Improving Pre-service Education in Ghana

Maternal mortality rates in Ghana stand at 319 per 100,000 live births, and under 5 mortality rates are 52 per 1,000 live births. To address these challenges, the government established 40 new midwifery schools and 21 general nursing schools between 2010 and 2015. However, despite these efforts, many challenges remain, including insufficient resources for training, variable knowledge and skill levels of tutors, and unacceptably high instructor to student ratios. Skills labs provide students with hands-on practice with anatomical models before applying skills in real-life situations. In 2014, the Maternal and Child Survival Program (MCSP) conducted an initial assessment in all nursing and midwifery training colleges to understand skills labs usage and availability of appropriate equipment for instruction. Results showed that none of the schools had a full complement of the required anatomical models and simulators, and some did not have a designated space for a skills lab. In response, MCSP developed a three-pronged implementation approach to enhance skills labs and improve students' life-saving competencies in maternal, newborn, and child health, malaria, and family planning. The implementation approach included purchasing and distributing medical equipment and anatomical models according to the needs of each school, training 330 tutors on management of skills labs with a focus on use of models and effective teaching methods, and integrating the use of skills labs into course syllabi and student practical sessions. A study was conducted to better understand the successes and challenges of skills labs in the pre-service education setting. The study used a cross-sectional mixed methods approach to document skills labs use and student skills in four community health nursing training schools. Objective structured clinical examinations (OSCEs) were administered to 30 third-year students at three time points: pre-intervention/baseline, one year after project support began, and two years after project support began. The selected schools' skills labs were equipped several years prior to the June 2018 endline assessment to allow sufficient time for students to access and use the skills labs. Four OSCE stations were used in the study at all time points, including malaria rapid diagnostic tests, home visit counseling on correct latching during breastfeeding, method-specific counseling for Jadelle contraceptive implant, and umbilical cord care. The study found significant improvements in student competencies in four thematic areas. Correct testing for malaria using RDT improved from 40% at baseline to 87% at endline. Clean cord care for newborns improved from 17% at baseline to 77% at endline. Counseling on correct latching of the newborn during breastfeeding improved from 48% at baseline to 61% at endline. Correct counseling on implants (family planning methods) increased from 33% at baseline to 44% at endline. Qualitative data from students, tutors, and principals provided perspectives on the usage of skills labs, challenges, significant changes, and success stories associated with the skills labs in the school. Respondents revealed that the refurbished skills labs have brought significant improvements to the schools. Some principals and tutors indicated that prior to skills lab installation, they were teaching theory without being able to show students the instruments they should use for a procedure. In addition, some tutors said they were previously teaching in abstract since there were no skills labs, especially for midwifery students. However, respondents also noted that it is not easy to translate skills learned when using models to demonstrating those same skills with real people. Despite this sentiment, participants also noted that practice with models was very helpful in building their skills. They felt that they are able to perform better than their peers who have not had a chance to practice with models under clinical staff observation.