title: Assessing the twinning model in the Rwandan Human Resources for Health Program: goal setting, satisfaction and perceived skill transfer.
abstract: BACKGROUND
  Because of the shortage of health professionals, particularly in specialty areas, Rwanda initiated the Human Resources for Health (HRH) Program. In this program, faculty from United States teaching institutions (USF) "twin" with Rwandan Faculty (RF) to transfer skills. This paper assesses the twinning model, exploring USF and RF goal setting, satisfaction and perceptions of the effectiveness of skill transfer within the twinning model.
  
  
  METHODS
  All USF and RF in the HRH Program from August 2012-May 2014 were invited to participate. An 85-item questionnaire for USF and 71-item questionnaire for RF were administered via Survey Monkey in April and May 2014. Associations among primary outcomes were assessed and factors related with outcomes were modeled using logistic regression.
  
  
  RESULTS
  Most RF and USF reported setting goals with their twin (89% and 71%, respectively). Half of RF (52%) reported effective skill transfer compared to 10% of USF. Only 38% of RF and 28% of USF reported being very satisfied with the twinning model. There was significant overlap in the three operational outcomes. For RF, the following factors were associated with outcomes: for effective skill transfer, being able to communicate in a common language and working at a nursing site outside of Kigali; and for satisfaction, 7+ years of professional experience and being part of a male RF-female USF twin pair. For USF, the following factors were associated with outcomes: for setting goals, prior teaching experience; and for satisfaction, experience in low resource settings for one month or less and feeling that HRH promotes a culture of respect.
  
  
  CONCLUSIONS
  Twinning is the cornerstone of the HRH Program in Rwanda. These findings helped the HRH team identify key areas to improve the twinning experience including better recruitment and orientation of USF and RF, consideration of additional factors during the twinning process, provide language training support, facilitate joint twin activities and cross-cultural training and improve the site leadership buy-in and support of the program. These results can inform other programs using twinning to develop skills in the health workforce.
authors.affiliation: Human Resources for Health, Ministry of Health, P.O. Box 84, Kigali, Rwanda. esndenga@gmail.com.
authors.forename: Esperance
authors.initials: E
authors.lastname: Ndenga
authors.affiliation: Human Resources for Health, Ministry of Health, P.O. Box 84, Kigali, Rwanda. uglorieuse@gmail.com.
authors.forename: Glorieuse
authors.initials: G
authors.lastname: Uwizeye
authors.affiliation: College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda. dana.r.thomson@gmail.com.|Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. dana.r.thomson@gmail.com.
authors.forename: Dana R
authors.initials: DR
authors.lastname: Thomson
authors.affiliation: Human Resources for Health, Ministry of Health, P.O. Box 84, Kigali, Rwanda. uwitonze.eric@gmail.com.
authors.forename: Eric
authors.initials: E
authors.lastname: Uwitonze
authors.affiliation: Human Resources for Health, Ministry of Health, P.O. Box 84, Kigali, Rwanda. joehrh2014@gmail.com.
authors.forename: Joel
authors.initials: J
authors.lastname: Mubiligi
authors.affiliation: College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda. bethhedt@gmail.com.|Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. bethhedt@gmail.com.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Hedt-Gauthier
authors.affiliation: College of Medicine and Health Sciences, University of Rwanda, P.O. Box 3286, Kigali, Rwanda. mswilkes@ucdavis.edu.|Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. mswilkes@ucdavis.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Wilkes
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. dr.agnes.binagwaho@gmail.com.|Ministry of Health, P.O. Box. 84, Kigali, Rwanda. dr.agnes.binagwaho@gmail.com.|Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH, 03755, USA. dr.agnes.binagwaho@gmail.com.
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D002983:Clinical Competence / Q000592:standards; D006040:Goals; D006282:Health Personnel / Q000639:trends*; D006801:Humans; D008611:Mentors; D009726:Nurses / Q000600:supply & distribution; D010820:Physicians / Q000600:supply & distribution; D016730:Program Development / Q000379:methods*; D015397:Program Evaluation; D012432:Rwanda; D013192:Staff Development / Q000379:methods*; D011795:Surveys and Questionnaires
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