title: Mid-level healthcare personnel training: an evaluation of the revised, nationally-standardized, pre-service curriculum for clinical officers in Mozambique.
abstract: BACKGROUND
  Mozambique suffers from a critical shortage of healthcare workers. Mid-level healthcare workers, (Tecnicos de Medicina Geral (TMG)), in Mozambique require less money and time to train than physicians. From 2009-2010, the Mozambique Ministry of Health (MoH) and the International Training and Education Center for Health (I-TECH), University of Washington, Seattle, revised the TMG curriculum. To evaluate the effect of the curriculum revision, we used mixed methods to determine: 1) if TMGs meet the MoH's basic standards of clinical competency; and 2) do scores on measurements of clinical knowledge, physical exam, and clinical case scenarios differ by curriculum?
  
  
  METHODS
  T-tests of differences in means examined differences in continuous score variables between curriculum groups. Univariate and multivariate linear regression models assess curriculum-related and demographic factors associated with assessment scores on each of the three evaluation methods at the p<0.05 level. Qualitative interviews and focus groups inform interpretation.
  
  
  RESULTS
  We found no significant differences in sex, marital status and age between the 112 and 189 TMGs in initial and revised curriculum, respectively. Mean scores at graduation of initial curriculum TMGs were 56.7%, 63.5%, and 49.1% on the clinical cases, knowledge test, and physical exam, respectively. Scores did not differ significantly from TMGs in the revised curriculum. Results from linear regression models find that training institute was the most significant predictor of TMG scores on both the clinical cases and physical exam.
  
  
  CONCLUSIONS
  TMGs trained in either curriculum may be inadequately prepared to provide quality care. Curriculum changes are a necessary, but insufficient, part of improving TMG knowledge and skills overall. A more comprehensive, multi-level approach to improving TMG training that includes post-graduation mentoring, strengthening the pre-service internship training, and greater resources for training institute faculty may result in improvements in TMG capacity and patient care over time.
authors: International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America; Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors: Caryl
authors: C
authors: Feldacker
authors: National Institute of Health, Mozambique Ministry of Health, Maputo, Mozambique.
authors: Sergio
authors: S
authors: Chicumbe
authors: Department of Human Resources, Mozambique Ministry of Health, Maputo, Mozambique.
authors: Martinho
authors: M
authors: Dgedge
authors: International Training and Education Center for Health, Maputo, Mozambique.
authors: Gerito
authors: G
authors: Augusto
authors: International Training and Education Center for Health, Maputo, Mozambique.
authors: Freide
authors: F
authors: Cesar
authors: International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America.
authors: Molly
authors: M
authors: Robertson
authors: National Institute of Health, Mozambique Ministry of Health, Maputo, Mozambique.
authors: Francisco
authors: F
authors: Mbofana
authors: International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America; Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors: Gabrielle
authors: G
authors: O'Malley
mesh_terms: D003479:Curriculum; D005069:Evaluation Studies as Topic; D006282:Health Personnel / Q000193:education*; D007318:Inservice Training / Q000592:standards*; D009073:Mozambique