minilaparotomy under local...

Minilaparotomy under Local Anesthesia

Facilitator’s Guide

MCSP is a global USAID initiative to introduce and support high-impact health interventions in 25 priority countries to help prevent child and maternal deaths. MCSP supports programming in maternal, newborn, and child health, immunization, family planning and reproductive health, nutrition, health systems strengthening, water/sanitation/hygiene, malaria, prevention of mother-to-child transmission of HIV, and pediatric HIV care and treatment. MCSP will tackle these issues through approaches that also focus on household and community mobilization, gender integration, and digital health, among others. This material was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of MCSP and do not necessarily reflect the views of USAID or the United States Government. January2018.

Minilaparotomy under Local Anesthesia: Facilitator’s Guide i

Contents

LEARNER’S GUIDE Overview ..................................................................................................................................... 1

Before Starting This Course ......................................................................................................... 1

Training Approach Used ............................................................................................................. 1

How People Learn ....................................................................................................................... 2

Competency-Based Training ..................................................................................................... 3

Humanistic Training Techniques ................................................................................................ 4

Components of the Minilaparotomy Training Package ....................................................... 4

Using the Minilaparotomy Training Package .......................................................................... 5

Introduction ................................................................................................................................. 6 Course Design .............................................................................................................................. 6

Evaluation ..................................................................................................................................... 6

Learning Objectives .................................................................................................................... 7

Course Syllabus ............................................................................................................................ 8

Instructions for Using the ZOE® Gynecologic Simulator ........................................................ 16 Contents ...................................................................................................................................... 16

Assembly ..................................................................................................................................... 17

Performing Procedures ............................................................................................................. 19

Care and Maintenance ........................................................................................................... 20

Minilaparotomy Under Local Anesthesia Knowledge Assessment ..................................... 21 Checklists for Minilaparotomy Clinical and Counseling Skills ............................................. 25

Using the Checklists ................................................................................................................... 25

Checklist for Interval Minilaparotomy Clinical Skills .............................................................. 26

Checklist for Postpartum Minilaparotomy Clinical Skills ...................................................... 29

Checklist for Minilaparotomy Clinical Skills for Circulating Nurses ..................................... 31

Checklist for Minilaparotomy Clinical Skills for Nursing Assistants ..................................... 33

Checklist for Counseling for Minilaparotomy in the Interval Period ................................. 35

Checklist for Counseling for Minilaparotomy in the Postpartum Period .......................... 37

Checklist for Verbal Anesthesia .............................................................................................. 39

Course Evaluation ..................................................................................................................... 41

ii Minilaparotomy under Local Anesthesia: Facilitator’s Guide

FACILITATOR’S GUIDE

Model Minilaparotomy Clinical Skills Course Outline ........................................................... 41 Minilaparotomy Under Local Anesthesia Knowledge Assessment – Key .......................... 62

Minilaparotomy Training Course: Individual and Group Assessment Matrix ................... 67

Precourse Skills Assessment .................................................................................................... 69 Using the Checklist..................................................................................................................... 69

Precourse Skills Assessment Checklist ..................................................................................... 70

Appendix 1: Minilaparotomy under Local Anesthesia – Algorithm for Using the Balanced Counseling Strategy Plus ........................................................................................ 71 Appendix 2: Minilaparotomy under Local Anesthesia Client Assessment Tool ................. 73 Appendix 3: Warmups and Other Exercises .......................................................................... 75

Minilaparotomy under Local Anesthesia: Facilitator’s Guide 1

OVERVIEW Before Starting This Course Welcome to the minilaparotomy under local anesthesia clinical skills training course! You may benefit from understanding a few things about the course before getting started. First, it will be conducted in a way that is very different from traditional training courses—based on the assumption that you are here because you:

• Are interested in providing minilaparotomy services;

• Wish to improve your knowledge and skills in minilaparotomy service delivery, and thus your job performance; and

• Desire to be actively involved in course activities. Therefore, the course will be very participatory and interactive, helping to create an environment that is conducive to learning. The development and assessment of your skills throughout the course will focus more on your performance than on what you know or have memorized. This is because clients deserve providers who are able to provide safe and effective services, not just knowledgeable about them. A variety of educational technologies will be used to maximize the effectiveness and efficiency of course activities, enhancing your learning experience while conserving valuable resources. All of the course materials focus on the learner. For example, the course content and activities are intended to promote learning, and the learner is expected to be actively involved in all aspects of that learning. The facilitator will create a comfortable environment and promote activities assist the learner in acquiring new knowledge, attitudes, and skills. The competency-based training approach used in this course stresses the importance of cost-effective use of resources, application of relevant educational technologies, and use of detailed (step-by-step) counseling and clinical skills checklists to help learner learn and measure their own progress. Competency-based knowledge questionnaires and the skills checklists assist the facilitator in evaluating each learner’s performance objectively.

Training Approach Used In the context of clinical skills training, the mastery learning approach assumes that all learners can master—or “achieve competency” in—the knowledge and skills required to provide a specific health service, provided that sufficient time is allotted and appropriate training methods are used. The goal of mastery learning is for 100% of those being trained to be competent in providing services by the end of the course. Skill competency means that the provider knows the steps and their sequence and can perform the required skill or activity safely, effectively, and independently at a “beginning level,” which is the goal of the course. Providers will become proficient in a skill only after they have regularly used it in the workplace. Skill proficiency means that the provider knows the steps and their sequence, and efficiently performs the required skill or activity. Key points about the mastery learning approach, as used in this course, include:

• From the outset, learners know (as individuals and a group) what they are expected to learn and where to find the information they need. They have ample opportunity for discussion with the facilitator about course content and their performance. This makes the training less stressful.

• Because people vary in their abilities to absorb new material, and learn best in different ways (e.g., through written, spoken, or visual means), a variety of learning methods are used. This helps to ensure that all learners have the opportunity to succeed.

2 Minilaparotomy under Local Anesthesia: Facilitator’s Guide

• Self-directed learning enables learner to become active participants in their progress toward course goals. To facilitate this learner role, the clinical trainer serves as a facilitator or “coach,” rather than as a more traditional instructor. Learners are also supported in identifying their own weaknesses and creating individualized plans for success.

• Continual assessment increases learners’ opportunities for learning. Through a variety of techniques, the facilitator keeps learners informed of their progress in learning new information and skills, so that they will know where they need to focus their efforts to achieve competency.

How People Learn

• Training must be relevant. Learning experiences should relate directly to the job responsibilities of the learners.

• People often bring a high level of motivation to training:

• Desire to improve job performance

• Desire to learn

• Desire to improve their life

• People need involvement during training. This can be accomplished by:

• Allowing learners to provide input regarding schedules, activities, and other events

• Using questioning and feedback

• Using brainstorming and discussions

• Providing hands-on work

• Conducting group and individual projects

• Setting up classroom activities or games

• People desire variety. Ways to provide this include:

• Varying the schedule

• Using a variety of audiovisuals aids:

− Slides

− Videotapes

− Overhead transparencies

− Flip charts or blackboards

− Models or real objects

• Using a variety of teaching methods:

− Illustrated lectures

− Demonstrations

− Small group activities

− Group discussions

− Role plays and case studies

− Guest speakers


• People need positive feedback. Positive feedback is letting learners know how they are doing, and providing this information in a positive manner. The facilitator provides positive feedback when she or he does one or more of the following:

• Verbally praising the learner either in front of other learners or individually • Recognizing appropriate responses during questioning:

− “That’s correct!” − “Good answer!” − “That was an excellent response!”

• Acknowledging appropriate skills while coaching in a clinical setting:

− “Very good work!” − “I would like everyone to notice the incision that was just made. Ilka did an excellent job and

your incisions should look like this one.”

• Letting the learners know how they are progressing toward achieving the learning objectives.

Competency-Based Training Competency-based training (CBT) is distinctly different from the traditional educational process; it is learning by doing. How the learner performs is emphasized rather than just what information the learner has acquired. This course focuses on the specific knowledge, skills, and attitudes needed to carry out LEEP service delivery-related tasks. To accomplish CBT successfully, the clinical skill or activity to be taught is first broken down into its essential steps. Each step is then analyzed to determine the most efficient and safe way to teach and learn it, a process called standardization. Once a procedure such as minilaparotomy under local anesthesia has been standardized, competency-based checklists can be developed to measure progress in learning and evaluate the learner’s overall performance of the skill or activity. An essential component of CBT is coaching. Coaching incorporates questioning, providing positive feedback, and active listening to help learners develop specific competencies, while encouraging a positive learning climate. In the role of coach, the facilitator first explains the skill or activity and then demonstrates it using an anatomic model or other training aid, such as a video or a checklist. Once the procedure has been demonstrated and discussed, the facilitator/coach observes and interacts with the learner to provide guidance as she/he practices the skill or activity. The facilitator continues monitoring learner progress—providing suggestions and feedback, as needed, to help the learner overcome problems, build confidence, and work toward greater independence. The coaching process ensures that the learner receives feedback regarding performance:

• Before practice—The facilitator and learner should briefly meet prior to each practice session to review the skill/activity including the steps/tasks that will be emphasized during the session.

• During practice—The facilitator observes, coaches, and provides feedback to the learner as she or he performs the steps/tasks as outlined in the checklist.

• After practice—This feedback session should take place immediately after practice. Using the checklist, the facilitator discusses the strengths of the learner’s performance and also offers specific suggestions for improvement.

When CBT is integrated with adult learning principles and is based on behavior modeling, the result is a powerful and extremely effective method for providing technical training. And, when the use of anatomic models and other teaching aids is incorporated, training time (and training costs) can be significantly reduced. For example, in a study conducted in Thailand, the traditional IUD training method was compared


with one using the CBT approach just described. When trainees were allowed to learn and repeatedly practice with pelvic models, 70% of the 150 trainees were judged to be competent after just two insertions in clients, and 100% by six. By contrast, of the 150 trainees taught without the use of pelvic models, 50% obtained competency only after an average of 6.5 insertions and 10% never achieved competency (i.e., were not qualified) even after 15. Incorporating the use of models (humanistic training) facilitates learning by allowing learners to learn and practice new skills initially in a simulated setting rather than with clients. This reduces stress for the learner as well as minimizes the risk of injury and discomfort to the client. Thus, employing this more humane training approach is an important component in improving the quality of clinical training and, ultimately, service provision.

Humanistic Training Techniques As described above, anatomic models that closely simulate the human body are used by learners for initial skill acquisition in minilaparotomy under local anesthesia and for enabling them to attain skill competency prior to working with clients in the clinical setting.

TERMS USED TO DESCRIBE THE LEVELS OF CLINICAL SKILL PERFORMANCE

Skill Acquisition: Knows the steps and their sequence (if necessary) to perform the required skill or activity but needs assistance

Skill Competency: Knows the steps and their sequence (if necessary) and can perform the required skill or activity

Skill Proficiency: Knows the steps and their sequence (if necessary) and efficiently performs the required skill or activity

For example, before a learner performs a clinical procedure with a client, two learning activities should occur:

• The facilitator should demonstrate the required skills and client interactions several times using an anatomic model and other appropriate training aids.

• While being supervised, the learner should practice the required skills and client interactions using the model and actual instruments in a simulated setting that is as similar as possible to the real situation.

Only when skill competency and some degree of skill proficiency have been demonstrated should the learner have her/his first contact with a client.

Components of the Minilaparotomy Training Package This clinical training course is built around use of the following components:

• Need-to-know information contained in a reference manual

• A Learner’s Guide for course participants containing questionnaires and checklists that break down the skill or activity (e.g., counseling or minilaparotomy) into its essential steps

• A Facilitator’s Guide including questionnaire answer keys, checklists, and detailed information about conducting the course


• Well-designed audiovisual materials, such as anatomic models and other training aids

• Competency-based performance evaluation The reference manual designed for use in this course is Minilaparotomy under Local Anesthesia. It is organized into 11 chapters and 8 appendices and contains essential information on the following topics: counseling; informed choice; eligibility, precautions, and client assessment; recommended infection prevention and control; anesthesia; the surgical procedure; postpartum minilaparotomy; postoperative recovery, discharge, and follow-up; management of complications; and mobile outreach services.

Using the Minilaparotomy Training Package As described above, when CBT is combined with behavioral modeling, it is particularly well-suited to providing technical training, such as minilaparotomy under local anesthesia and counseling. In designing the training materials for this course, particular attention has been paid to making them “user-friendly” and to permit the learners and facilitator the widest possible latitude in adapting the training to the learners’ (group and individual) learning needs. For example, at the beginning of each course, an assessment is made of each learner’s knowledge and clinical skills. The results of this precourse assessment are then jointly used by the learners and facilitator to adapt the course content as needed so that the training focuses on acquisition of new information and skills. A second feature relates to the use of the reference manual and facilitator and learner guides. The reference manual is designed to provide all of the essential information needed to conduct the course in a logical manner. Because it serves as the “text” for the learners and the “reference source” for the facilitator, special handouts or supplemental materials are not needed. In addition, because the manual contains only information that is consistent with the course goals and objectives, it becomes an integral part of all classroom exercises—such as giving an illustrated lecture or providing problem-solving information. The Learner’s Guide, on the other hand, serves a dual function. First, and foremost, it is the “road map” that guides the learner through each phase of the course. It contains the course syllabus and schedule as well as all supplemental printed materials (precourse questionnaire, individual and group assessment matrix, checklists, and course evaluation) needed during the course. The Facilitator’s Guide contains the same material as the guide for the learner as well as materials specifically for the facilitator. This includes the course outline, precourse questionnaire answer key, midcourse questionnaire and answer key, and competency-based qualification checklists. In keeping with the training philosophy on which this course is based, all training activities, whether in the classroom or clinic, will be conducted in an interactive, participatory manner. This requires that the role of the facilitator continually change throughout the course. For example, she or he is an instructor when presenting a classroom demonstration; a facilitator when conducting small group discussions or using role plays; and shifts to the role of coach when helping learners practice a procedure. Finally, when objectively assessing performance, she or he serves as an evaluator. In summary, the CBT approach used in this course incorporates a number of key features. First, it is based on adult learning principles, which means that it is interactive, relevant, and practical. Moreover, it requires that the clinical trainer facilitate the learning experience rather than serve in the more traditional role of an instructor or lecturer. Second, it involves use of behavior modification (modeling theory) to facilitate learning a standardized way of performing minilaparotomy under local anesthesia and counseling patients. Third, it is competency-based. This means that evaluation of the learner is based on how well the learner performs the procedure or activity, not just on how much has been learned. Fourth, where possible, it relies heavily on the use of anatomic models and other training aids (i.e., it is humanistic) to enable learners to practice repeatedly the standardized way of performing the skill or activity before working with clients. Thus, by the time each learner’s performance is evaluated by the facilitator using the checklist, every learner should be able to perform every skill or activity competently. This is the ultimate measure of clinical training.


INTRODUCTION Course Design This clinical training course is designed for specialists in surgery, general practitioners, or other clinicians, such as clinical officers. The course builds on each learner’s past knowledge and takes advantage of her/his high motivation to accomplish the learning tasks in the minimum time. Training emphasizes doing, not just knowing, and uses competency-based evaluation of performance. This training course differs from traditional courses in several ways:

• During the first day of the course, learners demonstrate their knowledge of the management of minilaparotomy services by completing a written test (precourse questionnaire). In addition, learners’ skills in performing a pelvic examination, using the uterine elevator, and performing other steps in minilaparotomy are assessed through use of a pelvic model that closely simulates the real situation.

• Classroom and clinic sessions focus on key aspects of service delivery (e.g., counseling of clients, how to provide services and manage side effects and other health problems).

• Progress in knowledge-based learning is measured during the course using a standardized written test (midcourse questionnaire).

• Clinical skills training builds on the learner’s previous family planning experience. Learners first practice on the anatomic model. In this way, they learn more quickly the skills needed to perform minilaparotomy competently with clients.

• Progress in learning new skills is documented using detailed checklists for clinical skills.

• Evaluation of each learner’s performance is conducted by a facilitator using competency-based skills checklists.

Successful completion of the course is based on mastery of both the content and skills components, as well as satisfactory overall performance of minilaparotomy counseling and clinical skills.

Evaluation This clinical training course is designed to produce qualified minilaparotomy service providers. Qualification is a statement by the training institution(s) that the learner has met the requirements of the course in knowledge, skills, and practice. Qualification does not imply certification. Personnel can be certified only by an authorized organization or agency. Qualification is based on the learner’s achievement in three areas:

• Knowledge—A score of at least 85% on the midcourse questionnaire

• Skills—Satisfactory performance of minilaparotomy counseling and clinical skills

• Practice—Demonstrated ability to provide minilaparotomy services in the clinical setting Responsibility for the learner becoming qualified is shared by the learner and the facilitator. The evaluation methods that will be used in the course are described briefly below:


• Midcourse questionnaire. This knowledge assessment will be given at the time in the course when all subject areas have been presented. An 85% or more correct score indicates knowledge-based mastery of the material presented in the reference manual. For those scoring less than 85% on their first attempt, the facilitator should review the results with each learner individually and guide her/him on using the reference manual to learn the required information. Learners scoring less than 85% can take the midcourse questionnaire again at any time during the remainder of the course.

• Counseling and Clinical Skills Checklists. The facilitator will use these checklists to evaluate each learner as he or she counsels clients and performs minilaparotomy with clients. Evaluation of the counseling skills of each learner may be done with clients; however, it may be accomplished at any time during the course through observation during role plays using learners or volunteers. Evaluation of the clinical skills usually will be done on the last day of the course (depending on class size and client caseload).

In determining whether the learner is qualified, the facilitator(s) will observe and rate the learner’s performance for each step of the skill or activity. The learner must be rated “satisfactory” in each skill or activity to be evaluated as qualified.

• Provision of Services (Practice). During the course, it is the facilitator’s responsibility to observe each learner’s overall performance in providing minilaparotomy services. This provides a key opportunity to observe the impact on clients of the learner’s attitude—a critical component of high-quality service delivery. Only by doing this can the facilitator assess the way the learner uses what he or she has learned.

It is recommended that, if possible, graduates be observed and evaluated in their institution by a course facilitator using the same counseling and clinical skills checklist within 3 to 6 months of qualification. (At the very least, the graduate should be observed by a skilled provider soon after completing training.) This postcourse evaluation activity is important for several reasons. First, it not only gives the graduate direct feedback on her/his performance, but also provides the opportunity to discuss any startup problems or constraints to service delivery (e.g., lack of instruments, supplies, or support staff). Second, and equally important, it provides the training center, via the facilitator, key information on the adequacy of the training and its appropriateness to local conditions. Without this type of feedback, training easily can become routine, stagnant, and irrelevant to service delivery needs.

Learning Objectives By the end of the training course, the learner will be able to:

1. Understand the principles and requirements for performing minilaparotomy under local anesthesia.

2. Provide effective counseling about minilaparotomy under local anesthesia.

3. Understand and apply the principles of informed choice for voluntary sterilization.

4. Explain eligibility, precautions, and client assessment for minilaparotomy under local anesthesia.

5. Use recommended infection prevention and control practices in the provision of minilaparotomy that minimize the risk of postoperative infections and contracting hepatitis B and HIV/AIDS.

6. Understand the principles of and requirements for the use of local anesthesia, including the importance of emotional preparation of the client and continual communication during surgery.

7. (Surgeon) Perform standard minilaparotomy procedures, including both interval and postpartum procedures, under local anesthesia.


8. (Nurse) Prepare the client for surgery and assist the surgeon during the minilaparotomy procedure.

9. Perform routine postoperative management for minilaparotomy, including discharge, follow-up, and appropriate management of side effects and other health problems.

10. Recognize and manage surgical and anesthesia-related complications.

11. Describe the basic requirements of mobile outreach services for minilaparotomy.

Course Syllabus Course Description This 12-day clinical training course is designed to prepare the learner to counsel individuals concerning minilaparotomy and to become competent in performing minilaparotomy under local anesthesia, managing surgical complications, and providing routine follow-up care.

