title: A framework for revising preservice curriculum for nonphysician clinicians: The mozambique experience.
abstract: Mozambique, with approximately 0.4 physicians and 4.1 nurses per 10,000 people, has one of the lowest ratios of health care providers to population in the world. To rapidly scale up health care coverage, the Mozambique Ministry of Health has pushed for greater investment in training nonphysician clinicians, Tιcnicos de Medicina (TM). Based on identified gaps in TM clinical performance, the Ministry of Health requested technical assistance from the International Training and Education Center for Health (I-TECH) to revise the two-and-a-half-year preservice curriculum. A six-step process was used to revise the curriculum: (i) Conducting a task analysis, (ii) defining a new curriculum approach and selecting an integrated model of subject and competency-based education, (iii) revising and restructuring the 30-month course schedule to emphasize clinical skills, (iv) developing a detailed syllabus for each course, (v) developing content for each lesson, and (vi) evaluating implementation and integrating feedback for ongoing improvement. In May 2010, the Mozambique Minister of Health approved the revised curriculum, which is currently being implemented in 10 training institutions around the country. Key lessons learned: (i) Detailed assessment of training institutions' strengths and weaknesses should inform curriculum revision. (ii) Establishing a Technical Working Group with respected and motivated clinicians is key to promoting local buy-in and ownership. (iii) Providing ready-to-use didactic material helps to address some challenges commonly found in resource-limited settings. (iv) Comprehensive curriculum revision is an important first step toward improving the quality of training provided to health care providers in developing countries. Other aspects of implementation at training institutions and health care facilities must also be addressed to ensure that providers are adequately trained and equipped to provide quality health care services. This approach to curriculum revision and implementation teaches several key lessons, which may be applicable to preservice training programs in other less developed countries.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Freistadt
authors.forename: Erin
authors.initials: E
authors.lastname: Branigan
authors.forename: Chris
authors.initials: C
authors.lastname: Pupp
authors.forename: Marzio
authors.initials: M
authors.lastname: Stefanutto
authors.forename: Carlos
authors.initials: C
authors.lastname: Bambo
authors.forename: Maria
authors.initials: M
authors.lastname: Alexandre
authors.forename: Sandro O
authors.initials: SO
authors.lastname: Pinheiro
authors.forename: Ruth
authors.initials: R
authors.lastname: Ballweg
authors.forename: Martinho
authors.initials: M
authors.lastname: Dgedge
authors.forename: Gabrielle
authors.initials: G
authors.lastname: O'Malley
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Justine Strand
authors.initials: JS
authors.lastname: de Oliveira
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000628:therapy*; D000488:Allied Health Personnel / Q000191:economics / Q000193:education* / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D017046:Cost Savings / Q000379:methods; D003479:Curriculum / Q000592:standards / Q000639:trends; D003657:Decision Making; D006801:Humans; D007391:International Cooperation; D009073:Mozambique; D009726:Nurses / Q000191:economics / Q000600:supply & distribution; D010823:Physician Assistants / Q000193:education / Q000592:standards / Q000639:trends; D010820:Physicians / Q000191:economics / Q000600:supply & distribution; D012456:Salaries and Fringe Benefits; D014146:Training Support; D014481:United States