The development of a training course for clubfoot treatment in Africa: learning points for course development

Tracey Smythe,Grace Le,Christopher Lavy,Linda Hansen,Birhanu Ayana,Rosalind Owen

doi:10.1186/s12909-018-1269-0

Abstract

BackgroundClubfoot is a common congenital musculoskeletal disorder that causes mobility impairment. There is a lack of trained mid-level personnel to provide clubfoot treatment in Africa and there is no standard training course. This prospective study describes the collaborative and participatory approach to the development of a training course for the treatment of clubfoot in children in resource constrained settings.MethodsWe used a systems approach to evaluate the development of the training course.Inputs: The research strategy included a review of context and available training materials, and the collection of data on current training practices. Semi-structured interviews were conducted with seven expert clubfoot trainers. A survey of 32 international and regional trainers was undertaken to inform practical issues. The data were used to develop a framework for training with advice from two technical groups, consisting of regional and international stakeholders and experts.Process: A consensus approach was undertaken during workshops, meetings and the sharing of documents. The design process for the training materials took twenty-four months and was iterative. The training materials were piloted nine times between September 2015 and February 2017. Processes and materials were reviewed and adapted according to feedback after each pilot.ResultsFifty-one regional trainers from Africa (18 countries), 21 international experts (11 countries), 113 local providers of clubfoot treatment (Ethiopia, Rwanda and Kenya) and local organising teams were involved in developing the curriculum and pilot testing. The diversity of the two technical advisory groups allowed a wide range of contributions to the collaboration.Output: The resulting curriculum and content comprised a two day basic training and a two day advanced course. The basic course utilised adult learning techniques for training novice providers in the treatment of idiopathic clubfoot in children under two years old. The advanced course builds on these principles.ConclusionFormative research that included mixed methods (both qualitative and quantitative) was important in the development of an appropriate training course. The process documentation from this study provides useful information to assist planning of medical training programmes and may serve as a model for the development of other courses.

Highlights

Clubfoot is a common congenital musculoskeletal disorder that causes mobility impairment
Inputs Partnership of stakeholders The Africa Clubfoot Training (ACT) project is a partnership between the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) at the University of Oxford, the Global Clubfoot Initiative (GCI), CURE Clubfoot and CURE Ethiopia Children’s Hospital, in co-ordination with the Ministries of Health in Ethiopia and Rwanda
This study outlines the formative research that informed the design of a training course for clubfoot providers in resource constrained settings

Summary

Introduction

Clubfoot is a common congenital musculoskeletal disorder that causes mobility impairment. There is a lack of trained mid-level personnel to provide clubfoot treatment in Africa and there is no standard training course. Congenital talipes equinovarus, is a common congenital disorder that causes mobility impairment if untreated. It is a structural and functional deformity where the child is born with the foot turned inwards [1]. The Ponseti method [2, 3] is promoted as an effective and low cost treatment of clubfoot [4] This minimally invasive method includes a correction phase and a maintenance phase, and can be delivered by trained mid-level health care providers in resource constrained settings [5]. To prevent recurrence of the deformity, it is recommended that a foot abduction brace is worn for 23 h/day for 3 months following correction, and at night until the child is 4 years old [6]

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Conclusion