Course Goals

• To influence in a positive way the attitudes of the learner toward the benefits and appropriate use of minilaparotomy

• To provide the learner with method-specific counseling skills for minilaparotomy, including verification of informed consent

• To provide the learner with the knowledge and skills needed to perform minilaparotomy under local anesthesia

• To provide the learner with the knowledge and skills needed to manage surgical complications and provide routine follow-up care

• To provide the learner with basic knowledge about mobile outreach services for minilaparotomy

How to Structure the Course for Postpartum ML/LA, for Interval ML/LA, or for Both The materials provided in this learning resource package can be used to structure training courses that cover both postpartum and interval ML/LA, or focus only on postpartum ML/LA skills, or only on interval ML/LA skills. While this decision will be mainly based on the training needs, the different versions provide flexibility for conducting courses at facilities with different capacities. For instance, facilities that provide labor and delivery services exclusively can participate as learning sites for postpartum ML/LA, while facilities where mostly interval procedures are provided can conduct interval ML/LA training. Similarly, providers can be trained on the required technique(s) (either or both), depending on the facility or clinic where they are working. While the basic knowledge and skills required for both for postpartum and interval ML/LA are the same, there are a few minor differences in the procedure itself, in addition to a few differences in confirming client eligibility and scheduling. Below are some of the points that facilitators should plan for when they are designing an interval or postpartum only ML/LA.

• The reference manual, as well as the learner and facilitator guides, covers all of the information required for both interval and postpartum ML/LA, and no additional resources are required for adaptations.

• Facilitators can use the sample 6-day schedule and modify it as needed to conduct either a postpartum ML/LA or interval ML/LA course. The 12-day training allows learners to practice with both interval and postpartum clients. However, the decision about the duration of the course should be determined to ensure that all learners have sufficient practice time to reach competency on real clients.


• Facilitators should work with other stakeholders and partners in choosing the sites with sufficient numbers of cases for each type of client.

• A flowchart outlining the differences for service provision and application of the procedure for interval and postpartum ML/LA is provided at the end of this section (Setting Up Training and Clinical Service Provision for INTERVAL or POSTPARTUM Minilaparotomy).

Training/Learning Methods

• Illustrated lectures and group discussions

• Individual and group exercises

• Role plays

• Simulated practice with anatomic (pelvic) model

• Guided clinical activities (pre-operative assessment and minilaparotomy under local anesthesia)

Training Materials

This guide is designed to be used with the following materials:

• Reference manual: Minilaparotomy under Local Anesthesia

• Minilaparotomy kits

• Anatomic (pelvic) models

• PowerPoint presentations and job aids

Learner Selection Criteria Learners for this course should be clinicians (a team of a surgeon and a nurse) working in a health care facility (clinic or hospital) that provides women’s health services, including family planning. The facility should have an anticipated caseload sufficient to support the provision of minilaparotomy services. Throughout this guide, and in other components of the learning resource package, the term “surgeon” is used to describe the person performing the procedure—it could be a specialist in surgery, a general practitioner, or other clinician (such as a clinical officer who has been trained in the procedure).

Evaluation

Learner

• Precourse Clinical Skills Assessment (completed by facilitator)

• Pre- and midcourse questionnaires

• Checklists for Minilaparotomy Counseling and Clinical Skills for surgeons, circulating nurses, and nursing assistants (used by the learner to acquire and practice skills during the course, and completed by the facilitator for qualification at the end of the course)


Course

• Course Evaluation (completed by learner)

Course Duration

• Twenty-four sessions in a 2-week (12 days) sequence.

• The course schedule included here for both postpartum and interval minilaparotomy skills is for 12 days, which can be modified as needed to ensure that all learners acquire competency.

• If the course is designed separately to cover only postpartum or only interval minilaparotomy skills, then course duration can be 6 days, but again, it can be modified as needed.

• Sample course schedules are provided for 12 days (both postpartum and interval), and 6 days (either postpartum only or interval only).

Suggested Course Composition

• Five surgical teams (10 learners)

• Two facilitators

• One counseling/infection prevention/clinic management facilitator Note: The course size will be limited by the available operating room (OR) space and the number of potential minilaparotomy clients per session at the clinical training sites.

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tio

n/E

xerc

ise:

Han

dwas

hing

, sur

gica

l scr

ub,

glov

ing

Su

rgic

al a

ttir

e

Han

dlin

g of

sha

rps

T

raffi

c flo

w in

OR

Sett

ing

up p

roce

dure

roo

m

H

igh-

leve

l dis

infe

ctio

n (H

LD)/

ster

iliza

tion

(Ass

ista

nt w

orks

with

faci

litat

or t

o se

t up

OR

, was

te d

ispo

sal,

and

inst

rum

ent

proc

essi

ng.)

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

Dis

cuss

ion

: Bei

ng p

repa

red

for

emer

genc

ies:

Gro

up

1: L

ist

emer

genc

y eq

uipm

ent;

Gro

up

2: L

ist

emer

genc

y dr

ugs;

Gro

up

3: L

ist

skill

s re

quir

ed t

o re

spon

d to

em

erge

ncie

s.

Rev

iew

: Rec

ogni

zing

and

man

agin

g in

trao

pera

tive

com

plic

atio

ns

OR

Pra

ctic

e:

Gro

up

3: A

ssis

t/pe

rfor

m M

L/LA

;

Gro

up

1: P

ract

ice

clie

nt c

ouns

elin

g,

pre-

op a

sses

smen

t, an

d cl

ient

pr

epar

atio

n;

Gro

up

2: O

bser

ve IP

C p

ract

ices

be

fore

and

aft

er s

urge

ry.

Lear

ners

ass

ess

each

oth

er’s

pe

rfor

man

ce u

sing

che

cklis

ts.

P.M

. (3

ho

urs

)

Exe

rcis

e: R

evie

w t

he a

sses

smen

t m

atri

x to

iden

tify

indi

vidu

al a

nd g

roup

le

arni

ng n

eeds

.

Dis

cuss

ion

: Fun

dam

enta

ls o

f m

inila

paro

tom

y un

der

loca

l an

esth

esia

(M

L/LA

)

Dem

on

stra

tio

n: In

terv

al

min

ilapa

roto

my:

Ani

mat

ed v

ideo

Pelv

ic m

odel

Rev

iew

of d

ay’s

act

iviti

es

To

ur

of c

linic

al w

orki

ng a

rea

P.M

. (3

ho

urs

)

Dis

cuss

ion

: Key

feat

ures

of M

L/LA

, in

clud

ing:

Elig

ibili

ty

Pr

ecau

tions

Clie

nt a

sses

smen

t

Dis

cuss

ion

: Pai

n m

anag

emen

t

Dem

on

stra

tio

n: T

echn

ique

for

loca

l an

esth

esia

usi

ng Z

OE

pelv

ic m

odel

Cla

ssro

om

Pra

ctic

e: S

urge

on/n

urse

te

ams

prac

tice

ML/

LA u

sing

pel

vic

mod

els

and

chec

klis

ts.

Rev

iew

of d

ay’s

act

iviti

es

P.M

. (3

ho

urs

)

Rev

iew

of c

ases

Dis

cuss

ion

: Fam

ily p

lann

ing

coun

selin

g:

C

ouns

elin

g sk

ills

M

etho

d-sp

ecifi

c co

unse

ling

In

form

ed c

onse

nt

U

se o

f Bal

ance

d C

ouns

elin

g St

rate

gy P

lus

(BC

S+)

Ro

le P

lay:

Div

ide

into

tea

ms

to

prac

tice:

Cou

nsel

ing

ML/

LA A

ccep

tor

and

Ver

ifyin

g In

form

ed C

hoic

e an

d C

onse

nt

Lear

ners

ass

ess

each

oth

er’s

pe

rfor

man

ce u

sing

che

cklis

ts.

Rev

iew

of d

ay’s

act

iviti

es

P.M

. (3

ho

urs

)

Rev

iew

of c

ases

OR

Pra

ctic

e:

Gro

up

2: A

ssis

t/pe

rfor

m M

L/LA

;

Gro

up

3: P

ract

ice

clie

nt, c

ouns

elin

g,

pre-

op a

sses

smen

t, an

d cl

ient

pr

epar

atio

n;

Gro

up

1: O

bser

ve IP

C p

ract

ices

be

fore

and

aft

er s

urge

ry.

Lear

ners

ass

ess

each

oth

er’s

pe

rfor

man

ce u

sing

che

cklis

ts.

Rev

iew

of d

ay’s

act

iviti

es

P.M

. (3

ho

urs

)

Rev

iew

of c

ases

Dis

cuss

ion

: Diff

eren

ces

betw

een

inte

rval

and

pos

tpar

tum

(PP

) M

L/LA

:

Cou

nsel

ing,

pre

oper

ativ

e pr

epar

atio

n

Tec

hniq

ue

C

omm

on c

ompl

icat

ions

Tim

ing

of t

he p

roce

dure

Hos

pita

l sta

y

Dem

on

stra

tio

n: P

ostp

artu

m M

L/LA

us

ing

mod

el

Pra

ctic

e: P

P M

L/LA

usi

ng m

odel

R

evie

w o

f day

’s a

ctiv

ities

Ass

ign

men

t: C

hapt

ers

1, 4

, 6, 7

A

ssig

nm

ent:

Cha

pter

s 2,

3, 8

; A

ppen

dix

B A

ssig

nm

ent:

Cha

pter

5; A

ppen

dice

s C

, D, E

, F

Ass

ign

men

t: C

hapt

er 8

; App

endi

x A

Ass

ign

men

t: C

hapt

er 9

; App

endi

x G

12

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MIN

ILA

PA

RO

TO

MY

UN

DE

R L

OC

AL

AN

ES

TH

ES

IA (

ML

/LA

) T

RA

ININ

G C

OU

RS

E S

CH

ED

UL

E (

Sta

nd

ard

Co

urs

e: 1

2 d

ays,

24

sess

ion

s, 6

ho

urs

per

d

ay)

Day

6

Day

7

Day

8

Day

s 9,

10,

& 1

1 D

ay 1

2

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

Dis

cuss

ion

: Pha

rmac

olog

y of

dru

gs

for

pain

man

agem

ent

OR

Pra

ctic

e:

Gro

ups

1 a

nd

2: P

erfo

rm M

L/LA

;

Gro

up

3: O

bser

ve/a

ssis

t:

Sett

ing

up p

roce

dure

roo

m

T

raffi

c flo

w in

OR

Surg

ical

att

ire

D

econ

tam

inat

ion

of

inst

rum

ents

/glo

ves

H

andl

ing

cont

amin

ated

was

tes

St

erili

zatio

n

Faci

litat

ors

asse

ss p

erfo

rman

ce u

sing

ch

eckl

ist.

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

Ro

le P

lay/

Dis

cuss

ion

: Tra

nsfe

r fr

om O

R t

o di

scha

rge

D

isch

arge

pre

para

tion

R

evie

w o

f rec

ordk

eepi

ng s

yste

m

OR

Pra

ctic

e:

Gro

ups

1 a

nd

3: P

erfo

rm M

L/LA

;

Gro

up

2: O

bser

ve:

Se

ttin

g up

pro

cedu

re r

oom

Tra

ffic

flow

in O

R

Su

rgic

al a

ttir

e

Han

dlin

g co

ntam

inat

ed w

aste

s

HLD

Faci

litat

ors

asse

ss p

erfo

rman

ce u

sing

ch

eckl

ist.

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

Dis

cuss

ion

: Qua

lity

serv

ice:

A

sses

sing

and

impr

ovin

g qu

ality

of

volu

ntar

y st

erili

zatio

n (V

S) s

ervi

ces

OR

Pra

ctic

e:

Gro

ups

2 a

nd

3: P

erfo

rm M

L/LA

;

Gro

up

1: O

bser

ve a

nd a

ssis

t as

ne

eded

ML/

LA p

roce

dure

s pe

rfor

med

by

Gro

up(s

) 2

and/

or 3

.

Ass

ista

nts

wor

k w

ith t

he O

R s

taff

to

set

up O

R, w

aste

dis

posa

l, an

d in

stru

men

t pr

oces

sing

.

Faci

litat

ors

asse

ss p

erfo

rman

ce u

sing

ch

eckl

ist.

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

OR

Pra

ctic

e

Gro

ups

rota

te a

ccor

ding

to

lear

ners

’ ne

eds.

Faci

litat

ors

asse

ss p

erfo

rman

ce fo

r q

ual

ifica

tio

n u

sing

che

cklis

t.

Intr

odu

ctio

n t

o A

ctio

n P

lan

(D

ay 9

): S

tart

ing/

expa

ndin

g M

L/LA

se

rvic

es a

t le

arne

rs’ f

acili

ties

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

OR

Pra

ctic

e

Gro

ups

rota

te a

ccor

ding

to

lear

ners

’ ne

eds.

Faci

litat

ors

asse

ss p

erfo

rman

ce fo

r q

ual

ifica

tio

n u

sing

che

cklis

t.

P.M

. (3

ho

urs

)

Rev

iew

of c

ases

Dem

on

stra

tio

n/D

iscu

ssio

n:

Pr

oble

m s

olvi

ng in

IPC

A

dis

cuss

ion

of t

he IP

C p

robl

ems

lear

ners

enc

ount

er in

the

ir o

wn

clin

ics,

and

sol

utio

ns t

o ad

dres

s th

em

Dis

cuss

ion

: Pos

tope

rativ

e re

cove

ry

and

follo

w-u

p ca

re:

Po

st-o

pera

tive

mon

itori

ng

Po

st-o

pera

tive

disc

harg

e

Fo

llow

-up

Pra

ctic

e S

essi

on

Rev

iew

of d

ay’s

act

iviti

es

P.M

. (3

ho

urs

)

Rev

iew

of c

ases

Dis

cuss

ion

: Man

agem

ent

of

com

plic

atio

ns:

Gro

up

1: A

nest

hesi

a co

mpl

icat

ions

;

Gro

up

2: I

ntra

-ope

rativ

e co

mpl

icat

ions

;

Gro

up

3: P

osto

pera

tive

com

plic

atio

ns.

Mid

cour

se Q

ues

tio

nn

aire

Rev

iew

of d

ay’s

act

iviti

es

P.M

. (3

ho

urs

)

Rev

iew

of c

ases

Dis

cuss

ion

: Qua

lity

of c

are

stan

dard

s in

VS

serv

ices

:

R

evie

w n

atio

nal s

tand

ards

, and

/or

Id

entif

y ke

y in

dica

tors

for

qual

ity

of c

are

stan

dard

s

Rev

iew

res

ults

of m

idco

urse

qu

estio

nnai

re w

ith g

roup

and

in

divi

dual

lear

ners

.

Dis

cuss

ion

: Mob

ile M

L/LA

ser

vice

s

Rev

iew

of d

ay’s

act

iviti

es

P.M

. (3

ho

urs

)

Day

s 9–

11: R

evie

w o

f cas

es

Dev

elo

pin

g A

ctio

n P

lan

s: L

earn

ers

wor

k in

the

ir c

linic

tea

ms.

The

y dr

aft

an a

ctio

n pl

an o

utlin

ing

next

ste

ps fo

r st

artin

g/ex

pand

ing

ML/

LA s

ervi

ces

at

thei

r fa

cilit

ies:

Fu

rthe

r tr

aini

ng n

eeds

Fa

cilit

y pr

epar

edne

ss

M

onito

ring

and

eva

luat

ion

Q

ualit

y as

sura

nce

Faci

litat

ors

revi

ew q

ualif

icat

ion

proc

ess

with

indi

vidu

al le

arne

rs a

nd

plan

follo

w-u

p ac

tiviti

es.

Rev

iew

of d

ay’s

act

iviti

es

P.M

. (3

ho

urs

)

Tea

m P

rese

nta

tio

ns

of A

ctio

n

Pla

ns

and

Gro

up D

iscu

ssio

n:

St

artin

g/ex

pand

ing

ML/

LA

serv

ices

A

ddre

ssin

g pr

oble

ms

and

cons

trai

nts

to V

S se

rvic

e de

liver

y in

lear

ners

’ ow

n cl

inic

set

tings

Co

urs

e S

um

mar

y

Co

urs

e E

valu

atio

n b

y le

arne

rs

Clo

sin

g C

erem

on

y

Ass

ign

men

t: C

hapt

er 1

0; A

ppen

dix

H

A

ssig

nm

ent:

Cha

pter

11

13

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

Sam

ple

Co

urs

e S

ched

ule

for

6 D

ays:

Thi

s sa

mpl

e 6-

day

sche

dule

can

be

used

for

eith

er in

terv

al [

I] o

r po

stpa

rtum

[PP

] M

L/LA

co

urse

s. F

or a

tra

inin

g co

urse

to

incl

ude

both

inte

rval

and

pos

tpar

tum

ML/

LA, u

se t

he 1

2-da

y sc

hedu

le.

MIN

ILA

PA

RO

TO

MY

UN

DE

R L

OC

AL

AN

ES

TH

ES

IA (

ML

/LA

) T

RA

ININ

G C

OU

RS

E (

6 d

ays,

12

sess

ion

s, 6

ho

urs

per

day

)

Day

1

Day

2

Day

3D

ay 4

D

ay 5

Day

6

A.M

. (3

ho

urs

)

Wel

com

e an

d

Intr

odu

ctio

ns

Ove

rvie

w o

f th

e C

ou

rse:

Goa

ls

O

bjec

tives

Sche

dule

Cou

rse

mat

eria

ls

Le

arne

r ex

pect

atio

ns

Pre

cou

rse

Qu

esti

on

nai

re

Dis

cuss

ion

: Ove

rvie

w o

f FP

and

volu

ntar

y st

erili

zatio

n (V

S)

prog

ram

s in

the

cou

ntry

Rev

iew

of i

ndiv

idua

l and

gro

up

asse

ssm

ent

mat

rix

Pre

cou

rse

Ski

ll A

sses

smen

t

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

Dis

cuss

ion

: Pre

pari

ng t

o ob

serv

e th

e su

rger

y

Dem

on

stra

tio

n b

y F

acili

tato

r: [

I o

r P

P]

ML/

LA

with

clie

nt

Exe

rcis

e: R

evie

w fa

cilit

ator

’s

dem

onst

ratio

n.

Cla

ssro

om

Pra

ctic

e:

Surg

eon/

nurs

e te

ams

prac

tice

ML/

LA u

sing

pel

vic

mod

els

and

chec

klis

ts.

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

Dis

cuss

ion

: Pha

rmac

olog

y of

dr

ugs

and

pain

man

agem

ent

OR

Pra

ctic

e: D

ivid

e in

to 3

gr

oups

(su

rgeo

n/nu

rse

team

s):

Gro

up

1: A

ssis

t/pe

rfor

m

ML/

LA; G

rou

p 2

: Pra

ctic

e cl

ient

cou

nsel

ing,

pre

-op

asse

ssm

ent,

and

clie

nt

prep

arat

ion;

Gro

up

3:

Obs

erve

IPC

pra

ctic

es b

efor

e an

d af

ter

surg

ery.

Lear

ners

ass

ess

each

oth

er’s

pe

rfor

man

ce u

sing

che

cklis

ts

and

rota

te g

roup

s.

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

Dis

cuss

ion

: Pos

t-op

erat

ive

reco

very

, dis

char

ge, a

nd

follo

w-u

p

OR

Pra

ctic

e: D

ivid

e in

to 3

gr

oups

(su

rgeo

n/nu

rse

team

s):

Gro

up

2: A

ssis

t/pe

rfor

m

ML/

LA; G

rou

p 3

: Pra

ctic

e cl

ient

cou

nsel

ing,

pre

-op

asse

ssm

ent

and

clie

nt

prep

arat

ion;

Gro

up

1:

Obs

erve

IPC

pra

ctic

es b

efor

e an

d af

ter

surg

ery.

Lear

ners

ass

ess

each

oth

er’s

pe

rfor

man

ce u

sing

che

cklis

ts

and

rota

te g

roup

s.

