Jeffery Heather E, Kocova Mirjana, Tozija Fimka, Gjorgiev Dragan, Pop-Lazarova Marina, Foster Kirsty, Polverino Jan, Hill David A
RPA Newborn Care, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
Med Educ. 2004 Apr;38(4):435-47. doi: 10.1046/j.1365-2923.2004.01785.x.
The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital-based initiative to develop the capacity of health professionals to introduce evidence-based perinatal practice into 16 participating hospitals. A "train the teachers" approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje.
To describe the development, implementation and evaluation of the educational intervention.
A curriculum, based on specific Macedonian needs, was developed in order to integrate teaching in the knowledge, skills and attitudinal domains of learning, using small group, interactive techniques. Twenty-five Macedonian doctors and nurses participated in 4-month (phase 1a) and 6-month (phase 1b) teaching programmes at a tertiary perinatal unit in Sydney. Australian staff conducted 4 2-week modules for 36 trainees in Macedonia (phase 2). The phase 1 trainees conducted 8 modules for 57 colleagues in Skopje (phase 3). The intervention was evaluated by trainee questionnaires, assessments of competence, changes in hospital practice and pre- (1997-99) and post-intervention (2000-01) comparisons of PMR.
A total of 115 doctors and nurses graduated from the programme. Positive responses to the education programme exceeded 80%. Evidence-based practice in 16 participating hospitals (covering 91% of all Macedonian births) was verified in 6 key areas of neonatology. The PMR fell significantly from 27.4 to 21.5 per 1000 births (RR 0.79, 95% CI 0.73, 0.85). The early neonatal death rate in babies weighing over 1000 g fell by 36%.
The intervention has increased the capacity of Macedonians to practise best-evidence perinatal medicine and improve outcomes. Sustainability is predicted by the "train the teachers" approach, with concurrent strengthening of the infrastructure and organisational framework.
马其顿的围产期死亡率在欧洲位居前列。世界银行资助了一位顾问（HEJ）与马其顿团队合作制定一项国家围产期战略，目标是降低围产期死亡率。以一项基于医院的倡议形式将教育作为优先事项，以培养卫生专业人员的能力，将循证围产期实践引入16家参与的医院。采用了“培训教师”的方法，学员们先在悉尼接受现代教育和临床实践培训，随后在斯科普里得到支持以培训他们的同事。
描述教育干预措施的制定、实施和评估情况。
根据马其顿的具体需求制定了一门课程，以便利用小组互动技术将教学融入学习的知识、技能和态度领域。25名马其顿医生和护士参加了悉尼一家三级围产期单位为期4个月（1a阶段）和6个月（1b阶段）的教学计划。澳大利亚工作人员为马其顿的36名学员开展了4个为期2周的模块培训（2阶段）。1阶段的学员为斯科普里的57名同事开展了8个模块的培训（3阶段）。通过学员问卷、能力评估、医院实践的变化以及围产期死亡率的干预前（1997 - 1999年）和干预后（2000 - 2001年）比较对干预措施进行评估。
共有115名医生和护士完成了该计划。对教育计划的积极反馈超过80%。在新生儿学的6个关键领域验证了16家参与医院（覆盖马其顿所有分娩的91%）的循证实践。围产期死亡率从每1000例分娩27.4例显著降至21.5例（相对危险度0.79，95%可信区间0.73，0.85）。体重超过1000克的婴儿早期新生儿死亡率下降了36%。
该干预措施提高了马其顿人实施最佳循证围产期医学并改善结局的能力。通过“培训教师”方法以及同时加强基础设施和组织框架预计可实现可持续性。
