Utilizing Train-the-Trainer Approach to Improve Pediatric Critical Care Medicine in Rural cities of China: An 8-year experience in capacity building

Uneven development of economic and infrastructure led to unbalanced medical service in large rural regions of China, mainly including 15 eastern and western provinces, like Xinjiang, Inner Mongolia, Heilongjiang, Yunnan and Sichuan. Pediatric critical care capacity plays a key role in the mortality of patients under 5-years-old, which was much higher in these rural areas than in big cities. The limitation lies in the shortage of skilled staff and lack of financial support which in turn impedes further development, and demonstrates significant discrepancy of children's health care in different areas.

Shanghai Children's Medical Center (SCMC) is one of important health care facilities supported by Project HOPE together with Shanghai Municipal Government. After 10 years effort for professional training and facility improvement, the hospital has taken the role in providing pediatric training for health professionals across the China by adopting the Train-the-Trainer (TtT) approach.

In 2002, Project HOPE initiated a Rural Training Program in SCMC aimed at providing critical care training for professionals from less developed regions. Each year, 25-30 physicians and nurses are selected based on their clinical experience and learning objectives. The candidates then accept a one-year's advanced clinical training in Shanghai. Project HOPE worked closely with SCMC to form training curriculum, monitor the process and evaluate the outcomes. The systematic training is mainly implemented by an assigned clinical mentor who supervises the learning experience and assists in the daily training. All of these fellows are finically supported by Project HOPE for their local accommodations, tuitions, living stipend and scholarship.

A total of 198 professionals have been trained, all of them graduated with “excellent” score of final evaluation, and 100% expressed “very satisfied” or “satisfied” to the program. In 2009, a questionnaire to survey long-term impact of the program was delivered to each individual, with a 53.3% return rate. The most outstanding achievements are: enlightened vision and passion (70.4%), updated knowledge/skill (64.8%), and changed perception of medical care (59.1%). Many fellows implemented new medical innovations when they went back, such as establishment (24 fellows) or improvement (28 fellows) of pediatric ICU, utilization of advanced therapies (Ventilator 40.9%, PICC 16.9%, new protocols for complicated diseases 9.9%). Through TtT model, they provided further training at the local settings, 15,500 local professionals been trained, and 102,300 patients benefited directly or indirectly from this Program. 46% of these fellows are now taking the role of chief/leader or professor in their hospitals.