Train the Foot Trainer (TtFT) Program in Europe February March 2015 An initiative of the International Working Group of the diabetic foot group in collaboration with International Diabetes Federation; IDF Consultative Section on the Diabetic Foot (IDF CS DF) Project Chair: Dr. Kristien Van Acker, Belgium Board of IDF CS DF: Hanan Gawish, Egypt, secretary; Z. Abbas, Tanzania; Shigeo Kono, Western Pacific, Japan; Zhang-Rong XU, China and Stephan Morbach, Germany; Karel Bakker as immediate -past president. IDF coordination: David Cavan, Director of Policy and Programmes, David Chaney, Senior Educator specialist and Daniela Chinnici, Policy and Programs Administrator
1. Background: 1.1 International Working Group on the Diabetic Foot The International Working Group on the Diabetic Foot (IWGDF) was founded in 1996 and in 2000 became a Consultative Section of the International Diabetes Federation (IDF). Since 2010 IWGDF has been an integral part of the IDF Diabetic Foot Programme. In 1999 the IWGDF first published the International Consensus on the Diabetic Foot and Practical Guidelines on the Management and the Prevention of Diabetic Foot Disease. To date, this publication has been translated into 26 languages, and more than 80.000 copies have been distributed globally. In order to implement the International Consensus, the IWGDF recruited local champions as members, who now represent over 100 countries from across the globe. In 2005, IWGDF decided that the International Consensus should be updated and expanded. Working groups of independent experts in the field were asked to revise and update the chapters of the original text, according to current knowledge and standards; the IWGDF Editorial Board guided this process. The last consensus document was launched at the 2011 meeting in Noordwijkerhout (see website: www.iwgdf.org ). 1.2 Step- by- Step programmes and Step- by- Step courses. In 2003, the International Working Group on the Diabetic Foot together with the Diabetic Foot Society of India (DFSI) and the Muhimbili University College Of Health Sciences, Dar es Salaam, Tanzania (MUCHS), initiated a foot care project called Step by Step - improving diabetic foot care in the developing world, with financial support from the World Diabetes Foundation (WDF). A number of programmes in the Caribbean region were financed by Rotary Clubs in several countries (led by the Rotary Club of Ledbury, UK), Rotary International and IDF. 2. The Train-the-Foot-Trainer (TtFT) course: 2.1 Step by Step programme The Step-by-Step programme (SbS) is a two-year project. Teams consisting of a doctor and a nurse or paramedic, are invited to attend a basic and an advanced course. During the two years, data collection is mandatory. The goal is to improve educational skills and the management of diabetic foot problems. By doing so this has created a cascade effect and sustainability in the region/country. An experienced national and international faculty is responsible for teaching and the practical sessions. Medical equipment and educational materials are provided to all participants. Successful pilot programmes were implemented in India and Tanzania in 2004 and 2005 (ref 1, 2). Recent publications have shown that well executed SbS programmes have a significant reduction in amputation rate (ref3). 2.2. From Step by Step programmes to Train the Foot Trainer Courses: How to set up a Step by Step Programme The spin-off effect of these courses was significant. The SbS programme has since been introduced in a dozen other countries and there is a rapidly increasing demand for the programme in more countries. As a result it was felt that in order to sustain this good work, a new model had to be adopted, which was robust both financially and in manpower terms. For this reason, in 2010, the Step by Step Development and Research Group (SSDRG) of the IWGDF initiated the idea of developing the Train the Foot Trainer course with the aim of reaching more regions in a shorter period. The first pilot projects were the TtFT courses held in the South and Central America (SACA) region in December 2012 and in the Caribbean Region in June 2013.
As a result, 13 of the 14 countries of the SACA region have developed plans to implementation programmes over the next 2-3 years. Some have already started a BASIC course and so far over 1000 healthcare providers have been trained. 2.3 TtFT course outline for Europe: Venue: Bled, Slovenia Period: February 2015 Aim: To train experts in diabetic foot disease to deliver effective, well structured, sustainable training programmes with demonstrable outcomes Statements - This training course is NOT just a training course to teach skills and knowledge about diabetes foot disease - It IS a training programme, which teaches course structure, organisation delivery methods and evaluation skills - It IS a course run for experts to train others to become experts in clinical and education skills and knowledge Course objectives For each of the delegate teams to organise and implement a Step by Step training programme for their own country (educational, organisational and public relations) To develop and support a European-based diabetic foot-care working group which facilitates sustainable development of integrated foot-care services. For this reason we would like to develop a Twinning program with well-established foot-care centres. To encourage, support and develop an ongoing mentorship programme for existing and new diabetic foot champions in this region To train trainers from their own localities to deliver SbS training programmes To evaluate the delivered course To collect and disseminate outcomes of the programme (national / regional / international {IWGF, IDF, DFSG etc.}) To identify and find solutions for their needs and barriers to implementation Intended course outcomes To integrate the International Consensus Guidelines on the Diabetic Foot into local foot care provision utilising the Step by Step training programme To help develop local, regional and national networks and study/working groups. To facilitate structured diabetic foot care infrastructure that includes a. sustainability of service and education b. service development and referral pathways, c. driving and implementing policy making To provide a support mechanism for local champions To have a sustainable impact upon service provision and clinical outcomes. To undertake minimum dataset collection to drive change and support research.
