Discussion

The diagnosis of many communicable diseases depends on the correct interpretation of image-based laboratory tests.  The World Health Organization states that in 1997 infectious and parasitic diseases still claimed 17 million deaths or 43% of the total deaths in developing countries (15). Microscope-based diagnostic tests constitute over 60% of the daily workload of primary healthcare laboratory personnel in developing countries.  Hence, one would assume that apprentices receive rigorous training to master the interpretation of image-based diagnostic tests and that regular refresher training be offered to practicing staff.  Alas, this is often not the case.

Despite their importance, the microscopic examination of specimens is not adequately taught at training institutions in developing countries.   External quality assessments of imaged-based laboratory procedures carried out as part of national quality assessment schemes have repeatedly demonstrated that training is inadequate.

Image-based diagnostic tests are taught through teacher-narrated lectures often not even supported by textbook images.  Where photographic images of specimens are available the image quality is often poor and few textbooks have to be shared by a sizeable student body.  Supervised instructions at the microscope suffer from lack of equipment, availability of suitable specimens, and instructor know-how.

Training needs in developing countries are abundant and resources are generally scarce. Given that resources are limited, special efforts are required to ensure that learning resources are effective, economic and enhance knowledge transfer from the classroom to the work place.  Interactive computer software programs that teach the interpretation of image-based laboratory tests meet those requirements.

Through this limited evaluation, we introduced the TUTOR programs to primary healthcare laboratory personnel in a developing country.  Learners at the National Public Health Laboratory in Kathmandu, Nepal now benefit from this new educational tool. This study, although limited, clearly shows that learners deem computer-assisted instruction superior to teacher-narrated lectures and even users with no previous computer knowledge are able to benefit from the program.

In addition, the TUTOR programs provide an excellent tool for competence-based assessment (15). Studies in the United States found Urinalysis-Tutor an effective tool for competence-based assessment (16).   Contemporary societies in many developing countries are used to pencil-and-paper tests and the introduction of competence-based assessment system might be received with some resistance.  However, if combined with traditional assessment methods it might bring benefits to the training process and the learning transfer from the classroom to the workplace.

We would like to argue that if interactive software programs such as the TUTOR were integrated into the curricula of healthcare workers in developing countries, the diagnostic quality of many communicable diseases could  improve globally.  Healthcare workers in western countries already benefit from these new educational tools. Commitment from international health planners, policy makers, and funds from donor agencies are needed to make them available to healthcare workers in the developing world as well. 

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Acknowledgement

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The Public Health Care Laboratory - 2001 � Gabriele Mallapaty