Training

Most traditional health care training is based on an etiologic model. Thus, the syndromic approach to STD management is a new concept to most health care workers. Therefore, the retraining of health care clinicians, whether they are physicians, nurse practitioners or public health nurses, is an important component of initiating this approach into a public health system.

Clinical training of STD personnel can be difficult and must reflect reality and be problem-oriented. Flowcharts are useful training tools for this purpose because they are based on the presenting symptoms and show the path of diagnostic reasoning to reach a proper diagnosis and to prescribe the best treatment. The skills of history taking and physical examination must not be neglected in this approach. Health care workers must still learn to ask the most relevant questions, including questions on sexual behavior, and to look for the most important physical signs. Active participation of students in the logical, step-by-step construction of flowcharts is educationally beneficial and facilitates their acceptance and use.

The following are important components of training in the syndromic approach to STD management:

- National STD guidelines and flowcharts must be established before training and should be the basis of the training module.

- Local data and local examples are important to convince participants of the utility of the training.

- Careful and proper training of the trainers is essential for a high quality transfer of ideas.

- All training must be followed up with frequent supervisory visits. It has been proven in numerous instances that merely providing training without follow-up reinforcement will produce poor results.