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Male Circumcision Under Local Anaesthesia Male Circumcision under Local Anaesthesia Course Notebook for Trainers Editors: Emmanuel Otolorin Peter Johnson September 2008 MALE CIRCUMCISION UNDER LOCAL ANAESTHESIA COURSE NOTEBOOK FOR TRAINERS SECTION ONE: GUIDE FOR PARTICIPANTS ACKNOWLEDGEMENTS ........................................................................................................ vi OVERVIEW Before Starting This Training Course ..................................................................................1 Mastery Learning .................................................................................................................1 Key Features of Effective Clinical Training ........................................................................2 Components of the Male Circumcision under Local Anaesthesia Training Package ..........4 Using the Male Circumcision under Local Anaesthesia Training Package .........................4 INTRODUCTION Course Design ......................................................................................................................6 Evaluation ............................................................................................................................6 Course Syllabus ...................................................................................................................8 Model Course Schedule for Male Circumcision under Local Anaesthesia .......................10 PRECOURSE QUESTIONNAIRE How the Results Will Be Used ..........................................................................................12 Precourse Questionnaire ....................................................................................................13 Precourse Questionnaire Answer Sheet .............................................................................17 ROLE PLAYS ..............................................................................................................................19 MALE CIRCUMICISION UNDER LOCAL ANAESTHESIA: COURSE EXERCISES* Exercise 1.1. Opposities Game ..........................................................................................22 Exercise 1.2. Societal Myths: Brainstorming ....................................................................22 Exercise 1.3. Cultural Issues: Group Discussion ...............................................................23 Exercise 2.1. Male Sexual and Reproductive Health Services: Debate .............................23 Exercise 3.1. Integration with Traditional Circumcision Events .......................................24 Exercise 3.2. Male Circumcision Clinical Skills Session ..................................................24 Exercise 4.1. Recognition of Circumcision Equipment .....................................................25 Exercise 5.1. Calculating Maximum Dose of Local Anaesthesia ......................................25 Exercise 5.2. Male Reproductive Anatomy: Anatomy Race .............................................26 Exercise 7.1. Promoting Postoperative Abstinence ...........................................................26 Exercise 8.1. Infection Prevention Case Study ..................................................................27 Exercise 8.2. Infection Prevention Clinical Skills Session ................................................27 Exercise 9.1. Developing and Maintaining Performance Standards ..................................28 Exercise 9.2. Analyzing Forms for “Good Data” Collection ............................................28 PRESENTATION GRAPHICS* MC Course Introduction ....................................................................................................29 Chapter 1. Male Circumcision and HIV Infection .............................................................35 Male Circumcision under Local Anaesthesia Course Notebook iii Chapter 2. Linking Male Circumcision to Other Male Sexual and Reproductive Health Services ............................................................................................................45 Chapter 3. Educating and Counselling Clients, and Obtaining Informed Consent ...........61 Chapter 4. Facilities and Supplies, Screening of Patients and Preparations for Surgery ...77 Chapter 5. Surgical Procedures for Adults and Adolescents .............................................87 Chapter 7. Postoperative Care and Management of Complications ................................121 Chapter 8. Prevention of Infection ...................................................................................135 Chapter 9. Managing a Circumcision Service .................................................................157 LEARNING GUIDES AND PRACTICE CHECKLISTS FOR MALE CIRCUMCISION COUNSELLING AND CLINICAL SKILLS Using the Learning Guides ..............................................................................................167 Using the Practice Checklists ...........................................................................................168 Learning Guide for Group Education on Male Circumcision and Male Reproductive Health .........................................................................................169 Learning Guide for Individual Counselling on Male Circumcision and Male Reproductive Health ..................................................................................................174 Learning Guide for Screening of Patients and Preparation for Male Circumcision ........178 Learning Guide for Dorsal Slit Male Circumcision Procedure .......................................182 Learning Guide for Forceps Guided Male Circumcision Procedure ...............................186 Learning Guide for Sleeve Resection Male Circumcision Procedure .............................190 Learning Guide for 48-Hour Postoperative Review ........................................................194 Practice Checklist for Group Education on Male Circumcision and Male Reproductive Health .........................................................................................................................196 Practice Checklist for Individual Counselling on Male Circumcision and Male Reproductive Health ..................................................................................................199 Practice Checklist for Screening of Patients and Preparation for Male Circumcision ....201 Practice Checklist for Dorsal Slit Male Circumcision Procedure ....................................204 Practice Checklist for Forceps Guided Male Circumcision Procedure ...........................207 Practice Checklist for Sleeve Resection Male Circumcision Procedure .........................210 Practice Checklist for 48-Hour Postoperative Review ....................................................213 COURSE EVALUATION .........................................................................................................215 (Completed by participants) * Chapter 6: Paediatric and Neonatal Circumcision is not within the scope of this training. iv Male Circumcision under Local Anaesthesia Course Notebook SECTION TWO: GUIDE FOR TRAINERS MODEL COURSE OUTLINE FOR MALE CIRCUMCISION AND REPRODUCTIVE HEALTH ............................................................................................................................1 PRECOURSE QUESTIONNAIRE Using the Individual and Group Assessment Matrix .........................................................29 Individual and Group Assessment Matrix .........................................................................30 Precourse Questionnaire Answer Key ...............................................................................33 COURSE EXERCISES: TRAINER GUIDELINES Exercise 1.1. Opposites Game ...........................................................................................37 Exercise 1.2. Societal Myths: Brainstorming ....................................................................39 Exercise 1.3. Cultural Issues: Group Discussion ...............................................................39 Exercise 2.1. Male Sexual and Reproductive Health Services: Debate .............................40 Exercise 3.1. Integration with Traditional Circumcision Events .......................................40 Exercise 3.2. Male Circumcision Clinical Skills Session ..................................................41 Exercise 4.1. Recognition of Circumcision Equipment .....................................................42 Exercise 5.1. Calculating Maximum Dose of Local Anaesthesia ......................................43 Exercise 5.2. Male Reproductive Anatomy: Anatomy Race .............................................44 Exercise 7.1. Promoting Postoperative Abstinence ...........................................................44 Exercise 8.1. Infection Prevention Case Study ..................................................................45 Exercise 8.2. Infection Prevention Clinical Skills Session ................................................46 Exercise 9.1. Developing and Maintaining Performance Standards ..................................47 Exercise 9.2. Analyzing Forms for “Good Data” Collection .............................................47 OTHER COURSE ACTIVITIES Crossword Puzzle and Answer Key ...................................................................................49 Male Circumcision “Jeopardy!” Game ..............................................................................53 MALE CIRCUMCISION UNDER LOCAL ANAESTHESIA MIDCOURSE QUESTIONNAIRE Using the Questionnaire
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