To encourage the development of further national training programmes with a national faculty to meet local needs Partnerships The initiative is taken by the IDF Consultative Section on the Diabetic Foot (IDF CS DF). This is a joint initiative of the IWGDF and IDF, under the responsibility of the chair of IDF CS DF, Dr. Kristien Van Acker. 3. A broader platform and twinning program: Cooperation with European organisations. The intention is to work in partnership with different European Organisations in order to create a platform to sustain the development of diabetic foot services across Europe. A key component of this is the development of twinning arrangements between centres who are developing a centre of excellence in diabetes foot care and partners who have already achieved success in developing a centre or a national programme. The institutions invited to contribute to this initiative are the following: IDF Europe: a. President: Joao Manuel Valente Nabais b. Proposed tasks: i. Identifying patient organisations with capacity to be involved in this project ii. Promoting educational programmes for nurses iii. Encouraging patient organisation to support the programme in the selected centres/countries European Association for the Study of Diabetes (EASD): a. President: Andrew Boulton b. Proposed tasks: i. Invited Lecture by Andrew Boulton ii. Identifying candidates for twinning centres Diabetic Foot Study Group (DSFG) of EASD: a. President: Ralf Lobmann b. Proposed tasks: i. Identifying candidates for twinning centres ii. Representing DSFG at the implementation day iii. Promoting studies in the European region on diabetic foot disease. Diabetes Education Study Group (DESG) of EASD: a. President: Line Kleinebreil b. Proposed tasks: i. Identifying candidates for twinning centres ii. iii. Representing DESG at the implementation day Promoting educational programmes for nurses/ podiatrists and other healthc are workers. Federation of European Nurses in Diabetes (FEND): a. President: Anne-Marie Felton b. Chair: Kristin De Bakker c. Proposed tasks: i. Identifying candidates for twinning centres ii. Representing FEND at the implementation day iii. Promoting educational programmes for nurses
European Wound Management Association (EWMA): a. President: Sala Seppanen b. Immediate past president: Jan Appelqvist c. Proposed tasks: i. Identifying candidates for twinning centres ii. Presenting the EWMA at the implementation day iii. Facilitating implementation in their network 4. Proposed Faculty Members: 1. Dr.Vilma Urbancic, Slovenia as Chair of Local Faculty- OK 2. Dr. Anna Korzon-Burakowska, Poland as co-chair of Local Faculty- to be asked 3. Dr. Stephan Morbach, Germany- OK 4. Dr. Kristien Van Acker, Belgium 5. Dr Arend Jan Woittiez, The Netherlands-OK 6. Erik Manning, The Netherlands- to be asked 7. Pod Maureen Mc Colgan Bates, UK, To be asked 8. Pod Neil Baker- UK, to be asked 5. Observers: 1. David Chaney, IDF, Senior educator specialist 2. David Cavan, IDF Director of Policy and Programmes 3. Daniela Clinnici, IDF Administrator 4. Maimouna Ndour, Project Coordinator DAFI 5. Evariste Bouenizabilla, IDF Africa 6. Christopher Attingar, US 7. Lawrence Harkless, US 6. Online and as twinning partners or participants: 1. Oleg Udovichenko, Russia, DFSG 2. Nikolaos Tentolouris, Greece, DFSG 3. Alberto Piaggesi, as IWGDF Eur representative and chair of the International Diabetic Foot Courses in Pisa 4. Ralf Lobmann, Germany, DFSG 5. Klaus Kirketerp-Moeller, Denmark, DFSG 6. Margreet Van Putten, podiatrist with a twinning program in Kosovo 7. Dr Bettina Peter-Riesch, Switzerland- to be asked 8. Dr Nina Petrova, UK- OK 9. 7. Selection criteria for participants: 1. In their CV it must be clear that the candidate has clinical experience in diabetic foot disease 2. The participant can be a medical doctor, nurse, podiatrist active in the field of diabetic foot disease. 3. The participants will be asked to come in pairs. The second person can be a non-medical person with organisation skills. 4. The participant must provide evidence in their CV of organisational skills required for implementation of DF programmes in their region or country. They need a TEAM spirit. 5. Twinning partners will be proposed to the participants; participants can also propose their own partner centre. 6. The participant must send the organisation a letter from the Patient organisation(s) of their country confirming their willingness to work with the participant in implementing this DF
program. The participant must be endorsed by the national patient organisation as a good representative for this project. 7. The participant must provide a copy of a letter written by him/herself to their ministry of Health. This letter must explain the programme and request a letter of support from the Minister for the implementation of the SbS programme to prevent amputation. This response should also be provided to the organisers. 8. If the country has an established Diabetic Foot Study Group, a letter of support from them should be provided to the organisers. 9. The costs for travelling must be paid by the participants (raised through local sponsorship or their ministry of health, for example). 10. Registration and accommodation costs will be paid by the organisers; if a participant cancels within six weeks of the course, a cancellation fee of 500 Euro will be payable. 11. The participants will sign a contract with the organisers to state: i. That they are prepared to implement a regional/national programme to prevention amputations related to diabetes. ii. iii. That they will report to the organisers after 2, 6, 12, 18, 24 and 30 months That they will contribute to an anonymised data collection system in line with the international principles of data security and privacy. Annex: TtFT program in Tobago. Train the Foot trainer (TtFT) program June 12 th to 15th 2013 Tobago An initiative of the International Working Group of the diabetic foot group in collaboration with International Diabetes Federation Course overview The course is designed to give delegates skills in delivering the SBS programme: Basic Course; Advanced course; General implementation & proceeding points Throughout this TtFT programme all theory content of the SBS course will be briefly covered and the workshop content will be interactively demonstrated We will have a flip chart or poster for photographs of all participants communication corner
DAY 1 Evening 12 th June 2013 20:30 22:00 Welcome. K Van Acker Introduction of International / Local Faculty and participants. S McConnie, S Morbach Expectations of delegates. N Campillo & S McConnie / K Van Acker
Comment from the organisers: We will probably add a half day on DATA collection program as supplementary training.