Adapting continuing medical education for post-conflict areas: assessment in Nagorno Karabagh - a qualitative study

Human Resources for Health

Byron Crape²  Kim Hekimian³  Hambardzum Simonyan¹  Arin A Balalian¹ 

[1] Fund for Armenian Relief of America (FAR), Healthcare Department, #22 Khorenatsi Street, Yerevan, Republic of Armenia;School of Public Health, American University of Armenia, #40 Baghramyan Street, Yerevan, Republic of Armenia;Institute for Human Nutrition, Columbia University, 630 West 168th Street PH 15 East, Suite 1512, New York, NY 10032, USA

关键词: Nagorno Karabagh;    Qualitative evaluation;    Infrastructures in post-conflict zones;    Human resources in health care in post-conflict zones;    Post-conflict zones;   

Others  :  1161186
DOI  :  10.1186/1478-4491-12-39

 received in 2014-01-09, accepted in 2014-07-28,  发布年份 2014

【 摘 要 】

Background

One of the major challenges in the current century is the increasing number of post-conflict states where infrastructures are debilitated. The dysfunctional health care systems in post-conflict settings are putting the lives of the populations in these zones at increased risk. One of the approaches to improve such situations is to strengthen human resources by organizing training programmes to meet the special needs in post-conflict zones. Evaluations of these training programmes are essential to assure effectiveness and adaptation to the health service needs in these conditions.

Methods

A specialized qualitative evaluation was conducted to assess and improve a post-conflict continuing medical education (CME) programme that was conducted in Nagorno Karabagh. Qualitative research guides were designed for this post-conflict zone that included focus group discussions with physician programme participants and semi-structured in-depth interviews with directors of hospitals and training supervisors.

Results

Saturation was achieved among the three participating groups in the themes of impact of participation in the CME and obstacles to application of obtained skills. All respondents indicated that the continuing medical education programme created important physician networks absent in this post-conflict zone, updated professional skills, and improved professional confidence among participants. However, all respondents indicated that some skills gained were inapplicable in Nagorno Karabagh hospitals and clinics due to lack of appropriate medical equipment, qualified supporting human resources and facilities.

Conclusion

The qualitative research methods evaluation highlighted the fact that the health care human resources training should be closely linked to appropriate technologies, supplies, facilities and human resources available in post-conflict zones and identified the central importance of creating health professional networks and professional confidence among physicians in these zones. The qualitative research approach most effectively identifies these limitations and strengths and can directly inform the optimal adjustments for effective CME planning in these difficult areas of greatest need.

