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Table 1 Comparison of standard and PALM PLUS training approaches of health care workers

From: Supporting middle-cadre health care workers in Malawi: lessons learned during implementation of the PALM PLUS package

Standard training approach by Malawi Ministry of Health PALM PLUS training approach
Centralized by health district Decentralized (on-site at individual clinics)
Presentations (primarily didactic and unidirectional) by external experts Educational outreach (facilitative, case-based) by trained peer facilitators
Large groups (50-100 participants); little discussion or interaction between participants and trainer Small groups (10-15 participants); discussion and interaction among participants and between participants and trainer encouraged
Disease specific care Symptom-based and integrated care
Written, narrative guidelines with figures, tables and algorithms, text-heavy PALM PLUS clinical tool consisting of algorithm- and symptom-based guidelines in a single spiral-bound book, with graphical interface
Financial training allowances given to individual participants No financial training allowances given to individual participants
Individual staff trained one at a time All staff at a health facility learn at the same time
Conducted over 1–14 consecutive days Conducted over 8–12 training sessions over a three-to-four month period