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

Rev

iew

res

ults

of m

idco

urse

qu

estio

nnai

re w

ith g

roup

and

in

divi

dual

lear

ners

.

Dis

cuss

ion

: Int

rodu

ctio

n of

ac

tion

plan

: Sta

rtin

g/ e

xpan

ding

M

L/LA

ser

vice

s

OR

Pra

ctic

e: G

roup

s pr

ovid

e M

L/LA

ser

vice

s; fa

cilit

ator

s as

sess

per

form

ance

usi

ng

chec

klis

ts. G

roup

s ro

tate

ac

cord

ing

to t

he le

arne

rs’

need

s.

A.M

. (3

ho

urs

)

Age

nda

and

open

ing

activ

ity

OR

Pra

ctic

e: G

roup

s pr

ovid

e M

L/LA

ser

vice

s; fa

cilit

ator

s as

sess

per

form

ance

usi

ng

chec

klis

ts. G

roup

s ro

tate

ac

cord

ing

to t

he le

arne

rs’

need

s.

Faci

litat

ors

asse

ss p

erfo

rman

ce

for

qual

ifica

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Setting Up Training and Clinical Service Provision for INTERVAL or POSTPARTUM Minilaparotomy

INTERVAL ML/LA Procedure:

Suprapubic incision (3 cm transverse incision, approximately 3 cm above pubic symphysis)

Use uterine elevator to locate the fallopian tubes

Use the INTERVAL ML/LA Checklist

Follow the same steps for:

Postoperative recovery and follow-up care

Management of complications

Infection prevention and control

POSTPARTUM ML/LA Procedure:

Subumbilical incision (3 cm transverse incision, approximately 1 cm below the uterine fundus)

No need to use the uterine elevator

Use the POSTPARTUM ML/LA Checklist

INTERVAL Minilaparotomy

FP counseling conducted and client chooses tubal ligation (TL) (interval)

POSTPARTUM Minilaparotomy

FP counseling during antenatal care

(Decision for postpartum TL made before onset of labor, if possible)

Conduct client assessment, confirm she is eligible for TL

Schedule: Any time (interval) Schedule:

Immediately after delivery to 7 days after delivery

(If > 7 days: Delay procedure until 42 days or more after childbirth; use interval technique)


INSTRUCTIONS FOR USING THE ZOE® GYNECOLOGIC SIMULATOR The ZOE gynecologic simulator is a full-sized, adult female lower torso (abdomen and pelvis). It is a versatile training model developed to assist health professionals to teach and practice the processes and skills needed to perform many gynecologic, obstetric and family planning procedures. The ZOE model is ideal for demonstrating and practicing the following:

• Bimanual pelvic examination including palpation of normal and pregnant uteri

• Vaginal speculum examination

• Visual recognition of normal cervices and cervical abnormalities

• Uterine sounding

• IUD insertion and removal

• Diaphragm sizing and fitting

• Laparoscopic inspection and occlusion of fallopian tubes (Falope rings or other clips)

• Minilaparotomy (both interval and postpartum tubal occlusion)

• Treatment of incomplete abortion using manual vacuum aspiration (MVA)

Contents The contents of the ZOE Gynecologic Simulator include the following:

Item Quantity

Normal ante- and retroverted uteri with transparent tops, attachments for round and ovarian ligaments as well as fallopian tubes and normal patent cervical os for pelvic examination and IUD insertion

2

6- to 8-week uterus (incomplete abortion) with dilated, patent cervical os, which allows passage of a 5- or 6-mm flexible cannula

1

10- to 12-week uterus (incomplete abortion) with dilated, patent cervical os, which allows passage of a 10- or 12-mm flexible cannula

1

Postpartum uterus (20-week size) with attached fallopian tubes for practicing postpartum tubal occlusion by minilaparotomy

1

Cervices (nonpatent) for use in visual recognition:

• Normal cervix

• Cervix with proliferation of columnar epithelium (ectropion)

• Cervix with inclusion (nabothian cyst) and endocervical polyp

• Cervix with lesion (cancer)

1

1

1

1


Item Quantity

Simulated round and ovarian ligaments (set of 2 each) 4

Normal tubal fimbriae and ovaries (2 each) 4

Fallopian tubes for tubal occlusion 10

Extra normal cervices with patent os for IUD insertion/removal 4

Extra cervices for 6- to 8-week and 10- to 12-week uteri (2 of each size) 4

Extra thin cervical locking rings 3

Flashlight with batteries 1

Soft nylon carrying bag 1

Outer Skin The outer skin of the model is foam-backed in order to simulate the feel of the anterior pelvic wall. The entire outer skin is removable to allow the model to be used for demonstration purposes (e.g., performing IUD insertion). The 3-cm incision (reinforced at each end) located just below the umbilicus can be used to insert a laparoscope to look at the uterus, round ligaments, ovaries and fallopian tubes and practice laparoscopic tubal occlusion. This incision also can be used for practicing postpartum tubal ligation by minilaparotomy. The 3-cm incision located a few centimeters above the symphysis pubis is used for practicing interval minilaparotomy. This incision also is reinforced, which allows the skin to be retracted to facilitate demonstration of the minilaparotomy technique.

Cervices The normal cervices have a centrally located, oval-shaped os, which permits insertion of a uterine sound, uterine elevator or IUD. The abnormal cervices are not patent (open) and can be used for demonstration only. Each of the cervices for treatment of incomplete abortion has a centrally located, oval-shaped os, which is dilated to allow passage of a 5- or 6-mm or 10- or 12-mm flexible cannula, respectively. The normal cervices and interchangeable uteri feature the patented “screw” design for fast and easy changing. Assembly To use the ZOE pelvic model for demonstrations or initially to learn how to change the parts (e.g., cervices and uteri), you need to know how to remove the skin.

Removing and Replacing the Detachable Skin and Foam Backing First, carefully remove the soft outer skin and its foam lining away from the rigid base at the “top” end of the model. (“Top” refers to the portion of ZOE nearest to the metal carrying handle located above the umbilicus.) Lift the skin and foam up and over the legs, one leg at a time.


Be as gentle as possible. The detachable skin is made of material that approximates skin texture and it can tear. If you wish to change the anteverted uterus and normal cervix, which are shipped attached to ZOE, first you must remove the uterus. Start by pulling the round ligaments away from the wall. Then grasp the uterus while turning the wide grey ring counterclockwise until the cervix and uterine body are separated. To remove the cervix, turn the thin grey ring counterclockwise until it comes off. You then can push the cervix out through the vagina. To reassemble, simply reverse this process. To replace the skin and foam lining, start by pulling them down around the legs. Then make sure the rectal opening is aligned with the opening in the rigid base. Pull the skin and foam over the top of the model. Finally, make sure both are pulled firmly down around the rigid base, and the skin is smoothly fitted over the foam. Once you understand how ZOE’s anatomical parts fit together, we suggest you change them through the opening at the top of the model. This helps to preserve ZOE’s outer shell as you will have to remove it only for demonstrations or to change the postpartum (20-week size) uterus. The anteverted and retroverted uteri have transparent top halves and opaque lower halves for use in demonstrating IUD insertion. These uteri are supported by round ligaments attached to the pelvic wall. The round ligaments, ovaries, and fallopian tubes are removable. To remove the uterus:

• Unscrew the wide locking ring attached to the uterus using a counterclockwise rotation.

• Unscrew the thin locking ring immediately outside the apex of the vagina.

• The cervix should be pushed through the vagina and removed from the introitus. To reassemble, proceed in reverse order.

Performing Procedures Speculum Examination

• Use a medium bivalve speculum.

• Prior to inserting the speculum, dip it into clean water containing a small amount of soap. (This makes inserting the speculum easier.)

• To see the cervix, fully insert the speculum, angle it posteriorly (as in the human, the vagina in the ZOE model is angled posteriorly), then open the blades fully.


• To increase the diameter of the opening, use the speculum thumb screw (Pederson or Graves specula).

Other Procedures Passing instruments (uterine sound, uterine elevator, dilator, or cannula) through the cervical os: Apply a small amount of clean water containing a drop or two of soap solution to the cervix (just as you would apply it with antiseptic solution in a client). This will make passing the instrument through the cervical os easier. Sounding the uterus, inserting an IUD, and performing interval minilaparotomy or laparoscopy: Use either the normal (nonpregnant) anteverted or retroverted uterus with a cervix having a patent os. Postpartum minilaparotomy (tubal occlusion): Use the postpartum uterus (20-week size) with a cervix having a patent os. Treatment of incomplete abortion using MVA: Use either the 6- to 8-week or 10- to 12-week uteri (incomplete abortion) with appropriate-sized cervix.

Care and Maintenance

• ZOE is constructed of material that approximates skin texture. Therefore, in handling the model, use the same gentle techniques as you would in working with a client.

• To avoid tearing ZOE’s skin when performing a pelvic exam, use a dilute soap solution to lubricate the instruments and your gloved fingers.

• Clean ZOE after every training session using a mild detergent solution; rinse with clean water.

• DO NOT write on ZOE with any type of marker or pen, as these marks may not wash off.

• DO NOT use alcohol, acetone, or Betadine® or any other antiseptic that contains iodine on ZOE. They will damage or stain the skin.

• Store ZOE in the carrying case and plastic bag provided with your kit.

• DO NOT wrap ZOE in other plastic bags, newspaper, plastic wrap, or any other kinds of material, as these may discolor the skin.


MINILAPAROTOMY UNDER LOCAL ANESTHESIA KNOWLEDGE ASSESSMENT Instructions: Circle the letter of the single best answer to each question.

1. Tubal ligation by minilaparotomy is best described as

a. performed on a postpartum or interval basis b. requiring an abdominal incision not more than 5 cm long c. done under local anesthesia and on an outpatient basis d. all of the above

2. When preparing the client for surgery, the staff should tell the client that

a. there will be a lot of pain during the procedure but that she won’t feel it because of the medication she will receive

b. she will probably feel some tugging, pulling, and slight cramping during the procedure c. the doctor is very good and that she will probably not feel anything during the surgery d. even though she might be feeling some cramping and discomfort during the procedure, she should

not mention it during the surgery

3. Prior to performing a minilaparotomy procedure, the surgeon must verify informed consent by

a. noting that the client discussed with the counselor and signed the consent form b. ensuring that the consent form is signed by both the client and her husband c. examining the consent form to see that the client’s signature was witnessed d. reviewing the consent for completeness and talking with the client to ensure that she understands the

procedure she has requested

4. If a pelvic examination was part of the initial pre-operative assessment, then another pelvic examination

a. must be performed before the surgery by the surgeon b. must be performed after the procedure to ensure that the uterus has not been perforated c. is unnecessary d. should be performed by the nurse to check for infection

5. If a systemic or local (pelvic) infection is noted on the day of the surgery

a. the procedure should be performed anyway b. the client should be sent home and told to return when she feels that the infection has been resolved c. laparoscopy should be performed instead of minilaparotomy d. the procedure should be postponed until the client has been treated for the infection and a

temporary method should be prescribed


6. When faced with an obese patient who requests minilaparotomy under local anesthesia, the surgeon should

a. plan to use more assistants during the procedure b. plan the procedure at a facility where general anesthesia and laparotomy can be performed c. suggest that the client to lose weight and ask her to return in 3 months d. use a vertical instead of an horizontal incision

7. After a minilaparotomy procedure, the only acceptable method for processing used instruments is

a. cleaning followed by sterilization b. cleaning, then disinfection with Dettol c. soaking in Dettol for at least 24 hours d. cleaning, followed by sterilization or high-level disinfection

8. The operating room should be cleaned with a disinfectant solution like 0.5% chlorine solution

a. after any contaminated case and weekly b. between all cases and also thoroughly on a monthly basis c. between all cases and thoroughly on a weekly basis d. after all cases with more than 250 ml of blood loss

9. Which one of the following is not a recommended infection prevention practice?

a. in high-volume settings, surgical staff should do a 3-minute scrub every hour or after every four or five cases

b. OR staff should change into clean scrub suits or gowns, caps, and masks inside the OR c. minilaparotomy procedures require sterile surgical gloves d. Chlorhexidine gluconate, iodophors, or alcohols can be used as antiseptics

10. Local anesthesia for minilaparotomy involves

a. using a maximum of 25 ml of 1% lidocaine and adrenaline b. sedating all clients with meperidine 100 mg and diazepam 10 mg c. infiltrating all abdominal wall layers with 1% lidocaine d. use of enough sedation so that the client is asleep

11. When infiltrating 1% lidocaine to produce local anesthesia for a minilaparotomy procedure

a. the surgeon must be sure that only the skin and subcutaneous tissue are infiltrated before starting the procedure

b. the incision may be made as soon as the lidocaine is injected c. epinephrine should always be used along with the lidocaine d. the surgeon must attempt to infiltrate all the layers from the skin to the peritoneum with anesthetic

12. If the uterus is retroverted, the uterine elevator should

a. not be used b. be inserted into the cervix with the tip downward, after which the handle is rotated c. be inserted in the same way as for an anteverted uterus d. be inserted after the abdomen has been opened, so that the uterus can be visualized


13. To minimize complications during both interval and postpartum minilaparotomy, the surgeon should remember to

a. use the uterine elevator in all minilaparotomy cases b. use toothed instruments to prevent intra-abdominal tissue from slipping c. ensure that the client has emptied her bladder prior to surgery d. all of the above

14. The technique used for tubal occlusion is called

a. Pomeroy technique b. Babcock technique c. Carman technique d. Parkland and Irving technique

15. The best time to perform a postpartum minilaparotomy under local anesthesia is

a. any time after the first menstrual cycle b. within the first 48 hours postpartum or more than 6 weeks after delivery c. within the first 6 weeks postpartum d. within the first 7 days postpartum

16. Which one of the following is not a precaution requiring postponement of the procedure until > 6 weeks for postpartum minilaparotomy?

a. age > 35 years old b. severe pre-eclampsia c. prolonged rupture of membranes d. severe hemorrhage (> 500 ml)

17. The following conditions indicate that the client is ready for discharge

a. her partner has arrived to take her home b. she can walk upright with minimal support c. she complains of nausea and vomiting d. she still feels very drowsy

18. During the postoperative period, the staff monitoring the client should

a. check and record vital signs every 15 minutes until the client is stable b. review the record upon receiving the client c. complete the client record form d. all of the above

19. Uterine perforation during a minilaparotomy procedure can be caused by

a. rough manipulation of the uterine elevator b. improper insertion of the uterine elevator c. using the uterine elevator during a postpartum procedure d. all of the above


20. In the minilaparotomy procedure, intra-abdominal bleeding

a. occurs solely in the operating room b. is related to the level of the anesthesia c. may occur in the operating room or at any time in the postoperative period d. usually occurs in women with a previous history of postpartum hemorrhage


CHECKLISTS FOR MINILAPAROTOMY CLINICAL AND COUNSELING SKILLS

USING THE CHECKLISTS The checklists included in this guide for minilaparotomy clinical and counseling skills are used by the learners and facilitators to develop new skills, as well as to assess each learner’s competency in providing minilaparotomy services. Each checklist contains in sequence the tasks performed by the respective clinician when performing a minilaparotomy procedure under local anesthesia. These tasks correspond to the information presented in relevant chapters of the reference manual. During skill acquisition and acquiring competency, checklists are very useful learning tools. Learners use checklists when observing a demonstration; when they are practicing on ZOE models or with role plays; and during service provision on real clients in the clinic. Used consistently, the checklists enable each learner to chart her/his progress and to pinpoint areas for improvement. Furthermore, they are designed to make communication (coaching and feedback) between the learner and facilitator easier and more helpful during learning. The facilitator then uses these checklists to evaluate the performance of each learner as she/he provides minilaparotomy services to one or more clients. Criteria for satisfactory performance by the learner are based on the knowledge, attitudes, and skills set forth in the Learner’s Guide. In general, a learner is expected to satisfactorily perform at least 5–10 minilaparotomy procedures with clients before being evaluated as competent and achieving qualification. When determining competence, the judgment of a skilled facilitator is the most important factor. Thus, in the final analysis, competence carries more weight than the number of procedures performed. Because the goal of this training is to enable every learner to achieve competency, additional training may be necessary. The checklists presented here can be used for five observations, and the facilitators should make enough copies for learners throughout the course.


CHECKLIST FOR INTERVAL MINILAPAROTOMY CLINICAL SKILLS

Place a in case box if step/task is performed satisfactorily, an if it is not performed satisfactorily, orN/O if not observed.

Satisfactory: Performs the step or task according to the standard procedure or guidelines

Unsatisfactory: Unable to perform the step or task according to the standard procedure or guidelines

Not Observed: Step or task or skill not performed by learner during evaluation by facilitator

LEARNER ________________________________________________ Course Dates _______________


STEP/TASK CASES

GETTING READY

1. Greet the client respectfully and review her medical record.

2. Verify the client’s identity and check that informed consent was obtained.

3. Ask if the client has emptied her bladder and washed her abdominal and pelvic areas.

SKILL/ACTIVITY PERFORMED SATISFACTORILY

PRE-OPERATIVE TASKS

1. Prepare instrument tray and open sterile instrument pack without touching items.

2. Give IV medication slowly.

3. Wash hands thoroughly with soap and water and dry with clean cloth.

4. Put clean examination gloves on both hands.

5. Perform bimanual pelvic examination and insert speculum.

6. Apply antiseptic solution to the cervix and vagina (two times), insert uterine elevator, identify the site of incision (do not remove the elevator), and dispose of gloves.

7. Put on cap and mask, perform surgical scrub, and put on sterile gown and sterile surgical gloves.

8. Apply antiseptic two times to incision area and drape the client for the procedure.

9. Throughout procedure, talk to the client (verbal anesthesia).




STEP/TASK CASES

PROCEDURE

Local Anesthesia

1. Raise a small skin wheal at the center of the incision site, and starting at the center of the planned incision, administer local anesthetic (about 3–5 ml) just under the skin along both sides of the incision line.

2. Without removing the needle from under the skin, insert the needle into the fascia at a 45-degree angle, with the needle directly above the incision line; withdraw the needle slowly while injecting 3–5 ml lidocaine (repeat on other side of incision line).

3. Insert the needle straight down through the rectus sheath to the peritoneum, inject 1–2 ml of anesthetic into the peritoneal layer. (Maximum dose of 1% local anesthetic, e.g., lidocaine, is 3.0 mg/kg.)

4. Massage the skin and tests with tissue forceps.

Abdominal Entry

5. Make a 3-cm transverse incision in the skin about 3 cm above the pubic symphysis.

6. Bluntly dissect subcutaneous tissues down to anterior fascia with retractors.

7. Cut anterior rectus fascia, separate rectus muscles, and identify peritoneum.

8. Check for bowel or other abdominal tissue and push away from planned entry site.

9. Make a small incision in the peritoneum with scissors and enlarge it transversely.

10. Locate uterine fundus and cornu of fallopian tubes utilizing uterine elevator through the sterile drape.

11. Identify the midportion of the fallopian tube and gently grasp with a Babcock forceps and bring it to the incision.

12. Alternatively, use the tubal hook method to grasp the fallopian tube

13. Identify fimbriae and ligate midportion of fallopian tube with a single free tie (absorbable suture) and excise the loop.

14. Repeat procedure on opposite side for second tube.

15. Assure hemostasis, then close fascia and skin in two layers.

16. Dress the wound.


POSTOPERATIVE TASKS

1. Remove the uterine elevator and place in chlorine solution.

2. Dispose of syringe, needle, and scalpel in puncture-proof container.

3. Dispose of waste materials according to guidelines.

4. Remove gloves and dispose of them.




STEP/TASK CASES

6. Check that vital signs are being monitored regularly.

7. Instruct client on wound care and return visit.

8. Record the procedure.


LEARNER IS QUALIFIED NOT QUALIFIED TO PERFORM INTERVAL

MINILAPAROTOMY UNDER LOCAL ANESTHESIA, BASED ON THE FOLLOWING CRITERIA:

• Score on Midcourse Questionnaire__________% (Attach Answer Sheet)

• Counseling and Clinical Skills Evaluation: Satisfactory Unsatisfactory

• Provision of Services (practice): Satisfactory Unsatisfactory

Facilitator’s Signature ____________________________________ Date __________________


CHECKLIST FOR POSTPARTUM MINILAPAROTOMY CLINICAL SKILLS

Place a in case box if step/task is performed satisfactorily, an if it is not performed satisfactorily orN/O if not observed.



