Introduction Sustainable endoscopy services could improve management of upper gastrointestinal malignancy and haemorrhage, both common in Malawi. Since 2008 we have committed to improving endoscopy training through an International Health Link (IHL) partnership with Malawi. We aimed to (1) develop a sustainable training “hub” with locally-trained Trainers in Blantyre (2) develop locally-relevant training courses, (3) extend training support to regional hospital “spokes”.
Methods We partnered in five training visits to Malawi, funded by the Tropical Health Education Trust and the British Society of Gastroenterology. We ran 14 courses (Basic Skills, Skills Enhancement, Training the Gastroscopy Trainers (TGT) and Endoscopy Nurses) involving 52 delegate-training-episodes (29 local doctors, 12 clinical officers (COs), three expatriate doctors, eight nurses). Outcomes were monitored by JAG-format DOPS and course evaluations. Progress over time towards the three aims was assessed.
Results Aim 1) Training models and audit, reporting and assessment tools were introduced in Blantyre. The mean number of delegate-episodes increased from 6.3 during the first four visits, to 20 during the last two visits. During the first four visits the local faculty was four expatriate doctors and one CO, increasing to seven local doctors, five COs, two nurses and one expatriate doctor during the last two visits. In the first four visits, 16/21 delegate-episodes involved only skills learning and 5/21 (24%) were as mentored or local faculty, while in the last two visits, 25/40 involved only skills learning and 15/40 (38%) were as mentored or local faculty. In 2011 we ran and evaluated the first TGT within Malawi. Aim 2) We developed a Basic Skills in Gastroscopy course appropriate to local circumstances, which was delivered, evaluated and modified over each visit, and ultimately delivered by two locally-trained Trainers. Aim 3) The delegates' region of origin for the first four visits was 18/19 from Blantyre, and for the last two visits was 15/40 Blantyre, 13/40 Lilongwe, 7/40 Zomba, 3/40 Mzuzu and 2/40 Zambia. The origin of UK external faculty increased from 1 to 3 sites, and two new IHLs were established with Lilongwe and Zomba.
Conclusion IHL partnerships represent a sustainable means of improving GI endoscopy training. Modified JAG-format courses, assessments and evaluations were useful even in a resource-limited setting. A hub-and-spoke model helped to support other regions. Future training priorities include training in therapy and further development of local trainers. Local reporting tools should allow audit of outcomes across regions.
Competing interests None declared.
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