Developing And Implementing The M.O.R.E. Ipe Training: Multidisciplinary Obstetric Fistula Response And Education In Lmics For Optimized Healthcare Delivery

Abstract

Background: Obstetric fistula is a severe childbirth injury that disproportionately affects women in Low- and Middle-Income Countries (LMICs). Effective management of this condition requires a multidisciplinary approach, yet healthcare professionals in LMICs often lack the interprofessional education (IPE) necessary to collaborate effectively. The M.O.R.E. (Multidisciplinary Obstetric Fistula Response and Education) IPE Training module was developed to address this gap and optimize healthcare delivery for obstetric fistula patients.

Objective: This study aimed to develop, implement, and evaluate the effectiveness of the M.O.R.E. IPE Training module in improving multidisciplinary collaboration, healthcare delivery, and patient outcomes in the management of obstetric fistulas across three major healthcare institutions in Pakistan.

Methodology: A multi-center, prospective cohort study was conducted from January 2022 to December 2023 at Liaquat University Hospital, Indus Hospital, and Shifa International Hospital. A total of 150 healthcare professionals, including gynecologists, surgeons, nurses, and allied health professionals, participated in the study. The intervention consisted of the M.O.R.E. IPE Training module, which included didactic sessions, simulation-based training, and on-the-job mentorship. Data were collected at baseline, immediately post-training, and six months post-implementation, including assessments of multidisciplinary collaboration, healthcare delivery outcomes, and patient outcomes.

Results: The implementation of the M.O.R.E. IPE Training module resulted in a significant improvement in multidisciplinary collaboration, as evidenced by a 24.4% increase in CPAT scores (p < 0.001). Healthcare delivery outcomes also improved, with a significant reduction in surgical complications (14.9% to 7.1%, p < 0.01), a decrease in hospital stay duration (10.2 days to 8.1 days, p < 0.01), and increased adherence to clinical guidelines (74.4% to 92.1%, p < 0.001). Patient outcomes were enhanced, with an increase in successful fistula repairs (82.4% to 91.0%, p < 0.001) and a reduction in recurrence rates (12.1% to 6.1%, p < 0.01). Stakeholder feedback indicated strong support for the program, with suggestions for integration into existing curricula to ensure sustainability.

Conclusion: The M.O.R.E. IPE Training module significantly improved multidisciplinary collaboration, healthcare delivery, and patient outcomes in the management of obstetric fistulas in Pakistan. These findings support the broader adoption of interprofessional education as a strategy for enhancing the quality of care in LMICs, particularly for complex and stigmatized conditions like obstetric fistulas. Further research is needed to explore the long-term impact and scalability of the M.O.R.E. IPE module in other healthcare settings.