Not Observed: Step, task or skill not performed by learner during evaluation by facilitator



STEP/TASK CASES

GETTING READY

1. Greet the client respectfully and review her medical record.

2. Verify the client’s identity and check that informed consent was obtained.

3. Check that the client has voided and thoroughly washed her abdominal and pelvic areas.


PRE-OPERATIVE TASKS

1. Prepare instrument tray and open sterile instrument pack without touching items.

2. Give IV medication slowly.


4. Determine fundal height.

5. Perform surgical scrub, and put on sterile gown and sterile gloves.

6. Clean umbilicus first with antiseptic.

7. Apply antiseptic two times to incision area and drape the client for procedure.

8. Throughout procedure, talk to the client (verbal anesthesia).


ML/LA PROCEDURE

Local Anesthesia

1. Raise a small skin wheal at the center of the incision line, and administer local anesthetic just under the skin, along both sides of the incision line.

2. Starting again at the center of the incision line, insert the needle into the fascia with the needle directed toward the transverse half of the incision line.

3. Withdraw the needle slowly while injecting 3–5 ml of lidocaine, repeat on the other half of the incision line. (The maximum dose should not exceed 150 mg for a woman who weighs 50 kg.)

4. Massage the skin and test with tissue forceps.



STEP/TASK CASES

Abdominal Entry

5. Make a transverse skin incision, approximately 3 cm long, about 1 cm inferior to the uterine fundus.

6. Bluntly dissect subcutaneous tissues down to anterior fascia.

7. Cut anterior rectus fascia and identify peritoneum.

8. Check for bowel or other abdominal tissue and push away from planned entry site.

9. Make a small incision in the peritoneum with scissors and enlarge it transversely.

10. Locate uterine fundus and position the incision over the fallopian tube.

11. Identify the midportion of the fallopian tube and gently grasp it with a Babcock or tubal hook and bring it up to the incision.

12. Identify fimbriae and ligate midportion of fallopian tube with absorbable suture and excise.

13. Repeat procedure on opposite side for second tube.

14. When hemostasis is assured, close wounds in layer.

15. Dress the wound.


POSTOPERATIVE TASKS

1. Dispose of syringe in puncture-proof container.

2. Dispose of waste materials according to guidelines.



5. Check that vital signs are being monitored regularly.

6. Instruct client on wound care and return visit.

7. Record the procedure.


LEARNER IS QUALIFIED NOT QUALIFIED TO PERFORM POSTPARTUM


• Score on Midcourse Questionnaire _______________% (Attach Answer Sheet)





CHECKLIST FOR MINILAPAROTOMY CLINICAL SKILLS FOR CIRCULATING NURSES






CHECKLIST FOR MINILAPAROTOMY CLINICAL SKILLS FOR CIRCULATING NURSES

STEP/TASK CASES

PRE-OPERATIVE

1. Ensure that all supplies and equipment for monitoring vital signs are available.

2. Greet the client, review record, and ensure that informed consent was obtained.

3. Position the client flat on her back on operating table.

4. Take and record vital signs.

5. Start IV medication slowly.

6. Prepare vaginal instruments for surgeon.

7. Assist with vaginal exam, prep, and insertion of uterine elevator (for interval procedures).


DURING SURGERY

1. Communicate with and be supportive of the client during procedure.

2. Monitor and record vital signs during procedure.

3. Monitor client’s general condition. Report any increased discomfort or stress to surgeon.


POSTOPERATIVE

1. Provide dressing to cover incision.

2. Record final vital signs before leaving operating room.

3. Assist client onto stretcher.

4. Introduce client to recovery room personnel and ensure that record is complete.



LEARNER IS QUALIFIED NOT QUALIFIED TO ASSIST IN THE PERFORMANCE OF







CHECKLIST FOR MINILAPAROTOMY CLINICAL SKILLS FOR NURSING ASSISTANTS






CHECKLIST FOR MINILAPAROTOMY CLINICAL SKILLS FOR NURSING ASSISTANTS

STEP/TASK CASES

PRE-OPERATIVE

1. Perform a surgical scrub and put on surgical garments.

2. Prepare sterile or high-level disinfected instruments for procedure.

3. Assist surgeon to drape the client.

4. Withdraw local anesthetic from vial held by circulating nurse.

5. Note start time of surgery for circulator to record.


DURING SURGERY

1. Assist during surgery, working as a team with surgeon.

2. Take gauze pieces and instrument count and report findings to circulator.

3. Record end time of surgery for circulator to record.

4. Place dressing on wound at end of procedure.


POSTOPERATIVE

1. Remove drape when wound is dressed.

2. Take used instruments from operating room and place in a bucket for cleaning.

3. Dispose of specimen of tube according to guidelines.


5. Wash hands with soap and water.

6. Prepare instruments and table for next case.



LEARNER IS QUALIFIED NOT QUALIFIED TO ASSIST IN THE PERFORMANCE OF







CHECKLIST FOR COUNSELING FOR MINILAPAROTOMY IN THE INTERVAL PERIOD







STEP/TASK CASES

GENERAL COUNSELING STEPS

1. Greet the client by introducing yourself and warmly welcome her to the clinic.

2. Obtain basic information (name, address, age, etc.).

3. Use the Balanced Counseling Algorithm and Cue Cards.

4. Listen to what the client says about her contraceptive needs.

5. Rule out pregnancy using the counseling card with six questions or a pregnancy checklist.

6. Ask her if she wants to space or limit births.

7. Help the client begin to choose an appropriate method.


STEPS IF THE CLIENT CHOOSES MINILAPAROTOMY

1. Make sure there is no medical condition that would make the client a poor candidate for ML/LA.

2. Clearly discuss the benefits of minilaparotomy: It is permanent (although there is a small chance of failure). It is very effective. It has no long-term effects.

3. Explain the importance of the partner being involved in the decision process.

4. Explain that minilaparotomy does not provide protection against sexually transmitted infections, including HIV/AIDS.

5. Explain common side effects and be sure they are understood fully.

6. Describe the surgical procedure and what the woman should expect during and afterwards. Explain common complications of the procedure.

7. Re-assess the client’s final decision and feelings and decide if she is making an informed decision.

8. Discuss scheduling the procedure and the possible need for contraception prior to minilaparotomy.



STEP/TASK CASES

9. If there are no contraindications based on medical assessment, ask her to sign the consent form.


ON SCHEDULED DAY, BEFORE THE MINILAPAROTOMY PROCEDURE

1. Verify the client’s identification and check that informed consent was obtained.

2. Review client assessment data to determine if the client is an appropriate candidate for minilaparotomy.

3. Ask the woman if she has any questions about the procedure.

4. Explain to the client what will happen next, and what she should expect during the procedure.


AFTER THE MINILAPAROTOMY PROCEDURE

1. After sedation is worn off, and the client is preparing for discharge, give postoperative instructions, orally, and in writing, if appropriate.

2. Provide information on warning signs for medical problems and the need to return to the clinic immediately should any occur.

3. Schedule a follow-up visit within 7 days.

4. Discuss arrangements for discharge.

5. Assure the client that she can return at any time if she has questions or concerns.

6. Have the client repeat all instructions to you.

7. Answer any remaining client questions.

8. Complete the client record.


LEARNER IS QUALIFIED NOT QUALIFIED TO PROVIDE COUNSELING FOR

MINILAPAROTOMY IN THE INTERVAL PERIOD, BASED ON THE FOLLOWING CRITERIA:






CHECKLIST FOR COUNSELING FOR MINILAPAROTOMY IN THE POSTPARTUM PERIOD







STEP/TASK CASES

GENERAL COUNSELING STEPS

1. Greet the client by introducing yourself and warmly welcome her to the clinic.

2. Obtain basic information (name, address, age, etc.) .

3. Listen for the client’s contraceptive needs.

4. Use the Balanced Counseling Algorithm and Cue Cards.

5. Ask her if she wants to space or limit births.

6. Help the client begin to choose an appropriate method.


STEPS IF THE CLIENT CHOOSES MINILAPAROTOMY

1. Make sure there is no medical condition that would make the client a poor candidate for ML/LA.

2. Clearly discuss the benefits of minilaparotomy: It is permanent (although there is a small chance of failure). It is very effective. It has no long-term effects.

3. Explain the importance of the partner being involved in the decision process.

4. Explain that minilaparotomy does not provide protection against sexually transmitted infections, including HIV/AIDS.

5. Explain common side effects and be sure they are understood fully.

6. Describe the surgical procedure and what the woman should expect during and afterwards. Explain common complications of the procedure.

7. Assess the client’s decision and feelings and decide if she is making an informed decision.

8. Discuss when the procedure will be performed (within 7 days of delivery)

9. If there are no contraindications based on medical assessment, ask her to sign the consent form.




STEP/TASK CASES

BEFORE THE MINILAPAROTOMY PROCEDURE

1. Verify the client’s identification and check that informed consent was obtained.

2. Review client assessment data to determine if the client is an appropriate candidate for minilaparotomy.

3. Ask the woman if she has any questions about the procedure.

4. Explain to the client what will happen next, and what she should expect during the procedure.


AFTER THE MINILAPAROTOMY PROCEDURE

1. After sedation is worn off, and the client is preparing for discharge, give postoperative instructions, orally, and in writing, if appropriate.

2. Provide information on warning signs for medical problems and the need to return to the clinic immediately should any occur.

3. Schedule a follow-up visit within 7 days.

4. Discuss arrangements for discharge.

5. Assure the client that she can return at any time if she has questions or concerns.

6. Have the client repeat all instructions to you.

7. Answer any remaining client questions.

8. Complete the client record.


LEARNER IS QUALIFIED NOT QUALIFIED TO PROVIDE COUNSELING FOR

MINILAPAROTOMY IN THE POSTPARTUM PERIOD, BASED ON THE FOLLOWING CRITERIA:






CHECKLIST FOR VERBAL ANESTHESIA






CHECKLIST FOR VERBAL ANESTHESIA

TASK/ACTIVITY CASES

GETTING READY

1. Greet the woman respectfully and with kindness.

2. Tell the client what you are going to do and encourage her to ask questions.

3. Tell the client that she may feel discomfort during some of the steps and you will tell her about any discomfort in advance.

4. Assess the client’s need for pain management medication.


PROCEDURE

1. Explain each step of the procedure prior to performing it.

2. Wait after performing each step or task to prepare the client for the next one.

3. Move slowly, without jerky or quick motions.

4. Use instruments with confidence.

5. Avoid saying things like “This won’t hurt” when it will hurt; or “I’m almost done” when you’re not.

6. Talk with the client throughout the procedure.


LEARNER IS QUALIFIED NOT QUALIFIED TO PERFORM VERBAL ANESTHESIA, BASED

ON THE FOLLOWING CRITERIA:






Course Evaluation (To be completed by Learners) Please indicate your opinion of the course components using the following rate scale: 5–Strongly Agree 4–Agree 3–No Opinion 2–Disagree 1–Strongly Disagree

COURSE COMPONENT RATING

1. The precourse questionnaire helped me to study more effectively.

2. I understand the principles of informed choice for voluntary sterilization.

3. I understand the eligibility criteria, precautions, and client assessment principles and can correctly identify clients who would be appropriate for minilaparotomy under local anesthesia (ML/LA).

4. The role play sessions on counseling skills were helpful.

5. There was sufficient time scheduled for practicing counseling through role play and with clients.

6. The demonstrations helped me gain a better understanding of ML/LA prior to practicing with the anatomic models.

7. The practice sessions with the anatomic models made it easier for me to perform ML/LA when working with actual clients.

8. There was sufficient time scheduled for practicing ML/LA with clients.

9. The interactive, participatory training approach used in this course made it easier for me to learn how to provide ML/LA services.

10. The time allotted for this course, and its different components, was sufficient for learning how to provide ML/LA services.

11. I feel confident in providing local anesthesia to ML/LA clients.

12. I feel confident in performing standard interval ML/LA.

13. I feel confident in performing standard postpartum ML/LA.

14. I feel confident in using the infection prevention and control practices recommended for ML/LA services.

15. I feel confident in conducting postoperative management for ML/LA, including discharge, follow-up, and management of side effects and other health problems.

16. I can describe the basic requirements of mobile outreach services for ML/LA.

(See next page.)


Additional Comments What topics (if any) should be added (and why) to improve the course? What topics (if any) should be deleted (and why) to improve the course? What should be done to improve how this course is conducted? Also, feel free to provide additional explanation for any of your ratings (Items 1 to 16).

Section 2: Facilitator’s Guide

41

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

Mo

del

Min

ilap

aro

tom

y C

linic

al S

kills

Co

urs

e O

utl

ine

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n O

ne:

Day

1, A

M (

180

min

utes

)

(10

min

utes

) A

ctiv

ity:

Wel

com

e

Wel

com

e by

faci

litat

ors

Co

urs

e E

qu

ipm

ent:

Ove

rhea

d pr

ojec

tor,

scr

een,

flip

cha

rt w

ith

mar

kers

, vid

eo p

laye

r an

d m

onito

r,

ZO

E G

ynec

olog

ic S

imul

ator

, su

pplie

s, a

nd in

stru

men

ts

(20

min

utes

) A

ctiv

ity:

Intr

oduc

tions

Le

arne

rs a

nd fa

cilit

ator

s di

vide

into

pai

rs, i

nter

view

, and

the

n in

trod

uce

each

oth

er b

y sh

arin

g th

eir

part

ner’

s na

me,

pla

ce o

f wor

k,

and

any

uniq

ue c

hara

cter

istic

s.

(20

min

utes

) O

bje

ctiv

e: D

escr

ibe

cour

se g

oals

and

ob

ject

ives

, cou

rse

mat

eria

ls, a

nd s

ched

ule.

R

evie

w g

oals

, cou

rse

sylla

bus,

lear

ning

obj

ectiv

es.

Rev

iew

and

dis

cuss

cou

rse

sche

dule

, dai

ly r

eadi

ng a

ssig

nmen

ts, t

ea

brea

ks a

nd lu

nch

times

, and

ses

sion

hou

rs.

Dis

trib

ute,

rev

iew

, and

dis

cuss

mat

eria

ls u

sed

in t

his

cour

se.

Rev

iew

the

tab

le o

f con

tent

s of

the

ML/

LA R

efer

ence

Man

ual.

ML

/LA

Lea

rner

’s a

nd

F

acili

tato

r’s

Gu

ides

:

Sylla

bus

and

sche

dule

ML

/LA

Ref

eren

ce M

anua

l (1

per

lear

ner)

(20

min

utes

) A

ctiv

ity:

Iden

tify

and

disc

uss

lear

ners

’ an

d fa

cilit

ator

s’ e

xpec

tatio

ns.

List

and

dis

cuss

lear

ners

’ exp

ecta

tions

of t

he c

ours

e.

Lear

ners

wri

te d

own

norm

s th

at w

ill b

e fo

llow

ed t

o ac

hiev

e th

ese

expe

ctat

ions

.

Tra

iner

s sh

are

thei

r ex

pect

atio

ns o

f the

lear

ners

.

Mat

eria

ls: F

lip c

hart

, mar

ker

pens

(20

min

utes

) A

ctiv

ity:

Ass

ess

lear

ners

’ pre

cour

se

know

ledg

e.

Com

plet

e pr

ecou

rse

ques

tionn

aire

for

ML/

LA c

linic

al s

kills

.F

acili

tato

r’s

Gu

ide:

Pre

cour

se

ques

tionn

aire

(10

min

utes

) B

reak

Le

arne

rs t

o co

mpl

ete

regi

stra

tion

proc

ess.

M

ater

ials

: Lea

rner

reg

istr

atio

n fo

rm

(20

min

utes

) D

iscu

ssio

n: O

verv

iew

of F

P an

d V

S pr

ogra

ms

in t

he c

ount

ry

Rev

iew

goa

ls a

nd o

bjec

tives

of t

he n

atio

nal F

P pr

ogra

m. E

xpla

in t

he

role

of V

S an

d M

L/LA

in a

ccom

plis

hing

pro

gram

obj

ectiv

es.

Mat

eria

ls: F

P/V

S gu

idel

ines

and

ot

her

rele

vant

pol

icy

docu

men

ts

(Fac

ilita

tors

pro

vide

the

se

docu

men

ts a

s av

aila

ble

for

each

co

ntex

t)

42

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

(25

min

utes

) O

bje

ctiv

e: D

escr

ibe

how

peo

ple

lear

n,

and

iden

tify

adul

t le

arni

ng c

hara

cter

istic

s.

Dis

cuss

ion

/Exe

rcis

es:

Act

ivit

y 1.

Bui

ldin

g a

Pape

r Bo

x

Act

ivit

y 2.

Num

bers

Gam

e

Act

ivit

y 3.

Nin

e D

ots

Puzz

le

Fac

ilita

tor’

s G

uid

e: “

How

Peo

ple

Lear

n”

(15

min

utes

) O

bje

ctiv

e: D

emon

stra

te h

ow t

o us

e an

d ca

re fo

r th

e Z

OE

pelv

ic m

odel

. D

iscu

ssio

n a

nd

Dem

on

stra

tio

n: U

sing

and

car

ing

for

the

ZO

E pe

lvic

mod

el

Vid

eo: Z

OE

pelv

ic m

odel

ZO

E pe

lvic

mod

el a

nd a

cces

sori

es,

talc

, dra

pes,

flas

hlig

ht

(20

min

utes

) A

ctiv

ity:

Pre

cour

se s

kill

asse

ssm

ent

Indi

vidu

ally

eva

luat

e ea

ch le

arne

r’s

entr

y-le

vel s

kills

in t

he fo

llow

ing

area

s:

C

ouns

elin

g (s

urge

on a

nd n

urse

)

Pelv

ic e

xam

inat

ion

(sur

geon

)

Kno

t ty

ing

(sur

geon

)

ZO

E pe

lvic

mod

el

Spec

ula

Tal

c, d

rape

s, fl

ashl

ight

, cot

ton

stri

ng

or y

arn

Prec

ours

e Sk

ills

Ass

essm

ent

Che

cklis

t

43

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

SE

SS

ION

Tw

o: D

ay 1

, PM

(18

0 M

inut

es)

(30

min

utes

) O

bje

ctiv

e: Id

entif

y in

divi

dual

and

gro

up

lear

ning

nee

ds.

Exe

rcis

e: F

acili

tato

rs r

etur

n co

rrec

ted

ques

tionn

aire

s. D

iscu

ss

answ

ers.

Lear

ners

com

plet

e in

divi

dual

ass

essm

ent

mat

rix.

Faci

litat

ors

can

eith

er p

roje

ct t

he m

atri

x on

a s

lide,

or

copy

it o

n a

flip

char

t an

d po

st it

in t

he t

rain

ing

room

. The

pre

cour

se m

atri

x th

en c

an b

e us

ed t

o co

mpa

re w

ith t

he r

esul

ts o

f mid

cour

se

know

ledg

e as

sess

men

t.

Dis

cuss

gro

up le

arni

ng n

eeds

.

Fac

ilita

tor’

s G

uid

e: In

divi

dual

and

G

roup

Ass

essm

ent

Mat

rix

Flip

cha

rt, m

arke

rs

(45

min

utes

) O

bje

ctiv

e: Id

entif

y th

e fu

ndam

enta

l fe

atur

es o

f min

ilapa

roto

my

unde

r lo

cal

anes

thes

ia.