【 授权许可】

   
2014 Balalian et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lemmon GT: Entrepreneurship in Postconflict Zones. United States of America: Council on Foreign Relations Press; 2012. Ref Type: Online Source
• [2]Brahimi L: State Building in Crisis and Post-conflict countries. 2007.
• [3]Nkurunziza JD: Civil War and Post Conflict Reconstruction in Africa. 2008.
• [4]Moser CON, Clark FC: Gender, conflict and building sustainable peace: recent lessons learnt from Latin America. Gend Dev 2001, 9:29-39.
• [5]Marques J, Bannon I: Central America: Education Reform in a Post-conflict Setting, Opportunities and Challenges. Washinton DC: World Bank’s Human Development Network and the Conflict Prevention and Reconstruction Unit of the Social Development Department; 2003:4. Ref Type: Report
• [6]Snellinger A, Shneiderman S: Framing the Issues: The Politics of ‘Post-conflict’. Fieldsights - Hot Spots: Cultural Anthropology Online; 2014. Ref Type: Online Source
• [7]Overhaus M: Violence in Post-conflict Transitions Twin Challenge for the EU in the ‘Arab Spring’. Berlin: Stiftung Wissenschaft und Politik (German Institute for International and Security affairs); 2011. Ref Type: Report
• [8]Ghobarah HA, Huth P, Russet B: Civil wars kill and maim people - long after the shooting stops. Am Polit Sci Rev 2003, 97:189-202.
• [9]Coghlan B, Brennan RJ, Ngoy P, Dofara D, Otto B, Clements M, Stewart T: Mortality in the Democratic Republic of Congo: a nationwide survey. Lancet 2006, 367:44-51.
• [10]Degomme O, Guha-Sapir D: Patterns of mortality rates in Darfur conflict. Lancet 2010, 375:294-300.
• [11]Roberts L, Lafta R, Garfield R, Khudhairi J, Burnham G: Mortality before and after the 2003 invasion of Iraq: cluster sample survey. Lancet 2004, 364:1857-1864.
• [12]Garfield R: The epidemiology of war. In War and Public Health. 2nd edition. Edited by Levy BS, Sidel VW. New York: Oxford University Press; 2007:23.
• [13]Peck C, McCall M, McLaren B, Rotem T: Continuing medical education and continuing professional development: international comparisons. BMJ 2000, 320:432-435.
• [14]Smith JH, Kolehmainen-Aitken RL: Establishing human resource systems for health during postconflict reconstruction. Manage Sci Health 2006., 3Ref Type: Online Source
• [15]World Health Organization: Guide to Health Workforce Development in Post-conflict Environments. Geneva: World Health Organization; 2005. Ref Type: Report
• [16]World Health Organization: Health in Emergencies-Human Resource Development in Crisis. Newsletter of Department of Health Action in Crisis. Geneva: World Health Organization; 2003. Ref Type: Magazine Article
• [17]Parfitt T: Years of ‘frozen conflict’ leave Abkhazia isolated and poor. Lancet 2006, 367:1043-1045.
• [18]Thompson ME, Dorian AH, Harutyunyan TL: Identifying priority healthcare trainings in frozen conflict situations: the case of Nagorno Karabagh. Confl Health 2010, 4:21.
• [19]Povey G, Mercer MA: East Timor in transition: health and health care. Int J Health Serv 2002, 32:607-623.
• [20]Pavignani E, Comolbo A: Providing Health Services in Countries Disrupted by Civil Wars: a Comparative Analysis of Mozambique and Angola. Geneva: World Health OrganizationRef Type: Report; 2001.
• [21]Rosenthal MS, Lannon CM, Stuart JM, Brown L, Miller WC, Margolis PA: A randomized trial of practice-based education to improve delivery systems for anticipatory guidance. Arch Pediatr Adolesc Med 2005, 159:456-463.
• [22]Allaire BT, Trogdon JG, Egan BM, Lackland DT, Masters D: Measuring the impact of a continuing medical education program on patient blood pressure. J Clin Hypertens (Greenwich) 2011, 13:517-522.
• [23]Kutcher SP, Lauria-Horner BA, MacLaren CM, Bujas-Bobanovic M: Evaluating the impact of an educational program on practice patterns of Canadian family physicians interested in depression treatment. Prim Care Companion J Clin Psychiatry 2002, 4:224-231.
• [24]Khachatryan L, Balalian A: Performance assessment through pre- and post-training evaluation of continuing medical education courses in prevention and management of cardio-vascular diseases in primary health care facilities of Armenia. J Community Health 2013, 38:1132-1139.
• [25]Thompson ME, Harutyunyan TL, Dorian AH: A first aid training course for primary health care providers in Nagorno Karabagh: assessing knowledge retention. Prehosp Disaster Med 2012, 27:509-514.
• [26]O’Hanlon KP, Budosan B: Post-disaster recovery: a case study of human resource deployment in the health sector in post-conflict Kosovo. Prehosp Disaster Med 2011, 26:7-14.
• [27]Homan FF, Hammond CS, Thompson EF, Kollisch DO, Strickler JC: Post-conflict transition and sustainability in Kosovo: establishing primary healthcare-based antenatal care. Prehosp Disaster Med 2010, 25:28-33.
• [28]Buwa D, Vuori H: Rebuilding a health care system: war, reconstruction and health care reforms in Kosovo. Eur J Public Health 2007, 17:226-230.
• [29]Brigley S, Littlejohns P, Young Y, McEwen J: Continuing medical education: the question of evaluation. Med Educ 1997, 31:67-71.
• [30]Minasyan S: Nagorno Karabagh after Two Decades of Conflict: Is Prolongation of Status Quo Inevitable?. Yerevan: Caucasus Institute; 2010. Ref Type: Report
• [31]Lattu K, Garner D, Culkin D: Humanitarian Needs Evaluation for Victims of The Nagorno Karabagh Conflict. 1998. Ref Type: Report
• [32]Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR: Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999, 282:1458-1465.
• [33]Kimura S, Pacala JT: Pressure ulcers in adults: family physicians’ knowledge, attitudes, practice preferences, and awareness of AHCPR guidelines. J Fam Pract 1997, 44:361-368.
• [34]Morikawa MJ: Primary care training in Kosovo. Fam Med 2003, 35:440-444.