Prepare Materials

Teaching institutions will need to

identify and prepare materials for
IMCI teaching, learning and
student assessment. If several
different materials are needed, staff
should prioritize which materials to
prepare first, and which to prepare
later. The list of priority materials
should include tools for assessing
the level of IMCI knowledge and
skills achieved by students.

All materials for IMCI teaching
should meet the following criteria:

2.2 TEACHING INSTITUTION(S)


I[ Define times, places, activities and
materials*

I[ Train teachers and clinical staff*

I[ Prepare clinical practice sites*

I[ Prepare materials*

D Coordinate teaching*

D Conduct and monitor teaching*

C Be consistent with the adapted IMCI clinical guidelines;

C Correspond to the IMCI learning objectives defined for the specific academic
programme (e.g. bachelor of medicine, bachelor of nursing, etc.);

C Support teaching, learning and assessment methods used by a teaching institution;
and

C Be available and affordable to students and teachers.

Some materials, such as case recording forms for clinical practice, may be difficult
and expensive to reproduce in large quantities. The IMCI Working Groups at
national, state and school levels will need to determine how to create an affordable
and sustainable supply of materials. For example, in some countries, revolving funds
have been established for the development and reproduction of materials. In other
countries, students have been requested to purchase IMCI materials at a low cost.

Objectives

The objectives for this task are to ensure that materials for IMCI teaching, learning
and student assessment:

C Are consistent with the locally-adapted IMCI clinical guidelines;

C Include essential elements of the IMCI strategy and clinical guidelines; and

C Support the methods used by teaching institutions for teaching, learning and
student assessment.





Timing

Once key persons decide when, where and how IMCI will be taught within an
academic programme, they can begin to identify and prepare appropriate materials for
IMCI teaching, learning and student assessment.

Who Should Prepare Materials?

The group that develops, adapts or revises materials should include persons with
expertise in: (a) the IMCI strategy and clinical guidelines; and (b) the development of
educational materials (e.g. persons from the Department of Medical Education).
Some materials may be developed, adapted or revised by staff within a teaching
institution. Other materials may be prepared by the national or state Coordinating
Group for IMCI Pre-Service Training, or by an association of teaching institutions.
Regardless of who initiates the task and where the materials are prepared, all
materials should be tested with students at teaching institutions before they are
finalized.

Description

The purpose of this task is to prepare materials that are consistent with the national
IMCI clinical guidelines, cover relevant IMCI learning objectives for a selected
academic programme, and correspond to the teaching, learning and assessment
methods used at specific teaching institutions.

Teachers will need to review the materials that they already use for teaching, learning
and student assessment e.g. textbooks, handouts, and slides and decide if these
materials can be revised to include elements of IMCI. They also need to decide if they
should adapt or develop new materials for IMCI teaching. (See Planning Matrix:
Matching Activities and Materials with Learning Objectives for IMCI in Annex 2.)

Many of the materials used in the IMCI in-service training course (e.g. the IMCI chart
booklet and case recording forms) are appropriate for teaching IMCI in medical and
paramedical schools, and may be used with few or no modifications. These materials
should be adapted to correspond to the national IMCI clinical guidelines. In addition,
WHO CAH has developed generic materials for IMCI pre-service training. The
generic pre-service materials also must be adapted to correspond to the locally-
adapted IMCI clinical guidelines before they can be used. Once adapted, all in-service
and pre-service materials can be incorporated, if desired, into materials that are
already in use by teaching institutions. A summary of materials, called Description of
Possible Materials for IMCI Teaching, Learning and Student Assessment, is provided




in Annex 2. The materials in this list can be requested from the Ministry of Health in
a country or from WHO.
23


When reviewing their needs, teaching institutions should consider the following types
of materials.

Materials for teachers:

Teachers at medical, nursing and other health professional schools frequently use
overhead transparencies, slides, handouts, videos, wall charts and audiocassettes
to support student learning. They also use local or international textbooks as
references and for student reading assignments. In addition, they often use course
descriptions, lesson plans, tutors books or other guides to help structure teaching
and ensure that important topics are covered.

