Training for Life Foundation was founded in 2014 to contribute to an improvement
of patient outcome by simulation-based education by facilitating knowledge and
resources about simulation-based education in combination with scientific
research. The projects are focused on a reduction in maternal and perinatal
mortality by simulation-based education.
The board of the foundation is formed by
- R.U.J.M. de Bruijn (voorzitter)
- J.W. Ditters (penningmeester)
- J.H.E. van den Thillart-van Brussel (secretaris)
They are all volunteers.
Together with the Ugandan Ministry of Health and obstetricians from Makerere University and New
Mulago Specialize Women and Neonatal Hospital, Training for Life foundation drafted an
Implementation Plan for the whole of Uganda. The plan includes a Training for Life center for
all fourteen teaching and district hospitals, including corresponding train-the-trainer courses
and main and repitition training for all local healthcare professionals at the obstetric department.
The multidisciplinary team trained in 2018 is equipped to carry out these plans. In addition,
Dr. Ntuyo has been trained as master trainer and coordinator for the Ugandan Training for Life
program. Effectivity of these team training sessions will be evaluated via knowledge tests,
skills tests, practice evaluation and the effect on maternal and perinatal mortality rates.
Three centers have been opened thusfar, in Mulago Specialized Women and Neonatal Hospital,
Kawempe Kampus and Mbale Hospital. With other Ugandan teaching and districts hospitals is
currently planned to open a local Training for Life center and provide the corresponding
train-the-trainer course. One of the key elements is to implement the use of a digital birth
register, specifically developed for this purpose with Perined, the Dutch Perinatal Registration
Current report of activities
Since the establishment of Training for Life foundation, in China one Training for Life center was
opened, and 34 trainers were trained as medical and communication trainer for simulation-based
education. In Uganda, three centers were opened and a total of 22 medical and communication trainers
have been trained thusfar. Dr. Ntuyo has been educated as master trainer and coordinator for
Training for Life Uganda. In 2019 we trained a group of seven hospital technicians as simulation
specialist: they prepare the simulation room and operate the technical equipment during the training
sessions and debriefing. They are connected via social media in a peer group to help eachother
solving any technical issues including technical malfunctions and maintenance of equipment.
Training for Life's multidisciplinary team consists of gynaecologists, obstetric residents, midwives and
engineers, joined together in the research group Fundamental Perinatology of
prof. dr. Guid Oei. In addition, we work with experts from medical education and simulation center Medsim, guided by CEO Rob Steinweg.
Our training program is based on the following literature:
- American Academics of Pedatrics. Helping Babies Survive.
- Bashour, H. N. et al., The effect of training doctors in communication skills on women's satisfaction with doctor-woman relationship during labour and delivery: a stepped wedge cluster randomised trial in Damascus. BMJ Open 2013;3:e002674.
- Birch, L. et al. Obstetric skills drills: evaluation of teaching methods. Nurse Educ Today 2007;27:915-22.
- Commitment to maternal and child survival. Investment case for Maternal, newborn, child and adolescent health sharpened plan for Uganda. March 2016.
- Cook, D.A. et al., Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA 2011; 306(9):978-988.
- Cooper, J.B. et al., Design and evaluation of simulation scenarios for a program introducing patient safety, teamwork, safety leadership, and simulation to healthcare leaders and managers. Simul Healthc 2011;6:231-8.
- Crofts, J.F. et al., Onsite training of doctors, midwives and nurses in obstetric emergencies, Zimbabwe. Bull World Health Organ 2015;93:347-351.
- Crofts, J.F. et al., Practical simulation training for maternity care--where we are and where next. BJOG 2011;118(Suppl):11-6.
- Draycott, T. J., et al. Improving neonatal outcome through practical shoulder dystocia training. Obstet Gynecol 2008;112:14-20.
- Draycott, T.J., et al. Does training in obstetric emergencies improve neonatal outcome? BJOG 2006;113:177-82.
- Forsetlund, L. et al., Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane database Syst Rev CD003030 2009, doi:10.1002/14651858.CD003030.pub2.
- Fransen, A.F. et al., Effect of obstetric team training on team performance and medical technical skills: a randomised controlled trial. BJOG 2012;119(11):1387-93.
- Grady, K. et al., Improving essential obstetric and newborn care in resource-poor countries. J Obstet Gynaecol 2011;31:18-23.