Dis

cuss

ion

: Int

rodu

ctio

n to

ML

unde

r LA

:

Met

hods

of t

ubal

occ

lusi

on

T

imin

g of

the

pro

cedu

re

Ef

fect

iven

ess

Sa

fety

Com

plic

atio

n ra

tes

A

dvan

tage

s an

d lim

itatio

ns o

f fem

ale

ster

iliza

tion

Si

de e

ffect

s

Del

iver

y of

ser

vice

s

Satis

fact

ion

and

diss

atis

fact

ion

afte

r m

inila

paro

tom

y

Ref

eren

ce M

anu

al: C

hapt

er 1

(85

min

utes

) A

ctiv

ity:

Dem

onst

rate

the

ent

ire

ML/

LA

proc

edur

e.

Ob

ject

ive:

Lea

rn in

terv

al m

etho

d fo

r M

L/LA

.

Ob

ject

ive:

Lea

rn h

ow t

o us

e th

e ch

eckl

ist

for

ML/

LA c

linic

al s

kills

.

Rev

iew

ML/

LA c

heck

list.

Iden

tify

the

key

step

s fo

r su

rgeo

ns t

o w

atch

cl

osel

y du

ring

the

dem

onst

ratio

n.

Dem

on

stra

tio

n: S

how

the

ani

mat

ed v

ideo

for

min

ilapa

roto

my

unde

r lo

cal a

nest

hesi

a.

Dem

on

stra

tio

n: In

terv

al M

L/LA

usi

ng Z

OE

mod

el

Exe

rcis

e: S

urge

on: M

L/LA

ret

urn

dem

onst

ratio

n as

sist

ed b

y fa

cilit

ator

usi

ng c

heck

list.

Nur

ses:

Ret

urn

dem

onst

ratio

n w

ith

faci

litat

or a

s su

rgeo

n us

ing

chec

klis

t.

Ref

eren

ce M

anua

l: C

hapt

er 7

ZO

E P

elvi

c M

od

el w

ith

min

ilapa

roto

my

kit,

drap

es, g

love

s,

sutu

re, t

alc

pow

der,

sim

ulat

ed w

ash

basi

n, b

ucke

ts fo

r w

aste

dis

posa

l and

de

cont

amin

atio

n

An

imat

ed V

ideo

: Ava

ilabl

e on

line

at: h

ttps

://w

ww

.you

tube

.com

/ w

atch

?v=

w-h

9eFy

NyN

M&

fe

atur

e=yo

utu.

be

Fac

ilita

tor’

s G

uid

e: C

heck

lists

for

ML/

LA C

ouns

elin

g an

d C

linic

al S

kills

fo

r su

rgeo

ns

44

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

(10

min

utes

) A

ctiv

ity:

Rev

iew

the

day

’s a

ctiv

ity.

Lear

ners

sha

re w

ith t

he g

roup

at

leas

t on

e ne

w p

iece

of i

nfor

mat

ion

they

lear

ned

duri

ng t

he d

ay.

(10

min

utes

) A

ctiv

ity:

Tou

r of

clin

ical

wor

k ar

eaLe

arne

rs id

entif

y th

e re

cept

ion

and

coun

selin

g se

ctio

ns, t

he

oper

atin

g ro

om, a

nd t

he r

ecov

ery

room

of t

he t

rain

ing

cent

er.

TO

TA

L: 3

60 m

inu

tes

Lear

ners

are

to

prac

tice

knot

tyi

ng in

the

eve

ning

.

Rea

din

g A

ssig

nm

ent:

Ref

eren

ce M

anu

al: C

hapt

ers

1, 4

, 6, 7

45

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n T

hre

e: D

ay 2

, AM

(18

0 m

inut

es)

(10

min

utes

) A

ctiv

ity:

Rev

iew

day

’s s

ched

uled

ac

tiviti

es.

War

mu

p E

xerc

ises

(30

min

utes

) O

bje

ctiv

e: P

repa

ratio

ns t

o ob

serv

e pr

oced

ure

Dis

cuss

OR

dec

orum

and

gro

und

rule

s fo

r th

e cl

inic

al

dem

onst

ratio

n. R

evie

w s

teps

/act

iviti

es le

arne

rs w

ill o

bser

ve.

(30

min

utes

) O

bje

ctiv

e: Id

entif

y pu

rpos

e an

d ty

pes

of

chec

klis

ts in

the

Fac

ilita

tor’

s G

uide

.

Act

ivit

y: H

ow t

o us

e th

e ch

eckl

ists

(c

ouns

elin

g, c

linic

al s

kills

, ver

bal

anes

thes

ia)

Bra

inst

orm

ing/

Dis

cuss

ion:

C

heck

lists

Rat

ing

scal

e

Fac

ilita

tor’

s G

uid

e: C

heck

list

for

ML/

LA c

ouns

elin

g an

d cl

inic

al s

kills

, ve

rbal

ane

sthe

sia

(60

min

utes

) O

bje

ctiv

e: O

bser

ve in

terv

al M

L/LA

se

rvic

es w

ith c

lient

s in

a c

linic

al s

ettin

g.

Dem

on

stra

tio

n: F

acili

tato

r te

am d

oes

a M

L/LA

with

a c

lient

; le

arne

rs fo

llow

pro

cedu

re u

sing

che

cklis

ts.

Fac

ilita

tor’

s G

uid

e: C

heck

list

for

ML/

LA c

ouns

elin

g an

d cl

inic

al s

kills

(10

min

utes

) Br

eak

(40

min

utes

) A

ctiv

ity:

Rev

iew

dem

onst

ratio

n of

M

L/LA

in t

he c

linic

al s

ettin

g.

Clin

ical

Co

nfe

ren

ce: L

earn

ers

revi

ew c

heck

lists

(co

mpl

eted

du

ring

faci

litat

or d

emon

stra

tion)

. F

acili

tato

r’s

Gu

ide:

Che

cklis

t fo

r M

L/LA

cou

nsel

ing

and

clin

ical

ski

lls

ZO

E m

odel

46

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n F

ou

r: D

ay 2

, PM

(18

0 m

inut

es)

(55

min

utes

)

Ob

ject

ive:

Des

crib

e ke

y fe

atur

es o

f M

L/LA

incl

udin

g el

igib

ility

, pre

caut

ions

, an

d cl

ient

ass

essm

ent.

Bra

inst

orm

ing/

Dis

cuss

ion

/Illu

stra

ted

Lec

ture

Ref

eren

ce M

anu

al: C

hapt

er 4

(50

Min

utes

) O

bje

ctiv

e: R

evie

w c

ompo

nent

s of

ef

fect

ive

pain

man

agem

ent

in M

L/LA

.

Act

ivit

y: D

emon

stra

tion

of lo

cal

anes

thes

ia t

echn

ique

Dis

cuss

ion

, Illu

stra

ted

Lec

ture

Dem

on

stra

tio

n: (

Surg

eon)

Ver

bal a

nd lo

cal a

nest

hesi

a te

chni

que

usin

g ch

eckl

ists

and

ZO

E pe

lvic

mod

el

Ro

le P

lay:

(N

urse

/ass

ista

nts)

Wor

king

with

nur

se t

rain

ers,

rol

e pl

ay

assi

stin

g in

the

loca

l ane

sthe

sia

step

and

pro

vide

ver

bal a

nest

hesi

a.

Ref

eren

ce M

anu

al: C

hapt

er 6

; A

ppen

dix

G

Fac

ilita

tor’

s G

uid

e: C

heck

lists

Mat

eria

ls: Z

OE

pelv

ic m

odel

s,

min

ilapa

roto

my

kits

, dra

pes,

fla

shlig

ht, g

love

s, t

alc,

buc

kets

(60

min

utes

) A

ctiv

ity:

Pra

ctic

e M

L/LA

pro

cedu

re in

a

sim

ulat

ed o

pera

ting

room

. E

xerc

ise:

Wor

king

in g

roup

s of

thr

ee o

r fo

ur, o

ne t

eam

(su

rgeo

n an

d nu

rse/

assi

stan

t) p

erfo

rms

ML/

LA o

n th

e Z

OE

pelv

ic m

odel

whi

le

the

othe

r te

am a

sses

ses

perf

orm

ance

usi

ng t

he c

heck

lists

(on

e m

embe

r w

ill r

ole

play

ZO

E w

hile

obs

ervi

ng).

Tea

ms

switc

h ro

les.

Fac

ilita

tor’

s G

uid

e: C

heck

lists

Mat

eria

ls: Z

OE

pelv

ic m

odel

s,

min

ilapa

roto

my

kits

, dra

pes,

fla

shlig

ht, g

love

s, t

alc,

buc

kets

(15

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

are

to

prac

tice

with

the

ZO

E m

odel

s.

Rea

din

g A

ssig

nm

ent:

Ref

eren

ce M

anu

al: C

hapt

ers

2, 3

, 8

47

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n F

ive:

Day

3, A

M (

180

min

utes

)

(10

min

utes

) A

ctiv

ity:

Rev

iew

day

’s s

ched

uled

act

iviti

es.

War

mu

p E

xerc

ises

(30

min

utes

) O

bje

ctiv

e: D

escr

ibe

the

role

of t

he n

urse

/ as

sist

ant

in M

L/LA

. B

rain

sto

rmin

g/D

iscu

ssio

n

Exe

rcis

e: R

evie

w c

heck

lists

for

circ

ulat

ing

nurs

es a

nd n

urse

as

sist

ants

.

Fac

ilita

tor’

s G

uid

e: C

heck

lists

(20

min

utes

) O

bje

ctiv

e: R

evie

w k

ey s

teps

in p

re-

oper

ativ

e as

sess

men

t an

d in

terv

al M

L/LA

te

chni

que.

Ob

ject

ive:

Iden

tify

prep

arat

ion

step

s fo

r su

rger

y.

Su

rgeo

n: D

iscu

ss w

ith p

hysi

cian

-tra

iner

ML/

LA s

teps

, inc

ludi

ng

pre-

oper

ativ

e as

sess

men

t.

Nur

ses:

Dis

cuss

with

nur

se-t

rain

er s

teps

in p

repa

ring

the

clie

nt

and

the

oper

atin

g ro

om fo

r su

rger

y.

Ref

eren

ce M

anu

al: C

hapt

ers

2, 3

, A

ppen

dix

B

Fac

ilita

tor’

s G

uid

e: C

heck

lists

(120

min

utes

) O

bje

ctiv

e: P

ract

ice

prov

isio

n of

ML/

LA

serv

ices

. E

xerc

ise:

In t

eam

s of

tw

o (s

urge

on a

nd a

ssis

tant

), le

arne

rs w

ill

assi

st in

pro

vidi

ng s

ervi

ces.

Tea

ms

switc

h ac

tiviti

es a

s ta

sks

are

com

plet

ed. L

earn

ers

will

als

o pr

actic

e as

sess

ing

each

oth

er’s

pe

rfor

man

ce u

sing

che

cklis

ts a

nd Z

OE

mod

el.

Fac

ilita

tor’

s G

uid

e: C

heck

lists

ZO

E m

odel

Min

ilapa

roto

my

kit

(set

)

Pra

ctic

e G

rou

ps:

Gro

up

1: S

urge

on w

ill a

ssis

t fa

cilit

ator

in p

erfo

rmin

g M

L/LA

. N

urse

/ass

ista

nt w

ill w

ork

with

nur

se-t

rain

er.

Gro

up

2: B

oth

surg

eon

and

assi

stan

t w

ill o

bser

ve c

lient

co

unse

ling.

Und

er s

uper

visi

on, s

urge

on w

ill c

ondu

ct p

re-o

p as

sess

men

t as

sist

ed b

y as

sist

ant.

Gro

up

3: S

urge

on o

bser

ves

infe

ctio

n pr

even

tion

and

cont

rol (

IPC

) pr

actic

es d

urin

g M

L/LA

. Nur

se/a

ssis

tant

wor

ks w

ith n

urse

-tra

iner

to

set

up

OR

, was

te d

ispo

sal,

and

inst

rum

ent

proc

ess.

Fac

ilita

tor’

s G

uid

e: C

heck

lists

Mat

eria

ls: Z

OE

pelv

ic m

odel

s,

min

ilapa

roto

my

kits

, dra

pes,

fla

shlig

ht, g

love

s, t

alc,

buc

kets

48

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n S

ix: D

ay 3

, PM

(18

0 m

inut

es)

(45

min

utes

) A

ctiv

ity:

Rev

iew

sel

ecte

d M

L/LA

cas

es

seen

in t

he c

linic

. C

linic

al C

on

fere

nce

: Lea

rner

s di

scus

s sa

lient

feat

ures

(c

ouns

elin

g, a

sses

smen

t, pr

oced

ural

, pos

tope

rativ

e co

urse

) of

se

lect

ed c

ases

, inc

ludi

ng p

robl

ems

and

com

plic

atio

ns e

ncou

nter

ed

duri

ng t

he p

rovi

sion

of s

ervi

ce.

Fac

ilita

tor’

s G

uid

e: C

heck

lists

(60

min

utes

) O

bje

ctiv

e: D

escr

ibe

the

impo

rtan

ce o

f co

unse

ling

and

its r

elat

ions

hip

to in

form

ed

cons

ent.

Ob

ject

ive:

Iden

tify

info

rmat

ion

need

ed b

y cl

ient

dur

ing

initi

al F

P co

unse

ling.

O

bje

ctiv

e: D

escr

ibe

step

s in

cou

nsel

ing

and

effe

ctiv

e co

unse

ling

tech

niqu

e, u

sing

the

Ba

lanc

ed C

ouns

elin

g St

rate

gy P

lus

(BC

S+).

Bra

inst

orm

ing/

Dis

cuss

ion

Ro

le P

lay:

Fac

ilita

tor(

s) a

nd/o

r le

arne

rs w

ill r

ole

play

cou

nsel

ing

follo

wed

by

disc

ussi

on o

f effe

ctiv

e te

chni

ques

use

d, a

nd a

reas

to

impr

ove.

D

iscu

ssio

n/D

emo

nst

rati

on:

FP

coun

selin

g te

chni

ques

Ref

eren

ce M

anu

al: C

hapt

ers

2, 3

, A

ppen

dix

B (T

ubal

Lig

atio

n Br

ochu

re a

nd C

ouns

elin

g C

ard)

F

acili

tato

r’s

Gu

ide:

Che

cklis

ts

Alg

orith

m fo

r U

sing

the

Bal

ance

d C

ouns

elin

g St

rate

gy P

lus

WH

O M

edic

al E

ligib

ility

Cri

teri

a fo

r C

ontr

acep

tive

Use

C

ontr

acep

tive

devi

ces

Flip

cha

rt

Mod

els

Info

rmat

ion,

edu

catio

n, a

nd

com

mun

icat

ion

mat

eria

ls

(60

min

utes

) A

ctiv

ity:

Pra

ctic

e co

unse

ling

for

ML/

LA

proc

edur

e in

a s

imul

ated

clin

ic.

Exe

rcis

e: W

orki

ng in

gro

ups

of t

wo

or t

hree

, tea

ms

will

rol

e pl

ay

initi

al a

sses

smen

t an

d in

form

ed c

onse

nt t

o pr

actic

e m

etho

d-sp

ecifi

c co

unse

ling

and

veri

ficat

ion

of in

form

ed c

onse

nt. T

eam

s sw

itch

role

s. O

bser

vers

ass

ess

role

pla

y us

ing

chec

klis

ts.

Fac

ilita

tor’

s G

uid

e: C

heck

lists

(15

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

are

to

prac

tice

with

the

ZO

E m

odel

s.

Rea

din

g A

ssig

nm

ent:

Ref

eren

ce M

anu

al: C

hapt

er 5

; App

endi

ces

C, D

, E, F

49

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n S

even

: Day

4, A

M (

180

min

utes

)

(10

min

utes

) A

ctiv

ity:

Rev

iew

day

’s s

ched

uled

act

iviti

es.

War

mu

p E

xerc

ises

(15

min

utes

) O

bje

ctiv

e: R

evie

w k

ey s

teps

in c

ouns

elin

g.

Bra

inst

orm

ing/

Dis

cuss

ion

Ref

eren

ce M

anu

al: C

hapt

ers

2, 3

; A

ppen

dix

B

Fac

ilita

tor’

s G

uid

e: C

heck

lists

(45

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

a s

imul

ated

ope

ratin

g ro

om.

Exe

rcis

e: W

orki

ng in

gro

ups

of t

hree

or

four

, tea

ms

(sur

geon

and

as

sist

ant)

per

form

ML/

LA w

ith t

he Z

OE

pelv

ic m

odel

whi

le

faci

litat

or a

sses

ses

perf

orm

ance

usi

ng t

he c

heck

list.

Com

pete

nt t

eam

will

be

queu

ed u

p to

pro

vide

sup

ervi

sed

ML/

LA in

a

clin

ical

set

ting.

ZO

E m

odel

Min

ilapa

roto

my

kit

(set

)

(30

min

utes

) O

bje

ctiv

e: D

escr

ibe

the

impo

rtan

ce o

f IPC

pr

actic

es in

FP

serv

ices

.

Act

ivit

y: IP

C o

verv

iew

dem

onst

ratio

n.

Exe

rcis

e/D

iscu

ssio

n:“

Who

has

AID

S?”

Dem

on

stra

tio

n/D

iscu

ssio

n

Ref

eren

ce M

anu

al: C

hapt

er 5

(15

min

utes

) O

bje

ctiv

e: Id

entif

y IP

C p

ract

ices

for

ML/

LA

serv

ices

. B

rain

sto

rmin

g/D

iscu

ssio

nR

efer

ence

Man

ual

: Cha

pter

5

Fac

ilita

tor’

s G

uid

e: C

heck

lists

(65

min

utes

) A

ctiv

ity:

IPC

pra

ctic

es d

emon

stra

tion

usin

g th

e IP

C t

each

ing

mat

eria

ls a

nd c

linic

al

sim

ulat

ion.

Dem

on

stra

tio

n/D

iscu

ssio

n

Han

dwas

hing

, sur

gica

l scr

ub, g

lovi

ng

Ope

ratin

g ro

om a

nd s

urgi

cal a

ttir

e

Safe

han

dlin

g of

sha

rps/

disp

osal

Tra

ffic

flow

in O

R

Sett

ing

up o

pera

ting

room

Hig

h-le

vel d

isin

fect

ion/

ster

iliza

tion:

Ass

ista

nt w

orks

with

faci

litat

or t

o se

t up

OR

, was

te d

ispo

sal,

and

inst

rum

ents

pro

cess

ing.

Ref

eren

ce M

anu

al: C

hapt

er 5

; A

ppen

dice

s C

, D, E

, F

IP T

each

ing

Mat

eria

ls: P

erso

nal

prot

ectiv

e eq

uipm

ent

such

as

glov

es,

mas

k, a

pron

, cap

, eye

gla

sses

/vis

or;

buck

ets,

sci

ssor

s, ju

g, a

ntis

eptic

s,

chem

ical

s us

ed fo

r st

erili

zatio

n,

brus

h, s

oap,

soa

p di

sh, t

owel

, sha

rps

disp

osal

con

tain

er, e

tc.

50

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n E

igh

t: D

ay 4

, PM

(18

0 m

inut

es)

(140

min

utes

) O

bje

ctiv

e: P

ract

ice

prov

isio

n of

ML/

LA

serv

ices

. E

xerc

ise:

In t

eam

s of

tw

o (s

urge

on a

nd n

urse

/ass

ista

nt),

lear

ners

w

ill a

ssis

t or

pro

vide

ser

vice

s. G

roup

s sw

itch

activ

ities

as

task

s ar

e co

mpl

eted

. Lea

rner

s as

sess

eac

h ot

her’

s pe

rfor

man

ce u

sing

ch

eckl

ists

.

Gro

up

2: S

urge

on w

ill b

e as

sist

ed b

y fa

cilit

ator

to

perf

orm

ML/

LA.

Nur

se/a

ssis

tant

will

be

coac

hed

by n

urse

-tra

iner

dur

ing

the

proc

edur

e.

