BACKGROUND The approach described below builds on the extensive experience the Global Laboratory Program of the Institute of Human Virology of the University of Maryland School of Medicine (GLP-IHVUMSOM) gained in supporting medical laboratory services in 7 countries in Africa and 2 in the Caribbean Region with more than 1500 laboratory professionals trained in the past seven years. The limited availability of well-trained laboratory personnel in both technical and managerial areas is a major hindrance in scaling-up health programs in Sub-Saharan Africa. In a survey conducted by GLP-IHVUMSOM recently in Ethiopia, Kenya, Nigeria, Rwanda, Tanzania, Uganda and Zambia, "Training and professional development" was indicated as the most important satisfaction factor and the highest rated incentive to stay at current job by more than 80% of laboratorians interviewed. These findings highlighted the urgent need for new approaches for in-service trainings aimed at increasing skills development while reducing absence from workplace. The numerous trainings delivered in the context of health system strengthening programs were face-to-face and they were successful in transferring knowledge while major gaps were observed in skills improvement. The lack of skills development was mainly to training strategy adopted that was often based on training sessions held in central location with minimum, if not absent, practical component. Despite the demand for hands-on sessions their number was limited because of the absence of training laboratories. In addition to the unsatisfactory level of skills development, this approach often entailed the reduction, if not the disruption, of laboratory activities at site level. NEW APPROACH The rationale behind this training approach is to renovate traditional learning to reflect the growing new technologies available in many African medical laboratories. A potential obstacle to educating laboratorians in becoming skilled with new diagnostics is the very low number of well-trained educators available at country level. A second major hindrance is represented by the lack of management systems and management skills for reaching and maintaining high quality in daily laboratory operations. A third barrier is the pedagogical approach of abundant lecture-based laboratory trainings where the teaching methodology only transfers information, without stimulating an active learning process. The pedagogical approach followed by GLP-IHVUMSOM encompasses different activities and methodologies with the main goal of transforming the learning method from a passive one-time event to a continuously active process. The blended teaching and learning method adopted includes both distance learning as well as some face-to-face training. This course consists of two components: the initial portion, where the learner is provided with paper-based material, and the second portion comprising hands-on on laboratory operations. In both parts participants have the opportunity to practice critical thinking in order to turn theoretical concepts into practical skills. With this method, trainers can focus their efforts on Good Laboratory Practice rather than spending days with lecture-based classes. Students have to complete a certain number of modules (8-12) covering valuable topics for an effective laboratory support of health programs. After an introduction of the course through a conference call, the course provider sends the students the first module by mail. At this stage the communication between trainer and student is limited while the learner-content interaction is high. This portion is dependent on self-regulation and motivation, driving students to develop critical autonomy, self-efficacy, and individual organizational skills. At the end of each time-sensitive module, students must complete a knowledge assessment test and send the results back to the provider for scoring. If the score is satisfactory the provider sends the following module and so forth for all remaining modules. At the end of the last module the total score for the first part of the course is obtained by tallying the single module-specific scores. Students are also required to prepare a short essay every three modules so to keep the dialogue between trainer and trainee active and to evaluate students' capacity for applying the knowledge acquired to real-world settings (i.e. their current workplace). For this purpose the students are asked to choose among three topics to reflect on their current practice and to relate it to their work environment. For example, an essay on Good Phlebotomy Practice is very effective if the learner has to describe it in the context of his/her daily routine work. developed in their own working environments. The essays are not used to grade students in part one, but they constitute the basis on which to develop part of the face-to-face training. Only pupils who show interest in the topic of the training, exhibit capacity in managing self-learning, and who are motivated in turning knowledge into practical skills will gain access to the second phase of the training. This natural selection allows for a highly instructive interaction among participants through open dialogue and critical debate. All these peculiarities can facilitate greater reflection on course content and broaden participants' learning experiences. The practical component is focused on diagnostic techniques and on all the steps of the Total Testing Procedure necessary to establish a long-term, functioning, quality management system in the laboratory. EXPECTED OUTCOMES Based on GLP-IHVUMSOM broad experience in providing trainings in these settings and the comprehensive understanding of final users' needs, the expected outcomes of this approach are the following: 1. To increase the number of Continuous Medical Education (CME) activities per year per laboratory professional as result of the reduced costs 2. To integrate CME activities into a broader individual Professional Development Plan (PDP) 3. To develop central teaching and training laboratory facility at in-country level that reflects the clinical laboratory environment where laboratory professionals provide their services 4. To minimize the student's absence from current workplace 5. To stimulate interest in the course content because of the subject-matter presentation and the multi-step awarding approach 6. To promote self-learning as a professional goal of individuals based on personal achievements only and not because of incentives 7. To increase skills development as the results of face-to-face sessions that concentrate on hands-on activities based on Good Laboratory Practice only
