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Dr. Beena Kamath-Rayne, American Academy of Pediatrics 

From training to changing behaviors - the role of remote training and mentorship  

About

Dr. Beena Kamath Rayne is a neonatologist working at the American Academy of Pediatrics (AAP). She has been involved in the development and implementation of the Helping Mothers and Babies Survive (HMBS) programs, which aim to reduce maternal and neonatal mortality by providing training resources for healthcare personnel in low- and middle-income settings.  

Background

Built on the foundation of the Helping Babies Breathe (HBB) program launched in 2010 together with the American Academy of Pediatrics, the HMBS educational programs cover essential care for newborns and mothers during labor, delivery, and the postnatal period. Together with the WHO the AAP has developed the updated Essential Newborn Care Course, currently available on hmbs.org. Dr. Kamath-Rayne shares what she’s learned through the process and the implications for the future.  

How do we apply a global perspective to facilitate scalability and sustainability of programs and most importantly, strengthen impact?  

I think we need to listen to what countries are telling us that they need to scale and sustain programs.  They know what will work best in their contexts and their leaders are in the best position to coordinate efforts with partners to move the work forward.  Activities must be country owned and country led. The AAP’s ideal model is to partner with other professional associations and/or local organizations who request our assistance to support training and implementation. Often the conversation starts with a needs assessment to understand what local leaders see as the gaps, and then to collaborate on a plan for how to move the work forward. 

What are some of the most pressing challenges for quality training and how can we address them?  

One big challenge is training new facilitators who embrace the training methodology of HBB that is now firmly ingrained in the WHO ENC course.  We have tried to be intentional about making sure that our training opportunities or mentorship opportunities include a diverse mix of health care professionals as well as career experience, so that we are bringing in various perspectives and continuing mentorship in multiple avenues.  Now that we have introduced remote facilitation, we need to develop improved methodologies for developing facilitator to learner and peer to peer relationships which promote open discussion and feedback.  
 
Another challenge is movement of highly skilled clinical staff and trainers within and out of facilities. One way to address this would be increasing emphasis on pre service training. If quality training is provided during med/nursing/midwifery school by experienced educators (who at this level are often in more stable, long-term positions), then the core tenants of the methodology are being instilled and ingrained as the norm. That seed of knowledge is being planted very early on, and then it continues to grow and flourish as these students transition to clinical practice. 

What do you see as the role of remote facilitation, blended learning and e-learning, now and into the future? Is there an ideal combination of remote and in-person training?

Our initial experience with remote facilitation and blended learning has been very positive. It has allowed for greater flexibility in a training schedule that accommodates the clinical duties of the learners, in addition to options for distributed or consolidated learning, while still emphasizing skills-based practice.  In our focused group discussions of a pilot and feasibility of remote facilitation for ENC, the learning methodology was well received by the learners, but there is still more that we need to do to support facilitators in different ways of delivering content, building and establishing relationships with the learners, supporting skills acquisition and practice, and encouraging peer to peer mentorship.  We have challenges with information technology infrastructure and web connectivity.  Remote facilitation has also continued to build on local expertise in ENC that started with Helping Babies Breathe and allowed local leaders to emerge and pave the way forward for their own countries in a way that is really exciting. And finally, we have to build more of an evidence base for the ideal combination of remote and in-person training.  While there are some initial exploratory studies that have been done, there are still a lot of questions about the ideal combination for different settings.   

We know that quality training is important. But it’s not always enough. What do you mean by the idea of: “we’ve gone wide but now we need to go deep”?   

The AAP, in collaboration with Laerdal and other partners, started training cascades in Helping Babies Survive that reached over 1 million health care professionals.  One important and humbling lesson from the HBB experience is that even though we trained many people, the learners did not always implement what they had learned, or the training cascade was not sustained.  We realized that training is only the first step to ongoing health care system strengthening and behavior change.  So we have pivoted to not only offering training, but also ongoing mentorship and supportive supervision with the AAP’s Customized Mentorship and Implementation Support Package (CRISP), where learners are partnered with a Global Mentor for 6-12 months after an initial training to continue to work on concepts like quality improvement, facilitator strengthening, monitoring and evaluation, etc. We have to build longer lasting collaborations with local champions and empower them to work within their contexts to improve care.  

How has the partnership with Laerdal Global Health evolved over the past decade to expand and diversify the scope and scale of the programs?   

The AAP and LGH partnership has been an ideal pairing of technical expertise (AAP) and educational innovation (LGH), that has now transcended to joint implementation of the HBS and now ENC programs.  Our partnership has only deepened with time as we continue to build a path forward together based on lessons learned from where we have been.  

How will we continue to collaborate and innovate to meet the emerging and evolving needs and challenges of healthcare workers and health systems?  

I think we need to listen to our global colleagues about their needs and center the work around those discussions.  For that reason, the AAP transitioned its former Helping Babies Survive Planning Group to a new Global Neonatal Advisory Committee that is truly international and multidisciplinary.  It includes representation from the essential partners in newborn care globally—midwives, nurses, pediatricians, researchers, obstetricians, among others.  These diverse perspectives have added a richness to our conversations about where we need to go next.  We have to work together to truly achieve improved neonatal outcomes.