title: An innovative approach to in-service training of maternal health staff in Cambodian hospitals.
abstract: 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).
  
  
  CONCLUSIONS
  Key clinical skills in low-resource settings can be improved by implementing CME using simulations and supportive follow-up.
authors.affiliation: University Research Co. Better Health Services project, Phnom Penh, Cambodia. Electronic address: jwoods@urc-chs.com.
authors.forename: Joan
authors.initials: J
authors.lastname: Woods
authors.affiliation: School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Laina
authors.initials: L
authors.lastname: Gagliardi
authors.affiliation: University Research Co. Better Health Services project, Phnom Penh, Cambodia.
authors.forename: Sun
authors.initials: S
authors.lastname: Nara
authors.affiliation: University Research Co. Better Health Services project, Phnom Penh, Cambodia.
authors.forename: Sim
authors.initials: S
authors.lastname: Phally
authors.affiliation: Kampong Cham Provincial Hospital, Kampong Cham, Cambodia.
authors.forename: Ouk
authors.initials: O
authors.lastname: Varang
authors.affiliation: Battambang Provincial Hospital, Battambang, Cambodia.
authors.forename: Nget
authors.initials: N
authors.lastname: Viphou
authors.affiliation: University Research Co. Better Health Services project, Phnom Penh, Cambodia.
authors.forename: Christophe
authors.initials: C
authors.lastname: Grundmann
authors.affiliation: Department of Social Medicine and Global Health, Lund University, Lund, Sweden.
authors.forename: Jerker
authors.initials: J
authors.lastname: Liljestrand
mesh_terms: D002160:Cambodia; D002983:Clinical Competence / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007318:Inservice Training / Q000379:methods*; D000068097:Maternal Health; D008505:Medical Staff, Hospital / Q000193:education*; D008880:Midwifery / Q000193:education*; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration; D011247:Pregnancy; D012151:Resuscitation / Q000193:education
keywords: Cambodia; Continuing medical education; Follow-up; Low-resource setting; Maternal mortality