The following materials are available for use by teachers (see Annex 2 for a
detailed description of each item):

C List of Possible Learning Objectives for IMCI (see Annex 1)
C Planning Matrix: Matching Activities and Materials with Learning Objectives
for IMCI (see Annex 2)
C IMCI Reference Library of Selected Materials
C IMCI Technical Seminars
C Photograph Booklet
C Videotapes
C Wall Charts
C Facilitators Guides for Outpatient and Inpatient Clinical Practice
C Checklists for Monitoring Outpatient and Inpatient Clinical Sessions (see
Facilitators Guides above and example group checklist in Annex 2)

Note: some countries have reduced the cost of reproducing the photograph
booklet by converting the booklet into slides.

Materials for students:

Students at medical, nursing and other health professional schools read a variety
of materials such as textbooks, handbooks, journal articles and handouts. They
also do exercises, solve case studies and use or develop various memory aids to
help them understand and practise a subject.





23
Examples may be requested from the WHO representative in a country, the WHO regional office, or the Department
of Child and Adolescent Health and Development (CAH), World Health Organization, Avenue Appia 20, 1211
Geneva 27, Switzerland (Fax: +41 22 791 4853, e-mail: CAH@who.int).




The following materials may be used by students (see Annex 2 for a detailed
description of each item):

C A textbook with IMCI incorporated (based on the IMCI Model Chapter for
Textbooks)
C An IMCI handbook based on the IMCI Model Handbook
C A workbook of IMCI exercises
C IMCI Chart Booklet
C IMCI Mothers Card
C IMCI Case Recording Form
C Management of the Child with a Serious Infection or Severe Malnutrition:
Guidelines for Care at the First-Referral Level in Developing Countries
(WHO/FCH/CAH/00.1)

Several teaching institutions have created IMCI case studies for students. Some
have developed IMCI exercise books for students. Many countries have reduced
the cost of reproducing the case recording forms by printing the forms rather than
photocopying them; or by producing laminated, reusable forms. Clinics that have
access to computers can create electronic patient recording systems that can be
used to record patient information and track patient histories.

Materials for assessing student knowledge and skills:

Assessment of student knowledge and skills is regarded as routine in most
medical, nursing and other health professional schools.

Assessment is typically used to:

Ensure that individual students have achieved minimum levels of competency;
Determine whether students can pass to the next stage of study;
Provide feedback to students on their progress;
Decide if the teaching programme has been effective in meeting its objectives;
Ensure that important subjects are given priority within the curriculum; and
Offer evidence to regulating authorities that standards are being met.

When academic advancement is contingent on passing assessments, students will
focus their studies on learning the material that will be examined. Conversely if
material is taught but not assessed, students will see no reason to concentrate on
that material. Hence, the philosophy is as follows if it is in the examinations, it
is important; if it is not in the examinations, it is not important. For this reason, it
is essential to prepare materials for assessing the IMCI knowledge and skills of
students, and to incorporate those materials into the standard process for student
assessment.




The methods frequently used for student assessment are:

C Written examinations: Questions or problems often range from more
objective multiple choice, true/false or fill-in-the-blank items to less objective
essay and short-answer items.

C Practical examinations: These exams frequently involve direct observation
while a student performs a technical or interpersonal skill in a real or
simulated environment. This often means completing a checklist while a
student performs certain tasks in the clinic or during an Objective Structured
Clinical Examination (OSCE).

C Oral examinations: This is typically a face-to-face interview between an
examiner and a student. Research has shown that the results of this method
tend to be subjective, biased and unreliable, particularly if examiners are
allowed to vary the questions asked from one student to the next.
24


C Assignments, projects or reports: This includes completing written
assignments, working on case studies, reporting on an internship or practical
experience, writing a thesis paper, conducting research or summarizing the
published literature on a topic.

It is important to define the purpose of each assessment activity. Will the
assessment measure student knowledge (i.e. understanding of a subject) or
practical skills (i.e. the ability to do something)? Will it help students to improve
their performance by providing feedback (i.e. formative assessment), or determine
if a student should move to the next stage of studies (i.e. summative assessment)?