Fac

ilita

tor’

s G

uid

e: C

heck

lists

Gro

up

3: B

oth

surg

eon

and

nurs

e/as

sist

ant

will

pro

vide

clie

nt

coun

selin

g. U

nder

sup

ervi

sion

, sur

geon

will

con

duct

pre

-op

asse

ssm

ent,

assi

sted

by

assi

stan

t.

Gro

up

1: S

urge

on w

ill o

bser

ve M

L/LA

pro

cedu

re o

f Gro

up 2

.

Nur

se/a

ssis

tant

wor

ks w

ith n

urse

tra

iner

to

set

up O

R, w

aste

di

spos

al, a

nd in

stru

men

t pr

oces

s.

(30

min

utes

) A

ctiv

ity:

Rev

iew

sel

ecte

d M

L/LA

cas

es

assi

sted

with

/obs

erve

d in

the

clin

ical

set

ting.

C

linic

al C

on

fere

nce

: Lea

rner

s di

scus

s sa

lient

feat

ures

(c

ouns

elin

g, a

sses

smen

t, pr

oced

ural

, pos

tope

rativ

e co

urse

) of

se

lect

ed c

ases

, inc

ludi

ng p

robl

ems

and

com

plic

atio

ns e

ncou

nter

ed

duri

ng s

ervi

ce p

rovi

sion

.

(10

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

are

to

prac

tice

with

the

ZO

E m

odel

s.

Rea

din

g A

ssig

nm

ent:

Ref

eren

ce M

anu

al: C

hapt

er 8

; App

endi

x A

51

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n N

ine:

Day

5, A

M (

180

min

utes

)

(10

min

utes

)

Act

ivit

y: R

evie

w d

ay’s

sch

edul

ed a

ctiv

ities

.W

arm

up

Exe

rcis

es

(20

min

utes

) O

bje

ctiv

e: Id

entif

y po

tent

ial e

mer

genc

y si

tuat

ions

whi

le p

rovi

ding

ML/

LA s

ervi

ces.

O

bje

ctiv

e: R

evie

w p

repa

ratio

ns fo

r em

erge

ncy.

Div

ide

the

lear

ners

into

thre

e gr

oups

: G

rou

p 1

: Lis

t em

erge

ncy

equi

pmen

t. G

rou

p 2

: Lis

t em

erge

ncy

drug

s.

Gro

up

3: L

ist

nece

ssar

y sk

ills

staf

f nee

d to

hav

e to

res

pond

to

emer

genc

ies.

Ea

ch g

roup

rep

orts

bac

k, fo

llow

ed b

y di

scus

sion

.

Ref

eren

ce M

anu

al: C

hapt

er 1

0;

App

endi

x H

(40

min

utes

) O

bje

ctiv

e: Id

entif

y co

mm

on in

tra-

oper

ativ

e co

mpl

icat

ions

. O

bje

ctiv

e: D

escr

ibe

how

to

reco

gniz

e an

d m

anag

e co

mpl

icat

ions

.

Bra

inst

orm

ing/

Dis

cuss

ion

/ Lec

ture

S

mal

l Gro

up

Dis

cuss

ion

/Act

ivit

y S

urg

eon

: Wor

ks w

ith fa

cilit

ator

to

disc

uss

man

agem

ent

of in

tra-

oper

ativ

e co

mpl

icat

ions

. N

urs

e/A

ssis

tan

t: W

orks

with

nur

se-t

rain

ers

to d

iscu

ss t

heir

rol

e in

pre

vent

ing

and

assi

stin

g m

anag

emen

t of

com

plic

atio

ns.

Ref

eren

ce M

anu

al: C

hapt

er 1

0;

App

endi

x H

(110

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

the

clin

ical

are

a.

Act

ivit

y: P

rovi

de a

com

plet

e M

L se

rvic

e,

incl

udin

g:

C

ouns

elin

g,

C

lient

ass

essm

ent

and

scre

enin

g, a

nd

M

L/LA

.

Exe

rcis

e: In

tea

ms

of t

wo

(sur

geon

and

ass

ista

nt),

lear

ners

will

as

sist

with

or

prov

ide

serv

ices

. Gro

ups

switc

h ac

tiviti

es a

s ta

sks

are

com

plet

ed. L

earn

ers

asse

ss e

ach

othe

r’s

perf

orm

ance

usi

ng

chec

klis

ts.

Gro

up

3: S

urge

on w

ill b

e as

sist

ed b

y fa

cilit

ator

to

perf

orm

ML/

LA.

Ass

ista

nt w

ill b

e co

ache

d by

nur

se-t

rain

er d

urin

g th

e pr

oced

ure.

Fac

ilita

tor’

s G

uid

e: C

heck

lists

Clie

nt A

sses

smen

t T

ool f

or M

L/LA

Gro

up

1: B

oth

surg

eon

and

nurs

e/as

sist

ant

will

pro

vide

clie

nt

coun

selin

g. U

nder

sup

ervi

sion

, sur

geon

will

con

duct

pre

-op

asse

ssm

ent

assi

sted

by

assi

stan

t. G

rou

p 2

: Sur

geon

will

obs

erve

ML/

LA p

roce

dure

of G

roup

1.

Nur

se/a

ssis

tant

wor

ks w

ith n

urse

tra

iner

to

set

up O

R, w

aste

di

spos

al, a

nd in

stru

men

t pr

oces

sing

.

52

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n T

en: D

ay 5

, PM

(18

0 m

inut

es)

(15

min

utes

)

Act

ivit

y: R

evie

w s

elec

ted

ML/

LA c

ases

se

en in

the

clin

ic.

Clin

ical

Co

nfe

ren

ce: L

earn

ers

disc

uss

salie

nt fe

atur

es

(cou

nsel

ing,

ass

essm

ent,

proc

edur

al, p

osto

pera

tive

cour

se)

of

sele

cted

cas

es, i

nclu

ding

pro

blem

s an

d co

mpl

icat

ions

enc

ount

ered

du

ring

the

pro

visi

on o

f ser

vice

.

(30

min

utes

) O

bje

ctiv

e: R

evie

w p

ostp

artu

m M

L/LA

. B

rain

sto

rmin

g/D

iscu

ssio

n:

Diff

eren

ces

betw

een

inte

rval

and

pos

tpar

tum

ML/

LA:

C

ouns

elin

g, p

reop

erat

ive

prep

arat

ion

T

echn

ique

Com

mon

com

plic

atio

ns

T

imin

g of

the

pro

cedu

re

H

ospi

tal s

tay

Ref

eren

ce M

anu

al: C

hapt

er 8

(45

min

utes

) A

ctiv

ity:

Dem

onst

rate

pos

tpar

tum

ML/

LA

on t

he Z

OE

mod

el.

Ob

ject

ive:

Lea

rn m

etho

d fo

r po

stpa

rtum

M

L/LA

usi

ng c

heck

lists

.

Dem

on

stra

tio

n/D

iscu

ssio

n:

Tra

iner

dem

onst

rate

s po

stpa

rtum

ML/

LA a

nd a

sks

lear

ners

to

poin

t ou

t di

ffere

nces

from

inte

rval

ML/

LA.

Ref

eren

ce M

anu

al: C

hapt

er 8

Fac

ilita

tor’

s G

uid

e: C

heck

lists

for

PP M

L/LA

.

(75

min

utes

) A

ctiv

ity:

Pra

ctic

e po

stpa

rtum

ML/

LA

proc

edur

e in

a s

imul

ated

ope

ratin

g ro

om.

Exe

rcis

e: W

orki

ng in

gro

ups

of t

hree

or

four

, one

tea

m (

surg

eon

and

nurs

e/as

sist

ant)

pra

ctic

es p

ostp

artu

m M

L/LA

on

the

ZO

E pe

lvic

m

odel

whi

le t

he o

ther

tea

m a

sses

ses

perf

orm

ance

usi

ng t

he

chec

klis

t. (O

ne m

embe

r w

ill r

ole

play

ZO

E w

hile

obs

ervi

ng.)

Tea

ms

switc

h ro

les.

ZO

E m

odel

Che

cklis

t

(15

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

are

to

prac

tice

inte

rval

or

post

part

um m

inila

paro

tom

y, a

s ne

eded

, with

the

ZO

E m

odel

s.

Rea

din

g A

ssig

nm

ent:

Ref

eren

ce M

anu

al: C

hapt

ers

9; A

ppen

dix

G

53

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n E

leve

n: D

ay 6

, AM

(18

0 m

inut

es)

(10

min

utes

) A

ctiv

ity:

Rev

iew

day

’s s

ched

uled

act

iviti

es.

War

mu

p E

xerc

ises

(30

min

utes

) O

bje

ctiv

e: D

escr

ibe

phar

mac

olog

y of

dr

ugs

used

in p

ain

man

agem

ent.

Dis

cuss

ion

, Lec

ture

Ref

eren

ce M

anu

al: C

hapt

er 6

; A

ppen

dix

G

(140

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

the

clin

ical

are

a (O

R

prac

tice)

.

Exe

rcis

e: In

tea

ms

of t

wo

(sur

geon

and

ass

ista

nt),

lear

ners

will

pr

ovid

e M

L/LA

ser

vice

s. G

roup

s sw

itch

activ

ities

as

task

s ar

e co

mpl

eted

. Fac

ilita

tor

eval

uate

s pe

rfor

man

ce u

sing

ML/

LA c

heck

list.

Gro

up

s 1

and

2: S

urge

on w

ill p

rovi

de M

L/LA

clin

ical

ser

vice

s as

sist

ed b

y th

e as

sist

ant.

Gro

up

3: S

urge

on w

ill o

bser

ve a

nd a

ssis

t, as

nee

ded,

with

ML/

LA

proc

edur

e pe

rfor

med

by

Gro

ups

1 an

d/or

2. A

ssis

tant

wor

ks w

ith

OR

sta

ff to

set

up

OR

, was

te d

ispo

sal,

and

inst

rum

ent

proc

essi

ng.

Che

cklis

t

54

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n T

wel

ve: D

ay 6

, PM

(18

0 m

inut

es)

(30

min

utes

)

Act

ivit

y: R

evie

w s

elec

ted

ML/

LA c

ases

as

sist

ed w

ith/o

bser

ved

in t

he c

linic

al s

ettin

g.

Clin

ical

Co

nfe

ren

ce: L

earn

ers

disc

uss

salie

nt fe

atur

es

(cou

nsel

ing,

ass

essm

ent,

proc

edur

al, p

osto

pera

tive

cour

se)

of

sele

cted

cas

es, i

nclu

ding

pro

blem

s an

d co

mpl

icat

ions

enc

ount

ered

du

ring

the

ser

vice

pro

visi

on.

(90

min

utes

) A

ctiv

ity:

Dis

cuss

ion

of IP

C p

ract

ices

ob

serv

ed d

urin

g th

e cl

inic

al p

ract

ices

and

pr

oble

m s

olvi

ng o

f IPC

pra

ctic

es t

hat

lear

ners

enc

ount

er in

the

ir c

linic

s

Dem

on

stra

tio

n/D

iscu

ssio

n:

Prob

lem

-sol

ving

act

iviti

es:

Ask

lear

ners

wha

t IP

C p

ract

ices

the

y ob

serv

ed d

urin

g th

e cl

inic

al

prac

tices

.

Ask

the

lear

ners

to

nam

e pr

oble

ms

that

the

y en

coun

ter

in t

heir

ar

eas

of p

ract

ice

that

hin

der

thei

r pe

rfor

man

ce o

f cor

rect

IPC

pr

actic

es. L

ist

prob

lem

s an

d di

scus

s so

lutio

ns. E

licit

expe

rien

ces

and

opin

ions

from

lear

ners

, and

con

duct

dem

onst

ratio

ns a

s ne

eded

.

Ref

eren

ce M

anu

al: C

hapt

er 5

; A

ppen

dice

s C

,D, E

. F

(45

min

utes

)

Ob

ject

ive:

Iden

tify

elem

ents

of

post

oper

ativ

e ca

re.

Ob

ject

ive:

Rec

ogni

ze s

igns

/sym

ptom

s of

co

mpl

icat

ions

.

Dis

cuss

ion

:

Post

oper

ativ

e m

onito

ring

Post

oper

ativ

e di

scha

rge

Fo

llow

-up

Iden

tify

role

s an

d re

spon

sibi

litie

s of

the

phy

sici

an a

nd O

R s

taff

afte

r th

e op

erat

ion.

Ref

eren

ce M

anu

al: C

hapt

er 9

(15

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

can

pra

ctic

e in

terv

al a

nd p

ostp

artu

m m

inila

paro

tom

y pr

oced

ures

usi

ng c

heck

lists

and

ZO

E m

odel

s at

eve

ry o

ppor

tuni

ty d

urin

g th

e cl

assr

oom

tra

inin

g to

impr

ove

thei

r sk

ills.

Rea

din

g A

ssig

nm

ent:

Ref

eren

ce M

anu

al: C

hapt

er 1

0; A

ppen

dix

H. R

evie

w p

revi

ousl

y co

vere

d ch

apte

rs.

55

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n T

hir

teen

: Day

7, A

M (

180

min

utes

)

(10

min

utes

)

Act

ivit

y: R

evie

w d

ay’s

sch

edul

ed a

ctiv

ities

.W

arm

up

Exe

rcis

es

(30

min

utes

) O

bje

ctiv

e: D

escr

ibe

key

step

s in

po

stop

erat

ive

and

follo

w-u

p ca

re.

Ob

ject

ive:

Rev

iew

rec

ordk

eepi

ng s

yste

m.

Ro

le P

lay/

Dis

cuss

ion

:T

rans

fer

from

OR

to

disc

harg

e:

D

isch

arge

pre

para

tion

R

ecor

dkee

ping

Ref

eren

ce M

anu

al: C

hapt

er 9

Fac

ilita

tor’

s G

uid

e: C

heck

lists

(140

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

the

clin

ical

are

a.

Exe

rcis

e: In

tea

ms

of t

wo

(sur

geon

and

nur

se/a

ssis

tant

), le

arne

rs

will

pro

vide

ser

vice

s. G

roup

s sw

itch

activ

ities

as

task

s ar

e co

mpl

eted

. Fac

ilita

tor

eval

uate

s pe

rfor

man

ce u

sing

ML/

LA c

heck

list.

Gro

up

s 1

and

3: S

urge

on w

ill p

rovi

de M

L/LA

clin

ical

ser

vice

s as

sist

ed b

y th

e as

sist

ant.

Che

cklis

ts

Gro

up

2: S

urge

on w

ill o

bser

ve a

nd a

ssis

t w

ith, a

s ne

eded

, ML/

LA

proc

edur

e pe

rfor

med

by

Gro

ups

1 an

d/or

3. N

urse

/ass

ista

nt w

orks

w

ith O

R s

taff

to s

et u

p O

R, w

aste

dis

posa

l, an

d in

stru

men

t pr

oces

sing

.

56

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n F

ou

rtee

n: D

ay 7

, PM

(18

0 m

inut

es)

(30

min

utes

)

Act

ivit

y: R

evie

w s

elec

ted

ML/

LA c

ases

as

sist

ed w

ith/o

bser

ved

in t

he c

linic

al s

ettin

g.

Clin

ical

Co

nfe

ren

ce: L

earn

ers

disc

uss

salie

nt fe

atur

es

(cou

nsel

ing,

ass

essm

ent,

proc

edur

al, p

osto

pera

tive

cour

se)

of

sele

cted

cas

es, i

nclu

ding

pro

blem

s an

d co

mpl

icat

ions

enc

ount

ered

du

ring

the

ser

vice

pro

visi

on.

(100

min

utes

) O

bje

ctiv

e: (

Surg

eon)

Des

crib

e st

eps

in

man

agin

g co

mpl

icat

ions

.

Ob

ject

ive:

(N

urse

/ass

ista

nt)

Rev

iew

es

sent

ial n

ursi

ng fu

nctio

ns s

uppo

rtiv

e of

pr

ovid

ing

high

-qua

lity

ML/

LA s

ervi

ces.

Dis

cuss

ion

:

Gro

up

1: A

nest

hesi

a co

mpl

icat

ions

Gro

up

2: I

ntra

-ope

rativ

e co

mpl

icat

ions

Gro

up

3: P

osto

pera

tive

com

plic

atio

ns

Dis

cuss

ion

on h

ow t

o di

agno

se a

nd m

anag

e co

mpl

icat

ions

.

Ref

eren

ce M

anu

al: C

hapt

er 1

0

(40

min

utes

) A

ctiv

ity:

Ass

ess

lear

ners

’ kno

wle

dge.

Com

plet

e m

idco

urse

que

stio

nnai

re.

Mid

cour

se q

uest

ionn

aire

(10

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

con

tinue

to

do s

uper

vise

d pr

actic

e w

ith r

eal c

lient

s fo

r in

terv

al o

r po

stpa

rtum

min

ilapa

roto

my,

as

the

case

s ar

e av

aila

ble

in t

he a

fter

noon

in t

he t

rain

ing

faci

lity.

Thi

s w

ill g

ive

them

the

opp

ortu

nity

to

be e

xpos

ed t

o as

man

y ca

ses

as p

ossi

ble

to im

prov

e th

eir

skill

s. T

he t

imin

g of

oth

er a

fter

noon

ses

sion

s in

clud

ed in

the

out

line

can

be

mod

ified

as

time

perm

its.

Rea

din

g A

ssig

nm

ent:

Ref

eren

ce M

anu

al: C

hapt

er 1

1

57

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n F

iftee

n: D

ay 8

, AM

(18

0 m

inut

es)

(10

min

utes

) A

ctiv

ity:

Rev

iew

day

’s s

ched

uled

act

iviti

es.

War

mu

p E

xerc

ises

(30

min

utes

) O

bje

ctiv

e: Id

entif

y ch

arac

teri

stic

s of

hig

h-qu

ality

ML/

LA s

ervi

ce p

rovi

sion

. B

rain

sto

rmin

g/D

iscu

ssio

nR

efer

ence

Man

ual

: Cha

pter

1

(140

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

the

clin

ical

are

a.

Exe

rcis

e: In

tea

ms

of t

wo

(sur

geon

and

nur

se/a

ssis

tant

), le

arne

rs

will

pro

vide

ser

vice

s. G

roup

s sw

itch

activ

ities

as

task

s ar

e co

mpl

eted

. Fac

ilita

tor

eval

uate

s pe

rfor

man

ce u

sing

ML/

LA c

heck

list.

Gro

up

s 2

and

3: S

urge

on w

ill p

rovi

de M

L/LA

clin

ical

ser

vice

s as

sist

ed b

y th

e as

sist

ant.

Gro

up

1: S

urge

on w

ill o

bser

ve a

nd a

ssis

t, as

nee

ded,

ML/

LA

proc

edur

e pe

rfor

med

by

Gro

ups

2 an

d/or

3. A

ssis

tant

wor

ks w

ith

OR

sta

ff to

set

up

OR

, was

te d

ispo

sal,

and

inst

rum

ent

proc

essi

ng.

Che

cklis

ts

Ses

sio

n S

ixte

en: D

ay 8

, PM

(18

0 m

inut

es)

(50

min

utes

) O

bje

ctiv

e: R

evie

w s

elec

ted

ML/

LA c

ases

se

en in

the

clin

ic.

Clin

ical

Co

nfe

ren

ce: L

earn

ers

disc

uss

salie

nt fe

atur

es

(cou

nsel

ing,

ass

essm

ent,

proc

edur

al, p

osto

pera

tive

cour

se)

of

sele

cted

cas

es.

(60

min

utes

) O

bje

ctiv

e: R

evie

w n

atio

nal g

uide

lines

on

qual

ity o

f car

e st

anda

rds

in V

S se

rvic

es.

Ob

ject

ive:

Def

ine

basi

c re

quir

emen

ts o

f pr

ovid

ing

ML/

LA s

ervi

ces.

Bra

inst

orm

ing/

Dis

cuss

ion:

If na

tiona

l gui

delin

es o

n qu

ality

of c

are

do n

ot e

xist

, lea

rner

s ca

n br

ains

torm

wha

t ne

eds

to b

e in

clud

ed in

suc

h gu

idel

ines

. Lea

rner

s di

scus

s ke

y as

pect

s of

ser

vice

del

iver

y, a

nd h

ow t

o en

sure

tha

t qu

ality

of c

are

stan

dard

s ar

e m

et fo

r se

rvic

e pr

ovis

ion.

