Kankaka Edward Nelson, Kigozi Godfrey, Kayiwa Daniel, Kighoma Nehemiah, Makumbi Frederick, Murungi Teddy, Nabukalu Dorean, Nampijja Resty, Watya Stephen, Namuguzi Daniel, Nalugoda Fred, Nakigozi Gertrude, Serwadda David, Wawer Maria, Gray Ronald H
Rakai Health Sciences Program, Kalisizo, Uganda.
School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
BJU Int. 2017 Apr;119(4):631-637. doi: 10.1111/bju.13685. Epub 2016 Nov 11.
To assess acquisition of knowledge and competence in performing Early Infant Male Circumcision (EIMC) by non-physicians trained using a structured curriculum.
Training in provision of EIMC using the Mogen clamp was conducted for 10 Clinical Officers (COs) and 10 Registered Nurse Midwives (RNMWs), in Rakai, Uganda. Healthy infants whose mothers consented to study participation were assigned to the trainees, each of whom performed at least 10 EIMCs. Ongoing assessment and feedback for competency were done, and safety assessed by adverse events.
Despite similar baseline knowledge, COs acquired more didactic knowledge than RNMWs (P = 0.043). In all, 100 EIMCs were assessed for gain in competency. The greatest improvement in competency was between the first and third procedures, and all trainees achieved 80% competency and retention of skills by the seventh procedure. The median (interquartile range) time to complete a procedure was 14.5 (10-47) min for the COs, and 15 (10-50) min for the RNMWs (P = 0.180). The procedure times declined by 2.2 min for each subsequent EIMC (P = 0.005), and rates of improvement were similar for COs and RNMWs. Adverse events were comparable between providers (3.5%), of which 1% were of moderate severity.
Competence-based training of non-physicians improved knowledge and competency in EIMC performed by COs and RNMWs in Uganda.
评估使用结构化课程培训的非医师在实施早期男婴包皮环切术（EIMC）方面的知识掌握情况和操作能力。
在乌干达拉凯，对10名临床干事（COs）和10名注册护士助产士（RNMWs）进行了使用莫根夹进行EIMC操作的培训。母亲同意参与研究的健康婴儿被分配给受训人员，每人至少进行10例EIMC。对能力进行持续评估和反馈，并通过不良事件评估安全性。
尽管基线知识相似，但COs获得的理论知识比RNMWs更多（P = 0.043）。总共评估了100例EIMC的能力提升情况。能力提升最大的是在第一次和第三次操作之间，所有受训人员在第七次操作时达到了80%的能力水平并保持了技能。COs完成一次操作的中位（四分位间距）时间为14.5（10 - 47）分钟，RNMWs为15（10 - 50）分钟（P = 0.180）。每后续进行一次EIMC，操作时间减少2.2分钟（P = 0.005），COs和RNMWs的提升率相似。提供者之间的不良事件发生率相当（3.5%），其中1%为中度严重程度。
对非医师进行基于能力的培训提高了乌干达COs和RNMWs在EIMC方面的知识和能力。
