Evaluating the introduction of workplace-based learning in a paediatric training programme: experience from Myanmar.

Abstract

Objective: Workplace-based learning (WPBL) for postgraduate paediatricians is well-established in advanced health systems but less so in low-resource settings. We evaluate the first WPBL pilot undertaken in paediatrics in Myanmar.

Design: This cohort study assesses the implementation of WPBL among 85 postgraduate doctors from five medical universities in Myanmar.

Setting: In 2018, Myanmar's paediatric medical leaders had outlined an ambitious plan to modernise learning at the postgraduate level through a multi-skilled in-situ approach. Supported by the Royal College of Paediatrics and Child Health (RCPCH, UK), a co-designed pilot programme of WPBL was trialled in a structured way.

Interventions: This pilot was Myanmar-led, with UK experts providing support to Myanmar supervisors and to the 85 paediatric postgraduate doctors whom they mentored. Progress was documented through a co-designed, standardised 'portfolio of learning' that included well-established WPBL strategies.

Main outcome measures: The quality of supervisor feedback in the portfolio to postgraduates was scored by independent assessors, as was the degree of completion of the portfolio, to determine adherence to the WPBL pilot objectives. Insights into the broader changes in practice resulting from the pilot were ascertained through a narrative commentary of moderated focus groups of both supervisors and postgraduates.

Results: 'Clinical' WPBL topics were more often chosen than 'softer' skill areas, for example, communication and leadership. Focus groups identified the benefits of a structured approach to learning, particularly in areas of weaker clinical performance. There were regional variations in how WPBL was delivered, with disparities between medical schools located in the north and those in the south, challenging WPBL standardisation.

Conclusions: Evidence on the impact of formalising WPBL in low-resource settings is minimal. This pilot demonstrates that setting up a WPBL programme is feasible in a low-resource setting, but it also presents challenges.