An innovative approach to in-service training of maternal health staff in Cambodian hospitals

Objective: To demonstrate the feasibility of implementing evidence-based continuing medical education (CME) to improve key skills among maternity staff in Cambodia. Methods: A skills-based CME program was implemented in 33 Cambodian hospitals. Each clinical skills practice (CSP) module consisted of a 1-day practice session, focusing on three maternal and newborn interventions, followed by support visits to participating hospitals. Skills were assessed at 27 intervention hospitals and five control hospitals 7-11 months after the practice sessions through observation of neonatal resuscitation, magnesium sulfate dilution, and aortic compression simulations. Results: A total of 559 healthcare workers attended at least one CSP practice session. The skills assessment included 47 doctors and 210 midwives. Hospital staff who participated in CSP performed significantly better than did those from control hospitals on neonatal resuscitation (mean score 31.22 vs 17.00; P <0.001), magnesium sulfate dilution (mean score 11.01 vs 8.47; P < 0.001), and aortic compression (mean score 13.87 vs 4.33; P <0.001). CSP participants were also significantly more likely to score higher than the 70% cutoff for neonatal resuscitation and magnesium sulfate dilution than were those from control hospitals, after adjustment for hospital level and profession (P <= 0.05). Conclusion: Key clinical skills in low-resource settings can be improved by implementing CME using simulations and supportive follow-up. (C) 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.