A good educational strategy will involve frequent activities for formative
assessment to ensure students are receiving opportunities to practise and improve
knowledge and skills that ultimately will be included in a summative assessment.

Schools that have introduced IMCI teaching have been able to incorporate IMCI
into the standard process for student assessment. They also have found that the
introduction of IMCI can strengthen the validity and reliability of student
assessment by giving more focus to the evaluation of practical skills (i.e. through
observation with checklists) and to formative assessment that provides feedback
to students to help them improve their performance.

Teaching institutions can develop a variety of materials for IMCI assessment,
such as questions for written exams (e.g. multiple choice, fill-in-the-blank, short
answer, and case study questions), exercise books and checklists for observing
IMCI clinical skills. To assist teaching institutions, WHO has developed IMCI

24
Newble D and Cannon R, eds. Assessing the Students. In A Handbook for Medical Teachers - Third
Edition. London, Kluwer Academic Publishers BV, 1994: 107-140.




Guidelines for the Assessment of Students and a video called Video Exercises on
IMCI. (For more information see Description of Possible Materials for IMCI
Teaching, Learning and Student Assessment in Annex 2).

Suggested Activities and Materials

In some countries, a national or state group (i.e. National Coordinating Group for
IMCI Pre-Service Training, National Association of Medical Schools, etc.) may begin
adapting materials - such as the IMCI handbook - for a particular academic
programme (e.g. bachelor of medicine, certificate of nursing, etc.). While a national
group might take responsibility for some materials, teaching institutions themselves
might prepare other materials such as IMCI case studies. Regardless of who initiates
the process, preparation of materials requires a long-term commitment that may
include peer reviews and other events such as materials development workshops.
Teaching institutions should collaborate with the National Coordinating Group on
IMCI Pre-Service Training to test, refine and finalize materials.

The following approaches can be used to prepare materials:

C Use nationally adapted material from the IMCI in-service training course such as
the chart booklet, mothers card, video and case recording forms;

C Develop new material such as IMCI case studies;

C Adapt generic materials - such as the IMCI model handbook, IMCI model chapter
for textbooks, or the IMCI facilitators guide for outpatient clinical practice - to
conform to the locally-adapted IMCI clinical guidelines;

C Incorporate relevant elements of IMCI into materials already used by teaching
institutions such as textbooks, handbooks, tutors guides or written examinations.

Experience has shown that teaching institutions often take a step-by-step approach to
incorporating IMCI into existing teaching materials. They start by adapting generic
material to the local IMCI clinical guidelines. They then use drafts of the adapted
material in actual teaching in order to get feedback from teachers and students on how
to improve the material. Finally, they revise the adapted material and incorporate it
into materials already used by the faculty, such as textbooks, handbooks, tutors
guides, written examinations, etc.

The steps below can be used to develop, adapt or revise materials:

C Estimate the budget needed. Estimate the costs related to designing and
reproducing materials and identify an appropriate source of funding. The funds
may come from the teaching institution itself, a national fund, or an international
agency working in the area of health or education. In addition to identifying




resources for the development of materials, it is important to identify affordable
ways to reproduce and supply the materials over time.

C Identify a focal person. The focal person will be responsible for coordinating the
production of material from start to finish. He or she may create the materials
alone, or coordinate the work of other writers and developers.

C If needed, form a development or review group. For large, complicated or highly
technical materials, it may be useful to form a small development group (two to
five persons) to assist with the production and review of materials. This group
should include specialists in both the technical content (i.e. IMCI) and in the
development of educational materials. Members of the group can include persons
both within and outside teaching institutions.

C Prepare draft materials. If a review group is formed, circulate draft materials to
the group for their review and comments.

C Review and revise. If material has been circulated for review, revise it based on
the comments of the group. Then create a working draft to be tested in actual
teaching environments.

C Test. Test the working draft with teachers and students during actual teaching.
Obtain feedback from teachers and students on how to improve the materials.

C Finalize. Revise materials based on student and teacher feedback, and finalize for
reproduction or for incorporation into other materials already used by teaching
institutions.