title: Comprehensive on-site medical and public health training for local medical practitioners in a refugee setting.
abstract: OBJECTIVE
  In refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers.
  
  
  METHODS
  The comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation.
  
  
  RESULTS
  Physicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers' knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support.
  
  
  CONCLUSIONS
  A long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.
authors.forename: Ramin
authors.initials: R
authors.lastname: Asgary
authors.forename: Karen
authors.initials: K
authors.lastname: Jacobson
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D000368:Aged; D003479:Curriculum; D003657:Decision Making; D054597:Disaster Medicine / Q000193:education*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D011634:Public Health / Q000193:education*; D012036:Refugees; D011795:Surveys and Questionnaires