to care by a student; (4) the presence of a family member/companion; (5) information about what is happening and answers to their questions; (6) information about all procedures and informed consent for each; (7) ambulate and eat/drink as desired if there are no contraindications; (8) assume the position of their choice for the birth; (9) breastfeed immediately after the birth; and (10) remain with their baby throughout their stay at the facility.

3. Equipment/supplies

A designated staff member on each shift will be responsible for checking/restocking all emergency equipment and trays per established guidelines and checklists. All staff members should have access to emergency equipment at all times (e.g., adult ambu bags and masks, IV solutions and administration sets, and medications such as oxytocin and magnesium sulfate).

4. Responsibility for client care

To ensure continuity and increase accountability for each client’s care, every client is assigned to a specific staff member (midwife, obstetrician, nurse), and that staff member is responsible for coordinating all care. This includes maintaining the partograph and other documentation (i.e., delivery register, referral forms, operative notes, and so on).

If the staff member cannot care for the client (because he or she is assisting at another delivery or an emergency arises), the client’s care should officially be turned over to another staff member.

Midwifery, nursing and medical students are not counted as regular staff.


Each student must be assigned to a regular staff member.

Each staff member should supervise no more than two students at a time.

Students can provide direct care to the woman/newborn, but only under the direct supervision of a regular staff member.

If a physical assessment shows the client is progressing normally, staff can instruct family members about assisting with ambulation, nourishment and other comfort measures. Staff should continue to assess the woman and maintain the partograph and other documentation as needed.

5. Documentation

The partograph will be used for every client once active labor has begun. Students may assist in gathering information for the partograph under the supervision of a regular staff member.

If a client is not in active labor, a chart will be established and updated at least every four hours or more often if the client’s condition warrants.

Specific documentation will be undertaken for women with complications. For example, documentation for pre-eclampsia/eclampsia includes vital signs (with respirations and reflexes), presence of convulsions, state of consciousness, presence of headache and abdominal pain, fetal heart rate and use of medications (time, dose and route).

6. Specific procedures

Routine procedures such as cervical exams, rupture of membranes and normal birth/newborn care/repair of minor lacerations should be carried out in the same room/bed throughout the client’s care.

Procedures such as MVA should be carried out in the labor ward, not the operating theater, so as to expedite the woman’s care and counseling and keep the operating theater open for urgent cases.

7. Newborn resuscitation

At least one resuscitation corner will be readily accessible to all delivery areas. It will be set up for immediate use at all times. It should include a table with a clean cover, exam gloves, a radiant lamp or other means to warm the newborn, oxygen if available, clean towels/cloths to dry the newborn, suction device, an ambu bag and newborn and premature-size masks, a clock with second hand and a wall chart for newborn resuscitation (e.g., the Helping Babies Breathe job aid).

8. Hand-off at end of shift

Providers leaving at the end of their shift will ensure that all materials, supplies and medications are replenished before they leave and that the newborn resuscitation corner is ready for use.

Incoming providers will meet with the outgoing staff and receive client assignments and an update about the status of each client, using the partograph and/or other documentation as a guide.

Incoming providers will immediately introduce themselves to clients.


APPENDIX B: EQUIPMENT AND SUPPLIES LIST The list below shows the standard equipment and supplies that are needed for training courses, both in the classroom and in the clinical setting. Learners will need basic supplies to simulate what they will find in the hospital, and these items can be kept and used for future training courses. After assessing the clinical site, facilitators may want to donate certain equipment, supplies and medications to the facility so that learners are able to care for clients according to global standards.

ITEMS NUMBERS NEEDED

Learners Facilitators Facility* Total

Examination

Adult sphygmomanometer 1 per team 2

Adult stethoscope 1 per team 2

Thermometer 1 per team 2

Tape 1 per team 2

Fetoscope 1 per team 2

Delivery

Delivery Kits 1 per team 3–5

• Instrument tray

• Cord scissors

• Hemostats (2) to clamp cord, or cord clamps

• Sponge forceps (2)

Galipot bowls for cotton/antiseptic for perineal cleansing; placenta bowl

1 per model 3–5

Plastic sheet to place under mother and clean cloths for draping

3–4 per model

5

Clean cloths to dry and cover baby 3–4 per model 2 dozen

Plastic apron 1 per team 5

Head covers 1 per learner 100

Masks 1 per learner 100

Gloves—sterile 6 pairs per learner

3 dozen, various sizes

Gloves—non-sterile 2 boxes per team

10 boxes

Barrier goggles 1 per learner 1 per facilitator

Gauze—4-inch x 4-inch squares in giant package, non-sterile and not individually wrapped

4 packages per team

6 boxes

Oxytocin vials 1 per team 50




Syringe and needle (3 cc syringe with 20 or 21 gauge needle)

1 per team 50

Amniotic hook or Kocher clamp 1 per team 3–5

Episiotomy

Sponges (foam blocks) of upholstery quality (8 inch x 4 inch x 4 inch)—should not tear easily when thread pulled through. Please test!

3 per learner 2

Suture needles—reusable, round body, half-circle suture needles either with suture already attached or with an eye so suture can be pulled through eye.