(30

min

utes

) E

xerc

ise:

Rev

iew

res

ults

of m

idco

urse

qu

estio

nnai

re.

Fac

ilita

tor’

s G

uid

e: M

idco

urse

qu

estio

nnai

re

(30

min

utes

) O

bje

ctiv

e: D

efin

e m

edic

al s

tand

ards

for

prov

idin

g hi

gh-q

ualit

y m

obile

ML/

LA

serv

ices

.

Bra

inst

orm

ing/

Dis

cuss

ion

Ref

eren

ce M

anua

l: C

hapt

er 1

1

(10

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

con

tinue

to

do s

uper

vise

d pr

actic

e w

ith r

eal c

lient

s fo

r in

terv

al o

r po

stpa

rtum

min

ilapa

roto

my,

as

the

case

s ar

e av

aila

ble

in t

he a

fter

noon

in t

he t

rain

ing

faci

lity.

Thi

s w

ill g

ive

them

the

opp

ortu

nity

to

be e

xpos

ed t

o as

man

y ca

ses

as p

ossi

ble

to im

prov

e th

eir

skill

s. T

he t

imin

g of

oth

er a

fter

noon

ses

sion

s in

clud

ed in

the

out

line

can

be

mod

ified

as

time

perm

its.

58

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

ns

Sev

ente

en, D

ay 9

, AM

(18

0 m

inut

es)

(10

min

utes

) A

ctiv

ity:

Rev

iew

day

’s s

ched

uled

act

iviti

es.

War

mu

p E

xerc

ises

(170

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

the

clin

ical

are

a.

Exe

rcis

e: In

tea

ms

of t

wo

(sur

geon

and

nur

se/a

ssis

tant

), le

arne

rs

will

pro

vide

ser

vice

s. G

roup

s sw

itch

activ

ities

as

task

s ar

e co

mpl

eted

. Fac

ilita

tor

eval

uate

s pe

rfor

man

ce u

sing

ML/

LA c

heck

list.

Gro

up

s 1,

2, a

nd

3: G

roup

s ro

tate

acc

ordi

ng t

o th

eir

need

s.

Surg

eons

will

pro

vide

ML/

LA c

linic

al s

ervi

ces

assi

sted

by

the

assi

stan

t.

Nur

se/a

ssis

tant

wor

ks w

ith O

R s

taff

to a

ssis

t, se

t up

OR

, was

te

disp

osal

, and

inst

rum

ent

proc

essi

ng.

Ses

sio

ns

Eig

hte

en: D

ay 9

, PM

(18

0 m

inut

es)

(60

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

the

clin

ical

are

a.

(con

tinue

d fr

om A

M)

Clin

ical

ser

vice

pro

visi

on (

cont

inue

d) (

as c

ases

are

ava

ilabl

e in

the

af

tern

oon)

(50

min

utes

) O

bje

ctiv

e: R

evie

w s

elec

ted

ML/

LA c

ases

se

en in

the

clin

ic.

Clin

ical

Co

nfe

ren

ce: L

earn

ers

disc

uss

salie

nt fe

atur

es

(cou

nsel

ing,

ass

essm

ent,

proc

edur

al, p

osto

pera

tive

cour

se)

of

sele

cted

cas

es.

(60

min

utes

) O

bje

ctiv

e: D

raft

an

actio

n pl

an o

utlin

ing

next

ste

ps fo

r st

artin

g/ e

xpan

ding

ML/

LA

serv

ices

at

lear

ners

’ fac

ilitie

s, in

clud

ing

furt

her

trai

ning

nee

ds, f

acili

ty p

repa

redn

ess,

m

onito

ring

and

eva

luat

ion

of s

ervi

ces,

and

qual

ity a

ssur

ance

. (Pa

rt 1

)

Bra

inst

orm

ing/

Dev

elo

pin

g an

Act

ion

Pla

n: L

earn

ers

wor

k in

th

eir

team

s to

sta

rt d

rafti

ng t

heir

act

ion

plan

s. T

hey

iden

tify

pote

ntia

l pro

blem

s an

d co

nstr

aint

s to

sta

rtin

g/ex

pand

ing

ML/

LA

serv

ices

, and

bra

inst

orm

on

how

to

addr

ess

them

.

(10

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

con

tinue

to

do s

uper

vise

d pr

actic

e w

ith r

eal c

lient

s fo

r in

terv

al o

r po

stpa

rtum

min

ilapa

roto

my,

as

the

case

s ar

e av

aila

ble

in t

he a

fter

noon

in t

he t

rain

ing

faci

lity.

Thi

s w

ill g

ive

them

the

opp

ortu

nity

to

be e

xpos

ed t

o as

man

y ca

ses

as p

ossi

ble

to im

prov

e th

eir

skill

s. T

he t

imin

g of

oth

er a

fter

noon

ses

sion

s in

clud

ed in

the

out

line

can

be

mod

ified

as

time

perm

its.

59

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

ns

Nin

etee

n, D

ay 1

0, A

M (

180

min

utes

)

(10

min

utes

) A

ctiv

ity:

Rev

iew

day

’s s

ched

uled

act

iviti

es.

War

mu

p E

xerc

ises

(170

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

the

clin

ical

are

a.

Exe

rcis

e: In

tea

ms

of t

wo

(sur

geon

and

nur

se/a

ssis

tant

), le

arne

rs

will

pro

vide

ser

vice

s. G

roup

s sw

itch

activ

ities

as

task

s ar

e co

mpl

eted

. Fac

ilita

tor

eval

uate

s pe

rfor

man

ce u

sing

ML/

LA c

heck

list.

Gro

up

s 1,

2, a

nd

3: G

roup

s ro

tate

acc

ordi

ng t

o th

eir

need

s.

Surg

eons

will

pro

vide

ML/

LA c

linic

al s

ervi

ces

assi

sted

by

the

assi

stan

t.

Ass

ista

nt w

orks

with

OR

sta

ff to

ass

ist,

set

up O

R, w

aste

dis

posa

l, an

d in

stru

men

t pr

oces

sing

.

Ses

sio

ns

Tw

enty

: Day

10,

PM

(18

0 m

inut

es)

(60

min

utes

) O

bjec

tive

: Dem

onst

rate

com

pete

ncy

in

ML/

LA p

roce

dure

in t

he c

linic

al a

rea.

(c

ontin

ued

from

AM

)

Clin

ical

ser

vice

pro

visi

on (

cont

inue

d) (

as c

ases

are

ava

ilabl

e in

the

af

tern

oon)

(50

min

utes

) O

bje

ctiv

e: R

evie

w s

elec

ted

ML/

LA c

ases

se

en in

the

clin

ic.

Clin

ical

Co

nfe

ren

ce: L

earn

ers

disc

uss

salie

nt fe

atur

es

(cou

nsel

ing,

ass

essm

ent,

proc

edur

al, p

osto

pera

tive

cour

se)

of

sele

cted

cas

es.

(60

min

utes

) O

bje

ctiv

e: D

raft

an

actio

n pl

an o

utlin

ing

next

ste

ps fo

r st

artin

g/ex

pand

ing

ML/

LA

serv

ices

at

lear

ners

’ fac

ilitie

s, in

clud

ing

furt

her

trai

ning

nee

ds, f

acili

ty p

repa

redn

ess,

m

onito

ring

and

eva

luat

ion

of s

ervi

ces,

qua

lity

assu

ranc

e. (

Part

2)

Bra

inst

orm

ing/

Dev

elo

pin

g an

Act

ion

Pla

n

Lear

ners

wor

k in

the

ir t

eam

s to

con

tinue

dra

ftin

g th

eir

actio

n pl

ans

(10

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

con

tinue

to

do s

uper

vise

d pr

actic

e w

ith r

eal c

lient

s fo

r in

terv

al o

r po

stpa

rtum

min

ilapa

roto

my,

as

the

case

s ar

e av

aila

ble

in t

heaf

tern

oon

in t

he t

rain

ing

faci

lity.

Thi

s w

ill g

ive

them

the

opp

ortu

nity

to

be e

xpos

ed t

o as

man

y ca

ses

as p

ossi

ble

to im

prov

e th

eir

skill

s. T

he t

imin

g of

oth

er a

fter

noon

ses

sion

s in

clud

ed in

the

out

line

can

be

mod

ified

as

time

perm

its.

60

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

ns

Tw

enty

-on

e, D

ay 1

1, A

M (

180

min

utes

)

(10

min

utes

) A

ctiv

ity:

Rev

iew

day

’s s

ched

uled

act

iviti

es.

War

mu

p E

xerc

ises

(170

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

the

clin

ical

are

a.

Exe

rcis

e: In

tea

ms

of t

wo

(sur

geon

and

nur

se/a

ssis

tant

), le

arne

rs

will

pro

vide

ser

vice

s. G

roup

s sw

itch

activ

ities

as

task

s ar

e co

mpl

eted

. Fac

ilita

tor

eval

uate

s pe

rfor

man

ce u

sing

ML/

LA c

heck

list.

Gro

up

s 1,

2, a

nd

3: G

roup

s ro

tate

acc

ordi

ng t

o th

eir

need

s.

Surg

eons

will

pro

vide

ML/

LA c

linic

al s

ervi

ces

assi

sted

by

the

assi

stan

t.

Ass

ista

nt w

orks

with

OR

sta

ff to

ass

ist,

set

up O

R, w

aste

dis

posa

l an

d in

stru

men

t pr

oces

sing

.

Ses

sio

ns

Tw

enty

-tw

o: D

ay 1

1, P

M (

180

min

utes

)

(60

min

utes

) O

bjec

tive

: Dem

onst

rate

com

pete

ncy

in

ML/

LA p

roce

dure

in t

he c

linic

al a

rea.

(c

ontin

ued

from

AM

)

Exe

rcis

e: fa

cilit

ator

s m

eet

indi

vidu

al t

eam

s to

rev

iew

qua

lific

atio

n pr

oces

s.

(50

min

utes

) O

bje

ctiv

e: R

evie

w s

elec

ted

ML/

LA c

ases

se

en in

the

clin

ic.

Clin

ical

Co

nfe

ren

ce: L

earn

ers

disc

uss

salie

nt fe

atur

es

(cou

nsel

ing,

ass

essm

ent,

proc

edur

al, p

osto

pera

tive

cour

se)

of

sele

cted

cas

es.

(60

min

utes

) O

bje

ctiv

e: D

raft

an

actio

n pl

an o

utlin

ing

next

ste

ps fo

r st

artin

g/ex

pand

ing

ML/

LA

serv

ices

at

lear

ners

’ fac

ilitie

s, in

clud

ing

furt

her

trai

ning

nee

ds, f

acili

ty p

repa

redn

ess,

m

onito

ring

and

eva

luat

ion

of s

ervi

ces,

qual

ity

assu

ranc

e. (P

art 3

)

Bra

inst

orm

ing/

Dev

elo

pin

g an

Act

ion

Pla

n: L

earn

ers

wor

k in

th

eir

team

s to

fina

lize

draf

ting

thei

r ac

tion

plan

s. T

hey

prep

are

thei

r pr

esen

tatio

ns fo

r D

ay 1

2.

(10

min

utes

) R

evie

w o

f day

’s a

ctiv

ities

TO

TA

L: 3

60 m

inu

tes

Lear

ners

con

tinue

to

do s

uper

vise

d pr

actic

e w

ith r

eal c

lient

s fo

r in

terv

al o

r po

stpa

rtum

min

ilapa

roto

my,

as

the

case

s ar

e av

aila

ble

in t

he a

fter

noon

in t

he t

rain

ing

faci

lity.

Thi

s w

ill g

ive

them

the

opp

ortu

nity

to

be e

xpos

ed t

o as

man

y ca

ses

as p

ossi

ble

to im

prov

e th

eir

skill

s. T

he t

imin

g of

oth

er a

fter

noon

ses

sion

s in

clud

ed in

the

out

line

can

be

mod

ified

as

time

perm

its.

61

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MO

DE

L M

INIL

AP

AR

OT

OM

Y C

LIN

ICA

L S

KIL

LS

CO

UR

SE

OU

TL

INE

: Sta

nd

ard

Co

urse

(12

day

s, 2

4 se

ssio

ns,

6 h

ou

rs p

er d

ay)

TIM

E

OB

JEC

TIV

ES

/AC

TIV

ITIE

ST

RA

ININ

G/L

EA

RN

ING

ME

TH

OD

SR

ES

OU

RC

ES

/MA

TE

RIA

LS

Ses

sio

n T

wen

ty-t

hre

e: D

ay 1

2, A

M (

180

min

utes

)

(10

min

utes

) A

ctiv

ity:

Rev

iew

day

’s s

ched

uled

act

iviti

es.

War

mu

p E

xerc

ise

(140

min

utes

) O

bje

ctiv

e: D

emon

stra

te c

ompe

tenc

y in

M

L/LA

pro

cedu

re in

the

clin

ical

are

a.

Exe

rcis

e: In

tea

ms

of t

wo

surg

eons

, lea

rner

s w

ill p

rovi

de s

ervi

ces.

G

roup

s sw

itch

activ

ities

as

task

s ar

e co

mpl

eted

. Fac

ilita

tors

ev

alua

te p

erfo

rman

ce u

sing

ML/

LA c

heck

list.

Gro

up

s 1,

2, a

nd

3: G

roup

s ro

tate

acc

ordi

ng t

o th

eir

need

s.

Surg

eon

will

pro

vide

ML/

LA c

linic

al s

ervi

ces

assi

sted

by

the

assi

stan

t.

Ass

ista

nt w

orks

with

OR

sta

ff to

ass

ist,

set

up O

R, w

aste

dis

posa

l, an

d in

stru

men

t pr

oces

sing

.

(30

min

utes

) A

ctiv

ity:

Rev

iew

sel

ecte

d ca

ses

of M

L/LA

ca

ses

seen

in t

he c

linic

. C

linic

al C

on

fere

nce

: Lea

rner

s di

scus

s sa

lient

feat

ures

(c

ouns

elin

g, a

sses

smen

t, pr

oced

ural

, pos

tope

rativ

e co

urse

) of

se

lect

ed c

ases

, inc

ludi

ng p

robl

ems

and

com

plic

atio

ns e

ncou

nter

ed

duri

ng t

he s

ervi

ce p

rovi

sion

.

Ses

sio

n T

wen

ty-f

ou

r: D

ay 1

2, P

M (

180

min

utes

)

(70

min

utes

) O

bje

ctiv

e: D

evel

op a

nd p

rese

nt a

dra

ft

actio

n pl

an fo

r in

trod

ucin

g/ e

xpan

ding

M

L/LA

ser

vice

.

Sm

all G

rou

p P

rese

nta

tio

ns:

Each

tea

m p

rese

nts

thei

r dr

aft

plan

s an

d la

rge

grou

p di

scus

sion

on

plan

s fo

r in

divi

dual

faci

litie

s.

(20

min

utes

) O

bje

ctiv

e: P

ost-

trai

ning

follo

w-u

p pl

anni

ngD

iscu

ssio

n:F

acili

tato

rs s

hare

the

pla

n an

d tim

elin

es fo

r po

st-

trai

ning

follo

w-u

p an

d su

perv

isio

n, a

nd g

et fe

edba

ck fr

om t

he

lear

ners

.

(30

min

utes

) E

xerc

ise:

Co

urs

e S

um

mar

yD

iscu

ssio

n:R

evie

w c

ours

e ob

ject

ives

and

con

duct

a s

umm

ary

of

the

cour

se.

(30

min

utes

) E

xerc

ise:

Iden

tify

stre

ngth

s an

d w

eakn

esse

s of

the

tra

inin

g co

urse

. In

divi

dual

com

plet

ion

of c

ours

e ev

alua

tion.

Ver

bal f

eedb

ack

from

le

arne

rs.

Cou

rse

Eval

uatio

n Fo

rm

(30

min

utes

) C

losi

ng

Cer

emo

ny

TO

TA

L: 3

60 m

inu

tes


MINILAPAROTOMY UNDER LOCAL ANESTHESIA KNOWLEDGE ASSESSMENT – KEY Instructions: Circle the letter of the single best answer to each question.

1. Tubal ligation by minilaparotomy is best described as

a. performed on a postpartum or interval basis b. requiring an abdominal incision not more than 5 cm long c. done under local anesthesia and on an outpatient basis d. all of the above

2. When preparing the client for surgery, the staff should tell the client that

a. there will be a lot of pain during the procedure but that she won’t feel it because of the medication she will receive

b. she will probably feel some tugging, pulling, and slight cramping during the procedure c. the doctor is very good and that she will probably not feel anything during the surgery d. even though she might be feeling some cramping and discomfort during the procedure, she

should not mention it during the surgery

3. Prior to performing a minilaparotomy procedure, the surgeon must verify informed consent by

a. noting that the client discussed with the counselor and signed the consent form b. ensuring that the consent form is signed by both the client and her husband c. examining the consent form to see that the client’s signature was witnessed d. reviewing the consent for completeness and talking with the client to ensure that she

understands the procedure she has requested

4. If a pelvic examination was part of the initial pre-operative assessment, then another pelvic examination

a. must be performed before the surgery by the surgeon b. must be performed after the procedure to ensure that the uterus has not been perforated c. is unnecessary d. should be performed by the nurse to check for infection

5. If a systemic or local (pelvic) infection is noted on the day of the surgery

a. the procedure should be performed anyway b. the client should be sent home and told to return when she feels that the infection has been

resolved c. laparoscopy should be performed instead of minilaparotomy d. the procedure should be postponed until the client has been treated for the infection

and a temporary method should be prescribed


6. When faced with an obese patient who requests minilaparotomy under local anesthesia, the surgeon should

a. plan to use more assistants during the procedure b. plan the procedure at a facility where general anesthesia and laparotomy can be

performed c. suggest that the client to lose weight and ask her to return in 3 months d. use a vertical instead of an horizontal incision

7. After a minilaparotomy procedure, the only acceptable method for processing used instruments is

a. cleaning followed by sterilization b. cleaning, then disinfection with Dettol c. soaking in Dettol for at least 24 hours d. cleaning, followed by sterilization or high-level disinfection

8. The operating room should be cleaned with a disinfectant solution like 0.5% chlorine solution

a. after any contaminated case and weekly b. between all cases and also thoroughly on a monthly basis c. between all cases and thoroughly on a weekly basis d. after all cases with more than 250 ml of blood loss

9. Which one of the following is not a recommended infection prevention practice?

a. in high-volume settings, surgical staff should do a 3-minute scrub every hour or after every four or five cases

b. OR staff should change into clean scrub suits or gowns, caps, and masks inside the OR c. minilaparotomy procedures require sterile surgical gloves d. Chlorhexidine gluconate, iodophors, or alcohols can be used as antiseptics

10. Local anesthesia for minilaparotomy involves

a. using a maximum of 25 ml of 1% lidocaine and adrenaline b. sedating all clients with meperidine 100 mg and diazepam 10 mg c. infiltrating all abdominal wall layers with 1% lidocaine d. use of enough sedation so that the client is asleep

11. When infiltrating 1% lidocaine to produce local anesthesia for a minilaparotomy procedure

a. the surgeon must be sure that only the skin and subcutaneous tissue are infiltrated before starting the procedure

b. the incision may be made as soon as the lidocaine is injected c. epinephrine should always be used along with the lidocaine d. the surgeon must attempt to infiltrate all the layers from the skin to the peritoneum

with anesthetic

12. If the uterus is retroverted, the uterine elevator should

a. not be used b. be inserted into the cervix with the tip downward, after which the handle is rotated c. be inserted in the same way as for an anteverted uterus d. be inserted after the abdomen has been opened, so that the uterus can be visualized


13. To minimize complications during both interval and postpartum minilaparotomy, the surgeon should remember to

a. use the uterine elevator in all minilaparotomy cases b. use toothed instruments to prevent intra-abdominal tissue from slipping c. ensure that the client has emptied her bladder prior to surgery d. all of the above

14. The technique used for tubal occlusion is called

a. Pomeroy technique b. Babcock technique c. Carman technique d. Parkland and Irving technique

15. The best time to perform a postpartum minilaparotomy under local anesthesia is

a. any time after the first menstrual cycle b. within the first 48 hours postpartum or more than 6 weeks after delivery c. within the first 6 weeks postpartum d. within the first 7 days postpartum

16. Which one of the following is not a precaution requiring postponement of the procedure until > 6 weeks for postpartum minilaparotomy?

a. age > 35 years old b. severe pre-eclampsia c. prolonged rupture of membranes d. severe hemorrhage (> 500 ml)

17. The following conditions indicate that the client is ready for discharge

a. her partner has arrived to take her home b. she can walk upright with minimal support c. she complains of nausea and vomiting d. she still feels very drowsy

18. During the postoperative period, the staff monitoring the client should

a. check and record vital signs every 15 minutes until the client is stable b. review the record upon receiving the client c. complete the client record form d. all of the above

19. Uterine perforation during a minilaparotomy procedure can be caused by

a. rough manipulation of the uterine elevator b. improper insertion of the uterine elevator c. using the uterine elevator during a postpartum procedure d. all of the above


20. In the minilaparotomy procedure, intra-abdominal bleeding

a. occurs solely in the operating room b. is related to the level of the anesthesia c. may occur in the operating room or at any time in the postoperative period d. usually occurs in women with a previous history of postpartum hemorrhage

67

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e

MIN

ILA

PA

RO

TO

MY

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AIN

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UR

SE

: IN

DIV

IDU

AL

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RO

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AS

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SE

: ___

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68

Min

ilap

aro

tom

y u

nd

er L

oca

l An

esth

esia

: Fac

ilita

tor’

s G

uid

e


PRECOURSE SKILLS ASSESSMENT USING THE CHECKLIST This skills assessment activity is intended to assist both the facilitator and learner as they begin their work together in the course. The results will identify those clinical skills (i.e., pelvic examination) that are performed satisfactorily and those that may need to be learned or require additional practice during the course. Each learner will receive a copy of her or his completed assessment at the beginning of the course. The learner should use the results of the assessment to guide her or his learning activities during guided clinical activities sessions. In using the checklist, it is important that the scoring be done carefully and correctly. If the task is performed satisfactorily, the facilitator should mark a “√” in the “Satisfactory” column. If any step of the task is performed incorrectly or out of sequence, the facilitator should mark an “x” in the “Not Satisfactory” column. If the rating for any task is “not satisfactory,” the facilitator should note specific deficiencies to assist the learner in learning or correcting the performance of this skill(s) during the classroom clinical practice sessions.


