Prepare Clinical Practice Sites

Experience has shown that students

should learn and practise the IMCI
clinical guidelines in an
environment where the guidelines
are used on a routine basis. For this
reason, it is essential to carefully
select and prepare appropriate
health facilities for IMCI clinical
practice.

Objectives

The objectives of preparing a
clinical practice site are to ensure
that:


2.2 TEACHING INSTITUTION(S)


I[ Define times, places, activities and
materials*

I[ Train teachers and clinical staff*

I[ Prepare clinical practice sites*

D Prepare materials*

D Coordinate teaching*

D Conduct and monitor teaching*

C Administrators of the site understand and support IMCI;

C Relevant clinical staff manage sick children according to the IMCI guidelines;
and
C Necessary supplies, equipment and patients are available.
Timing

It can take several months to orient administrators and prepare the staff, supplies and
equipment needed to teach and practise IMCI at a health facility. The IMCI Working
Group at a teaching institution should, therefore, start early to identify and prepare
one or more sites where students can practise managing sick children according to the
IMCI clinical guidelines.

Who Should Prepare Clinical Practice Sites?

The IMCI Working Group should work together with administrators and staff from
health facilities to prepare clinical practice sites for IMCI teaching. The National




Coordinating Group for IMCI Pre-Service Training can help to ensure that necessary
supplies and equipment are available. For more information, see the tasks called
Create a National Coordinating Group on IMCI Pre-Service Training, Analyse the
Situation and Create an IMCI Working Group in Phase One of these guidelines.

Description

The purpose of this task is to ensure that students practise IMCI in a first-level health
facility - such as a clinic, health centre or outpatient department of a hospital - where
the IMCI guidelines are supported and used on a routine basis.

The objectives of clinical practice sessions are for students to:

See examples of signs of illness in real children;
See demonstrations of how to manage sick children according to the IMCI clinical
guidelines;
Practise managing sick children and counselling mothers about food, fluids and
when to return;
Receive feedback from teachers about how well they performed and on how to
strengthen particular skills; and
Gain experience and confidence using the IMCI clinical guidelines.

In order to achieve these objectives, each clinical practice site should meet the
following criteria:

C Represents a first-level health facility where IMCI is used (e.g. clinic, health
centre, or small hospital);
C Administration and staff are supportive of IMCI;
C Receives a sufficient supply of appropriate patients;
C Informs clients that students are being trained in the facility;
C Trains relevant staff in the IMCI clinical guidelines;
C Manages sick children according to the IMCI clinical guidelines;
C Ensures that a staff member is available to assist with clinical practice activities,
such as selecting cases;
C Has sufficient supplies of the drugs and equipment needed to implement IMCI;
C Has sufficient space and facilities for student practice;
C Makes IMCI chart booklets or wall charts available, or posts them on display; and
C Enables students to practise the full IMCI guidelines, including identifying
treatment and counselling.

Clinical practice sites should be representative of first-level health facilities where
IMCI is normally practised. They should receive enough sick children for each
student to practise managing several cases with a wide variety of IMCI conditions,
clinical signs and classifications. Outpatient community clinics and outpatient wards
of hospitals are frequently used for IMCI clinical practice. Regardless of the type of




facility, clinical staff at the facility should routinely manage sick children according to
IMCI. For this reason, it is essential to gain the support of decision-makers at the clinical
practice site, and to train relevant clinic staff in IMCI.

If the staff members at a teaching institution decide to provide student transportation for
practise at an outpatient clinic, they should consider how this transportation will
be sustained over time. In many cases, it may be more feasible for students to practise IMCI
in the outpatient ward of a teaching hospital, and then to complete an internship at a
community clinic where IMCI is used on a routine basis. If internships are organized at
community clinics, it is important to remember that key staff at the clinic should be trained
to both practise and teach IMCI.

Clinical practice sites should allow students to practise the full IMCI case management
process, including identifying treatment and counselling the caretakers of sick children.

Suggested Activities and Materials

The IMCI Working Group should identify clinical sites that are representative of first- level
health facilities and that have an adequate flow of patients under the age of five years.

The national or state coordinating group, teaching institutions and administrators and staff
at clinical practice sites should then work together to:

C Orient decision-makers. Opinion leaders and decision-makers at a health facility need
to understand and accept IMCI before they can effectively support IMCI teaching. For
more detailed information see the task called Orient National Opinion Leaders and
Decision-makers in section 1.2 of this guide.

C Train relevant clinical staff. See the task titled Train Relevant Teachers and
Clinical Staff in section 2.2 of this guide.

C Ensure that necessary supplies and equipment are available. Staff from the teaching
institution and clinical practice site should work with the National Coordinating Group
for IMCI Pre-Service Training to ensure that the drugs and supplies needed for IMCI
clinical practice are consistently available at health facilities that conduct IMCI clinical
practice. See Annex 2 for a List of Drugs and Supplies Needed for IMCI Practice in
Outpatient Clinics.