50

50

Rolls/spools of regular sewing thread (good quality so goes through practice sponge easily). Needed only if suture needles do not have suture attached.

10 rolls/spools per team

Episiotomy/laceration repair kits—include metal tray or container with needle holder, episiotomy scissors, non-toothed dissecting forceps, towel clips, stitch scissors, sponge-holding forceps, long straight artery forceps

1 per team

3

10 cc syringe with 1.5-inch needle (pretendfilled with 0.5% lidocaine); or lidocaine 1% and sterile water for injection, for dilution to 0.5%.

1 per

50

Infection Prevention

Plastic buckets 3 per team 6

Large steamer pot with lid (for steaming/ boiling)

1

Plastic bucket for chlorine solution 1 per model (childbirth

and newborn)

6

Heavy cleaning gloves 2 pairs

Toothbrush 6

Puncture-proof container for sharps disposal

1 per childbirth

model

6

Plastic bucket for paper disposal 1 per model (childbirth

and newborn)

0 6

Bottles of alcohol and glycerin gel for hand cleansing

1 per station 0 6

Dish/liquid soap 1 per classroom

0 5

Individual towels 1–2 per 1–2 per




learner facilitator

PPH, PE/E and other EmONC Management

Foley bladder catheter 1 per model 0 5

Condom idem 0 5

Suture idem 0 5

IV fluids administration set idem 0 10

Adult ambu bag with mask 1 0 1

Oxytocin 10 IU idem 0 50

Cesarean tray, if CEmONC 1 per 4–6 learners

0 3

Vacuum extractor 1 per 4–6 learners

0 1

MVA kit 1 per team 0 1

NeoNatalie kits, including models, ambu bags/masks, and mucous extractors; or separate models and equipment

1 per 4–6 learners

0 1

Antihypertensives 0 Based on # of cases at training

sites, if stockouts

are anticipated

Magnesium sulfate 0 idem

Antibiotics for treatment of maternal and newborn infection 0

idem

Chlorhexidine 4% for newborn cord care 0 idem

*Numbers needed for each facility will depend on what is found during the clinical site assessment; some facilities are well-equipped while others will have no spare equipment for use by learners.


APPENDIX C: PRACTICUM LOGBOOKS FOR DOCUMENTING SKILLS PERFORMED WITH CLIENTS Practicum Logbook for Nurses/Midwives and Obstetricians (to be filled out during EmONC training)

DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8

Partograph

Normal delivery

Active management of third stage of labor

Episiotomy and/or repair of episiotomy/laceration



Manual vacuum aspiration

Manual removal of the placenta

Bimanual compression of the uterus

Compression of abdominal aorta

Condom tamponade

Cesarean section*

Laparotomy for extra-uterine pregnancy*

Laparotomy for uterine rupture*

*For obstetricians only


Practicum Logbook for Anesthetists (to be filled out during EmONC training)

DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 DAY 8

Treatment of shock/adult resuscitation

Cardiopulmonary resuscitation

Establish IV line

Control of the airway/ endotracheal intubation

Setup of operating room

Preoperative care

Spinal anesthesia

Ketamine anesthesia

General anesthesia

Postoperative care

Blood transfusion

Case referred



APPENDIX D: SAMPLE ACTION PLAN FOR LEARNERS Learner Name:

Country of Residence:

Training Attended:

Name of Facility:

Date:

Based on what you learned during this training, please write down three things that you would like to change at your facility over the next year:

Goal #1

Goal #2

Goal #3

List the actions/steps needed to achieve the goal, along with the date that each activity is completed. Include the names of colleagues who will assist you and list the specific tasks they are assigned.

Goal #1

ACTIVITIES/STEPS DATEPLANNED

COLLEAGUES WHO WILL ASSIST AND THEIR ASSIGNED

TASKS

DATECOMPLETED

Goal #2


COLLEAGUES WHO WILL ASSIST AND THEIR TASKS

DATECOMPLETED

Goal #3


COLLEAGUES WHO WILL ASSIST AND THEIR TASKS

DATECOMPLETED


APPENDIX E: TRAINING EVALUATION QUESTIONNAIRE

PLEASE EVALUATE THE FOLLOWING STATEMENTS

STRONGLY AGREE

AGREE UNDECIDED DISAGREE STRONGLY DISAGREE

1. For the work I do, the training was appropriate.

2. Training facilities and arrangements were satisfactory.

3. The facilitators/teachers were knowledgeable and skilled.

4. The facilitators/teachers were fair and friendly.

5. The training updated my knowledge and skills.

6. Training objectives were met.

7. Teaching aids were useful.

8. Practice in the clinical areas was important and helpful.

Please answer the following questions. Use the back for more writing space if needed.

1. What was the most useful part of the training course for you?

2. What, if any, part of the training course was not useful to you?

3. What suggestions do you have for improving the training course?

4. Other comments:


APPENDIX F: TRAINING INFORMATION MONITORING SYSTEM: DATA RECORDING FORM

guidelines for basic and comprehensive inservice...

Documents