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Professional Skills Training Center for Family Medicine Project in Lori – Armenia

OVERALL GOAL:

Improve healthcare in rural regions of Armenia through the development of a family medicine retraining and model service delivery site in Lori Region.

BACKGROUND:

This project aims to provide training within the practice model and service system settings, thereby allowing for an appropriate balance of didactic and practicum instruction. AIHA will create “clinical classroom” for teaching and demonstration.

Policlinics, ambulatory and FAP services constitute an essential element of primary healthcare and may be provided by primary care providers comprised of sole-providers or teams of physicians and nurses. As the source of first contact care to which all members of a population have direct access, this workforce is responsible for providing continuing and coordinated health promotion, disease prevention, diagnostic, curative, rehabilitative and supportive services. The scope and content of these services and the effectiveness and efficiency by which they are provided will depend primarily on their education and training.

Several NGOs and universities have begun to address the need for family medicine education and services in Armenia, however none have previously focused on needs in rural areas. Although 33 percent of the population lived in rural regions in 2000 (according to the Population Division of the United Nations Secretariat), programs have not previously focused on rural care providers.

This program is designed to improve the care in the rural areas of Lori Marz by providing training to rural ambulatories’ health centers’ and FAP’s staff to improve their professional skills and competencies, thus improving the quality of the care provided.

OBJECTIVES:

OBJECTIVE 1: Establish Primary Skills Retraining Center

The Primary Skills Retraining Center is located in Lori Region’s Polyclinic Number Five. AIHA selected this site because of previous success in working with the clinic’s staff and administration, and because a previous AIHA partnership laid the physical foundation by installing a Learning Resource Center and various equipment, as well as has prepared a cohort of well-trained physicians and nurses.

The Armenian Ministry of Health is focusing on developing Family Medicine in the country to improve the access to sufficient healthcare services, and Lori Marz is one of the pilot areas, where the introduction of the new concept of primary health care delivery will be implemented.

Project funds were used to renovate and furnish the training center, purchase the necessary equipment and supplies, provide logistical support for the trainings. Included within the training center is one lecture room, two offices and three classrooms, a door leading to the clinic and a separate, outside entrance.

OBJECTIVE 2: Develop a faculty consisting of five trainers and one director

The training team is salaried and continues to serve patients part-time. Hiring in-country, salaried staff provides for the Center’s sustainability. The trainers are skilled in providing healthcare services as well as in adult teaching methodology. They reflect the trainee population so that they serve both as instructors and as role models with similar responsibilities and concerns.

OBJECTIVE 3: Develop Retraining Curricula

The curricula are skills-based, module-based, problem-oriented retraining curricula that will target the training needs of solo-provider nurses and generalist physicians staffing rural Armenian ambulatories and FAPs.

The curricula focuses on family medicine training, which involves substituting polyclinics and ambulatories for hospitals as a major deliverer of care, thereby reducing the number of hospital beds and hospitalizations and increasing the variety of services rendered in a given region. Family medicine is the most flexible and readily adaptable of the primary healthcare practice models in terms of its potential for building on Armenia’s existing polyclinic and ambulatory primary care physician model of district pediatrician and therapist. It has the capacity to provide high quality, family and community-oriented care that addresses the health needs and problems of the specific population served.

The curricula were designed in accordance with the national post graduate medical training policies and to increase the availability of continuing education opportunities in areas related to rural healthcare in Armenia. The curricula integrate several pieces, such as the emergency medicine curriculum, already successfully executed in Armenia.

OBJECTIVE 4: Train physicians and nurses in Lori Region

Previously, healthcare education in the former Soviet Union generally consisted of training physicians in areas such as pediatrics, internal medicine, surgery, and other narrow specialty areas, but not to treat the entire family. These training seminars provide clinical opportunities in primary care settings. Previously, faculty had limited primary care clinical competencies and deficient understanding of the goals and scope of family medicine, but the trainers at PRSC will be trained specifically in family medicine. While previously, nursing education was underdeveloped, the curriculum aims at increasing the competencies of sole-provider nurses. Specific modules include:

1.   Emergency medical care
2.   Chest Pain
3.   Acute Abdomen
4.   Joint problems
5.   Infectious diseases
6.   Community health assessment
7.   Prevention and risk reduction
8.   Pediatric ARI and diarrhea
9.   NRP
10. Nutritional health and vulnerable groups
11. Oral and dental health

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