- Graham, W.J., Criterion-based clinical audit in obstetrics: bridging the quality gap? Best Pract Res Clin Obstet Gynaecol. 2009;23:375-88.
- Hogerzeil, H. V. et al., Instability of (methyl)ergometrine in tropical climates: an overview. Eur J Obstet Gynecol Reprod Biol 1996;69:25-9.
- Hoop, E. de, et al., The stepped wedge cluster randomized trial always requires fewer clusters but not always fewer measurements, that is, participants than a parallel cluster randomized trial in a cross-sectional design. In reply. J Clin Epidemiol 2013;66:1428.
- Hussey, M. A. et al., Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials 2007;28:182-91.
- Issenberg, S.B. et al., Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005;27(1):10-28.
- Jhpiego. Helping Mothers Survive Bleeding after Birth.
- Kalyango, J. N., et al., Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda. BMC Health Serv Res 2012;12:323.
- Kirkpatrick D.L. et al., Evaluating training programs: The four levels. San Fransisco CA Berrett-Koehler Publ. 1994.
- Lonkhuijzen, L. van, et al., A systematic review of the effectiveness of training in emergency obstetric care in low-resource environments. BJOG 2010;117:777-87.
- Maouris, P. et al., Outreach obstetrics training in Western Australia improves neonatal outcome and decreases caesarean sections. J Obstet Gynaecol 2010;30:6-9.
- Mbonye A.K. et al., Declining maternal mortality ratio in Uganda: priority interventions to achieve the Millennium Development Goal. Int J Gynaecol Obstet 2007;98(3):285-90.
- Mckay, A.L., The Ugandan Maternal and Newborn HUB: Supporting Sustainable and Effective Professional voluntarism. 2013:1-53.
- Mdege, N.D., et al., Systematic review of stepped wedge cluster randomized trials shows that design is particularly used to evaluate interventions during routine implementation. J Clin Epidemiol 2011;64:936-48.
- Merién, A.E.R., et al., Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. Obstet Gynecol 2010;115:1021-31.
- Ministry of Finance, Planning and Economic Development the republic of Uganda. Millennium Development Goals Report for Uganda 2013
- MOH. Annual Health Sector Performance Report 2011/12. Kampala. 2012.
- Nelissen, E., et al., Helping mothers survive bleeding after birth: an evaluation of simulation-based training in a low-resource setting. Acta Obstet Gynecol Scand 2014:93:287-95.
- Nelissen, E., et al., Applicability of the WHO maternal near miss criteria in a low-resource setting. PLoS One 2013;8:e61248.
- Penny, S., et al., Training initiatives for essential obstetric care in developing countries: a "state of the art" review. Health Policy Plan 2000;15:386-93.
- Phipps, M.G., et al., Outcomes from a labor and delivery team training program with simulation component. Am J Obstet Gynecol 2012;206:3-9.
- Riley, W., et al., Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital. Jt Comm J Qual Patient Saf 2011;37:357-64.
- Say, L., et al., Maternal near miss - towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol 2009;23:287-96.
- Scholefield, H., Embedding quality improvement and patient safety at Liverpool Women's NHS Foundation Trust. Best Pract Res Clin Obstet Gynaecol 2007;21:593-607.
- Sorensen, B.L., et al., Substandard emergency obstetric care - a confidential enquiry into maternal deaths at a regional hospital in Tanzania. Trop Med Int Health 2010;15:894-900.
- Souza, J.P., et al., The WHO maternal near-miss approach and the maternal severity index model (MSI): tools for assessing the management of severe maternal morbidity. PLoS One 2012;7:e44129.
- Tunçalp, O., et al., The prevalence of maternal near miss: a systematic review. BJOG 2012;119:653-61.
- UNDP, The 2013 Uganda MDG Progress report.
- UNICEF, Uganda Statistics.
- Walker, D.M. et al., Impact Evaluation of PRONTO Mexico: A Simulation-Based Program in Obstetric and Neonatal Emergencies and Team Training. Sim Healthcare 2016;11:1-9.
- WHO, Children: Reducing Mortality.
- WHO, Definition of Maternal Mortality Ratio.
- WHO, Sustainable Development Goals.
- Woertman, W., et al., Stepped wedge designs could reduce the required sample size in cluster randomized trials. J Clin Epidemiol 2013;66:752-8.
- World bank, Ugandan Maternal Mortality Ratio.
- World bank, Ugandan Neonatal Mortality Ratio.