PRECOURSE SKILLS ASSESSMENT CHECKLIST

Instructions: Place a “” in the “Satisfactory” column if task is performed correctly, or an “” in the “Not Satisfactory” column if task is performed incorrectly or out of sequence. Participant_________________________________________________ Date______________

PRECOURSE MINILAPAROTOMY SKILLS ASSESSMENT CHECKLIST

Task/Activity Satisfactory Not Satisfactory/

Comment

SURGEON

Demonstrates appropriate counseling and interviewing skills.

Is able to verify informed consent.

Performs appropriate physical examination.

Performs pelvic examination.

Inserts speculum.

Inserts and demonstrates use of uterine elevator.

Identifies site for intended incision.

Ties surgical knot correctly.

NURSE

Demonstrates appropriate counseling and interviewing skills.

Is able to take appropriate history.

Is able to assist surgeon in gowning and gloving.

Demonstrates necessary monitoring skills (BP, pulse, respiration, consciousness, etc.).

Demonstrates necessary cleaning and infection prevention steps.


Appendix 1: Minilaparotomy under Local Anesthesia – Algorithm for Using the Balanced Counseling Strategy Plus


Source: Population Council. 2015. The Balanced Counseling Strategy Plus: Trainer’s Guide, third edition.


Appendix 2: Minilaparotomy under Local Anesthesia Client Assessment Tool Instructions: Use this tool to assess a client’s eligibility for ML/LA, the timing of the procedure, and the level of the health facility required for the client’s specific conditions.

Part A: Confirm the client understands and prefers female sterilization

Yes No

1. She is certain that she wants no more children.

2. Client’s age or health problems might cause high-risk pregnancy.

3. She understands that the method is permanent and voluntarily gives informed consent for the procedure.

4. She prefers a method that is care-free.

Part B: Rule out conditions requiring precautions; delay the procedure as needed

No

(Perform ML/LA)

Yes

(Delay)

5. Pregnancy

6. Postpartum client (If any one of these conditions is present, delay until after 6 weeks.)

After 7 days postpartum

Severe pre-eclampsia

Intrapartum or postpartum sepsis or fever

Severe hemorrhage (> 500 ml)

Trauma to genital tract

Uterine rupture or perforation

Umbilical hernia

7. Client has one or more of the following: Unexplained vaginal bleeding, acute pelvic inflammatory disease (PID), acute systemic infection, anemia, abdominal skin infection, cancer of the genital tract, deep venous thrombosis, postabortion sepsis or fever, severe hemorrhage, trauma to genital tract, uterine perforation, acute hematometra.

(If any one of the above conditions is present, delay until the condition is resolved.)

Note: Do not perform the procedure or delay accordingly, if the client’s response falls into any one of the rows in the red column in Part A and Part B. If all of the responses are in the green column, ML/LA can be performed.


Part C: Manage conditions requiring action Yes No Action

8. Ask if the client has:

Diabetes, symptomatic heart disease, high BP, coagulation disorders, overweight, abdominal or umbilical hernia, multiple lower abdominal incisions/scars

The procedure should be performed only by an experienced clinician in a facility with full backup.

9. Further assess concerns if the client: If appropriate, help the client choose another method.

Desires more children

Shows excessive interest in reversal

Disagrees with or does not want to sign informed consent form

Appears to have been pressured to have the procedure

Is depressed

Has mental problems

Is single

Has no children

Part D: Screen for ambulatory health care facilities Favorable

(For ambulatory health care facility)

Not Favorable

10. Assess the client for the following to decide if she can have the procedure in an ambulatory health care facility:

Client’s general health (history and limited physical examination): Negative history and no current symptomatic heart, lung, or kidney disease

Emotional state: Calm, stable

Blood pressure: < 160/100 mmHg

Weight: Max.: 80 kg (176 lbs), Min.: 35 kg (77 lbs)

Previous abdominal/pelvic surgery: Cesarean section only if pelvic exam indicating no uterine adhesions

Previous pelvic disease, ectopic pregnancy, or ruptured appendix: No history and normal exam

PID: No acute PID and normal exam

Anemia: Hg> 7 g/dl

Note: Do not perform the procedure at an ambulatory health care facility if the client’s response falls into any one of the rows in the red column in Part D. In that case, refer the client to a facility with full backup.


APPENDIX 3: WARMUPS AND OTHER EXERCISES

WARMUP/OTHER EXERCISE: DON’T COUNT ON IT

Objectives To stimulate learners to discover new ways of thinking and find innovative solutions to solve issues and bridge the gaps Time: 10 minutes

Materials

• Copies of the exercise for the participants (copy below) and answer key for facilitators

Instructions for the Facilitator Have enough copies of the exercise for each learner.

Procedure

1. Distribute one copy of the exercise to each learner.

2. Tell learners to read the questions and answer as many as they can.

3. Do not give them too many hints. You want them to be aware that they might be assuming things that may not be true when looking at situations, especially old ones.

4. After 3–5 minutes, start reviewing the answers.

Discussion Questions

1. How did you feel while doing the exercise?

2. Why was it difficult to find some of the answers to the questions?

3. Ask the learners to relate this exercise to their work when they have to look for new solutions to old issues/gaps.

Summarize the Main Points

• Something that looks difficult to resolve may not be as difficult as first imagined.

• Some people may see the solution very quickly and be frustrated by those who cannot.

• Thinking about an old situation in a new way is a technique that can be learned and taught. Sometimes you have to look “outside of the box.”

• Sometimes we can find simple and/or innovative solutions if we allow ourselves to think “outside of the box.”


DON’T COUNT ON IT

(HANDOUT FOR THE LEARNER1)

1. Moe and Les played six games of Monopoly (or name some other familiar game for the country/region where you are training). They each won four games. How can that be?

2. Why are 2004 pennies (or the equivalent monetary unit in your country) worth more than 2003 pennies?

3. How can you take half of 10 and end up with zero?

4. A fungus from outer space attacks Earth. It doubles its size each day. After 20 days, it covers half the Earth. When will it cover the entire planet?

5. Rover, the Wonder Dog, was tied to a 15-foot leash, yet he was able to fetch a stick 40 feet away. How is that possible?

6. Rover’s friend, Spot, dug a rectangular hole that measured four feet wide, four feet long, and three feet deep. How much mud was in the hole?

7. Can you see a way to make the following equation make sense? 6 X 6 = 18

8. You have a rooster and you plan to have it lay 12 dozen eggs. You will sell half of that total at the market, give a quarter of what’s remaining to your friends, and donate another 15 to your relatives. How many eggs will you have left?

9. We all know that 1 + 1 = 2, but there is something wrong with this question. What is it?

1 Adapted from: Brisman A (ed). 1999. Don’t Count on It. Nickelodeon GAS: Games and Sports for Kids (A

Supplement to Nickelodeon Magazine) October: 7.


DON’T COUNT ON IT (ANSWER KEY)

1. Moe and Les played six games of Monopoly (or name some other familiar game for the country/region where you are training). They each won four games. How can that be?

They did not play the games against each other.

2. Why are 2004 pennies (or the equivalent monetary unit in your country) worth more than 2003 pennies?

Because there is one more penny in 2004 pennies. (They are amounts, not years.)

3. How can you take half of 10 and end up with zero?

Take the “1” away from “10,” and you’re left with “0” (zero).

4. A fungus from outer space attacks Earth. It doubles its size each day. After 20 days, it covers half the Earth. When will it cover the entire planet?

On the 21st day. The fungus has already covered half the Earth, so it will take only 1 more day for it to double in size and cover the planet.

5. Rover, the Wonder Dog, was tied to a 15-foot leash, yet he was able to fetch a stick 40 feet away. How is that possible?

Rover was tied to the leash, but the leash was not tied to anything.

6. Rover’s friend, Spot, dug a rectangular hole that measured 4 feet wide, 4 feet long, and 3 feet deep. How much mud was in the hole?

None. A hole doesn’t contain anything except air.

7. Can you see a way to make the following equation make sense? 6 X 6 = 18

Turn the page upside down. The equation becomes 81 = 9 X 9.

8. You have a rooster and you plan to have it lay 12 dozen eggs. You will sell half of that total at the market, give a quarter of what’s remaining to your friends, and donate another 15 to your relatives. How many eggs will you have left?

None. Roosters don’t lay eggs; hens do.

9. We all know 1 + 1 = 2, but there is something wrong with this question. What is it?

The number of the question is wrong. It should have been labeled question 9, not 10, in the sequence.


WARMUP/OTHER EXERCISE: CREATIVE THINKING

Objective To stimulate learners to discover new ways of thinking and find innovative solutions to solve issues and bridge the gaps Time: 5–10 minutes

Materials

• Handout of Creative Thinking puzzle (or write it on a large flip chart paper). See model below.

Instructions for the Facilitator Have enough copies of the exercise for each learner.

Procedure

1. Ask the learners to work individually to complete the exercise.

2. Review the answers.

3. Discuss the process by which they came to the answers.


1. How did you feel during the exercise?

2. Why was it difficult to find the solution?

3. Ask the learners to relate this exercise to their work when they have to look for new solutions to old issues/gaps.


• You solved the first question by thinking about Roman numerals, but nobody said the second question could be solved with Roman numerals.

• Never assume information! It is best to look at a situation without an assumption, as many times those assumptions or expectations prevent us from seeing a solution or a different alternative.

• Sometimes we can find simple and/or innovative solutions if we allow ourselves to think “outside of the box.”



(HANDOUT FOR LEARNERS)

1. This is the Roman numeral for the number 6. Change the 6 to a 7 using one line.

VI


IX



(ANSWER KEY)


VI ANSWER: To change the Roman numeral VI to a seven, add one line:

VII


IX ANSWER: To change the Roman numeral IX to six using one line, use an “S” to make SIX.

SIX Remember: Nobody said it had to be another Roman numeral, and nobody restricted the line style to a straight line.


WARMUP/OTHER EXERCISE: HORSE AND RIDER

Objective To stimulate learners to discover new ways of thinking and find innovative solutions to solve issues and bridge the gaps Time: 10–15 minutes

Materials

• Drawings of two horses and two riders on one piece of paper (example below) to photocopy

Instructions to the Facilitator

• Decide whether to conduct this exercise with pairs, small teams, or individuals.

• Cut out the picture of the horses so that you have two separate horses for each learner or team.

• Have the picture of the riders together on one piece of paper, to distribute to each learner or team.

• Each learner or team will receive three pieces of paper: two horses (separate papers) and two riders (one paper).

Procedure

1. Divide the learners and have them work in pairs, small teams, or individually.

2. Ask the learners to position the drawing of the riders so that they are sitting on the horses.

3. Tell them that the riders cannot be upside down on their horses and that neither of the papers can be folded.

4. After 5 minutes, if no one has positioned the riders correctly on the horses, give the learners the following hint: “Who said the drawing is of one horse?”

5. Show learners the “right position” (example below).



2. Why was it difficult to put the pictures together correctly?

3. Ask the learners to relate this exercise with their work when they have to look for new solutions to old issues/gaps.

Summarize the Main Points Sometimes we can find simple and/or innovative solutions if we allow ourselves to think “outside of the box.”


Horse and Rider Drawings for Photocopying


WARMUP/OTHER EXERCISE: HORSE AND RIDER

(ANSWER KEY)


WARMUP/OTHER EXERCISE: BUILDING A PAPER BOX

Objective The learners will be able to understand the importance of effective training and coaching. Time: 20 minutes

Materials

• Sufficient number of pieces of paper for each learner

• Handout describing “How to build a paper box”

• Flip chart paper and markers or overhead transparency or white board


• This activity requires two sessions. An ineffective facilitator teaches the first; an effective facilitator/coach teaches the second.

• Conduct this activity by following the steps below. Note: Build a box in advance to show the learners at the start of the second session.

Procedure with Discussion Questions

1. Ask the learners to work individually and build a box following your instructions (demonstrate this first session working rapidly, and using ineffective coaching and training techniques).

• Do not state any objectives. Just start by showing the previously built box.

• Do not provide a handout explaining the steps.

• Display a negative attitude and do not provide any positive feedback.

• Do not maintain eye contact.

• Criticize the boxes that the learners are trying to build.

• Do not offer any help or assistance.

2. After the demonstration, conduct a brainstorming session. Ask for a list of all the poor training and coaching techniques the learners observed. List these on one side of a flip chart, writing board, or overhead transparency.

3. Ask the learners for suggestions of how the demonstration could have been improved. List these suggestions on the flip chart or transparency next to the first list, and compare the two lists.

4. Ask the learners to work individually again and build a box using the instructions of an effective coach and facilitator.

• State the objectives while showing the learners the finished product (previously built box). For example: “You will learn how to build a box like this one. This box can be used for candies or as a small trash box.”

• Distribute a handout describing the steps of the activity and materials needed to build a box (see below).

• Demonstrate the entire activity once and then show each step individually.


• Repeat individual steps for the learners to follow.

• Ask if there are any questions or if anyone needs assistance.

• Ask learners to build additional boxes until they feel comfortable in mastery of the skill.

• Check their progress, giving immediate feedback and correcting mistakes.

Summarize the Main Points Compare the ineffective with the effective facilitating and coaching techniques. Reiterate the importance of each of the steps in Number 4 above. Also, relate this exercise with the importance of positive feedback when the learners return to their workplaces and start coaching people on new practices.


INSTRUCTIONS: HOW TO BUILD A PAPER BOX

STEPS IN THE PROCEDURE KEY POINTS

Figure 1

1. Make two crosswise creases.

Divide the paper into three equal parts. To do this, roll the paper into a cylinder, matching the ends.

Figure 2 2. Make two lengthwise creases.

Divide the paper into three equal parts. To do this, roll the paper into a cylinder, matching the ends.

Figure 3

3. Make diagonal creases at the corners.

The diagonal crease starts at the point where the lengthwise and crosswise creases (corners) intersect. One corner at a time, match the lengthwise and crosswise creases. Corners should fold away.

Figure 4

4. Fold the ends of the box. Fold around the end of the

box, not the sides. Overlay corners evenly. Corners should be square.

Figure 5

5. Fold the flaps down. Bend the flaps out in line with

top of the box.


WARMUP/OTHER EXERCISE: THE NUMBER GAME

Objectives The learners will be able to demonstrate the importance of practice and repetition in learning a skill. Time: 15 minutes

Materials

• Handouts of the page full of numbers (see below), three copies for each learner (refer learners to “The Number Game” pages in their Learner’s Guide)


• Have the learners place the sheets of numbers face down in front of them so they cannot see the numbers.

• Explain that this is a simple hand-eye coordination exercise in which they are to work as quickly as they possibly can within a given time period.

Procedure

1. Have the learners turn over the top sheet, mark it with a #1 at the top, and with pen or pencil draw a line from #1 to #2 to #3, etc. until they connect all the numbers or are told to stop, whichever comes first.

2. Allow 60 seconds for the exercise. Then ask the learners to stop, circle the highest number reached, and set this page aside.

3. Repeat this procedure (turn the next page over and have them mark it with a #2 at the top, then begin to connect the numbers, starting with #1) for another 60 seconds.

4. Repeat this procedure (turn the next page over and have them mark it with a #3 at the top, then begin to connect the numbers, starting with #1) for another 60 seconds.

5. When finished, have the learners turn over all three pages and see how far they progressed with each subsequent page.

6. Make a graph of the learners’ progress on a flip chart.



2. “Practice makes perfect” is a saying that applies here. If it is really true, all should have shown a significant increase in the number attained with each attempt. Is it true for all learners? If not, why not?

Summarize the Main Points Something that looks simple and fun is one way to show us how important it is to practice, practice, practice until we can do the steps well and quickly.


28 40 627

5241 14

23 34

43

45

1


WARMUP/OTHER EXERCISE: THE NINE DOTS PUZZLE

Objective The learners will be able to use their imaginations for creative ways to solve problems. Time: 15 minutes

Materials

• Flip chart or white board, and blank papers with pencils or pens for learners

Instructions to the Facilitator Draw nine dots (as illustrated below) on the flip chart or white board for all learners to see.

Procedure

1. Have the learners copy this nine-dot configuration exactly onto their blank sheet of paper.

2. Give these instructions: “Without taking pen or pencil off your paper, connect all nine dots with four (4) straight lines.”

3. Give them some time to work on the puzzle.

4. If some of the learners have seen this puzzle, ask them to do it with only three (3) straight lines.

5. Ask one or more volunteers to show how to solve the puzzle on the flip chart.


1. Ask the learners to identify the problems they had when working the puzzle.

2. We often find ourselves constrained or boxed in on many projects. How can we counteract such situations?


• Something that looks difficult to resolve may not be so difficult as first imagined.

• Some people may see the resolution very quickly, and be frustrated by those who cannot.

• Thinking about problems in a new way is a technique that can be learned and taught. Sometimes you have to look “outside of the box.”

• Do not assume you already know all the parts or pieces to a problem. Many times, you have to actually go and look at a problem/situation to come up with a reasonable and helpful solution.


WARMUP/OTHER EXERCISE: THE NINE DOTS PUZZLE

(ANSWER KEY)

As a reminder, the most frequently used solution for connecting all nine dots with four (4) straight lines is shown here:

24

3

1

To connect all nine dots with three (3) straight lines, try this solution:

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