Technology Spotlight: Virtual Training for Clubfoot Treatment Piloted in the Philippines, Zimbabwe

February 05, 2021

Qualified health workers are at the heart of our mission. Increasing the number and availability of trained providers who can deliver quality care for a leading birth defect is central to our model of expanding access to its treatment. We do this by training physiotherapists, casting technicians, and orthopedic specialists in basic and advanced Ponseti skills and by developing regional teams of qualified trainers who can grow workforce capacity in their own countries.

COVID-19 amplified the need for alternatives to in-person instruction for MiracleFeet’s growing global network of health workers providing clubfoot care.

In partnership with OPENPediatrics (a program out of Boston Children’s Hospital), we recently launched ACT Online, an eight-module online version of the ACT Basic Program, which includes the world’s first interactive 3D model of clubfoot. The curriculum, developed by experts at the University of Oxford and the Global Clubfoot Initiative, and endorsed by the UK’s Royal College of Surgeons, is designed specifically for learning and applying clubfoot treatment skills in low-resource settings.

ACT Online is being piloted in the Philippines, led by three master trainers: physiotherapists in Zimbabwe and London, and an orthopedic surgeon in the Philippines. These world-class instructors are training three inaugural classes of orthopedic residents.

Due to the pandemic, in-person provider trainings have been put on hold in many countries, including in the Philippines. ACT Online utilizes a blended learning format with four live virtual sessions paired with eight asynchronous online modules. Once in-person trainings resume, ACT Online will serve as a preliminary orientation for hands-on trainings, ensuring trainees are equipped with a basic understanding of the Ponseti Method and the anatomy and maneuvers involved, and are better prepared for an enriched learning experience. 

An added benefit to the virtual course: it significantly decreases the cost of training and expands learning to more remote locations, including conflict-affected areas where MiracleFeet supports treatment. 

The initiative was originally funded by Google as part of an Impact Challenge grant supporting nonprofits using emerging technologies to create access and opportunity for people living with disabilities.

How it works

ACT Online takes providers through the concepts necessary to identify, assess, plan, and treat a patient under two years old with non-complex idiopathic clubfoot. The course includes videos and animations demonstrating proper technique, activities, and quizzes to assess learning. Successful course completion includes achieving a satisfactory assessment on the practical skills test in addition to completing the online modules and engaging in the live sessions. Ongoing mentoring in clinics and supportive supervision will flag any quality problems once the trainees begin treating patients.

What was that about a 3D model?

The ACT Online training features an 3D interactive clubfoot simulation developed by 3DTOZ and launched by MiracleFeet earlier this year. Providers can use the online tool to visualize normal foot and clubfoot anatomy and observe the virtual foot through the individual correction phases and through the full Ponseti Method sequence. Users can rotate the foot 360 degrees and explore alternate views of the anatomy and manipulations (anterior, posterior, medial, and plantar) and examine the underlying anatomical layers (bone and tendon structures of the foot). Together, the online course and 3D model will supplement and enhance hands-on learning, serving as critical references for new and experienced clubfoot treatment providers alike.

What’s next?

In anticipation of ongoing COVID-related travel interruptions and gathering limitations, we will continue to pilot this blended learning approach in other regions. Additional pilot sites include Zimbabwe and India. We also have plans to translate the course into French and Spanish to expand its effectiveness and to add additional course modules for training in advanced techniques.

ACT Online has the potential to systematically transform our process of expanding the global network of clubfoot treatment providers, a critical step in scaling clubfoot treatment to all children who need it worldwide. The initial success of the pilot demonstrates the remarkable job our global partners have done to ensure our work can continue despite the limitations of the time.

About OPENPediatrics

OPENPediatrics is an open access online community of healthcare professionals sharing best practices from all resource settings around the world through innovative collaboration and digital learning technologies. We believe improving pediatric care begins with better access to peer-reviewed, expert-driven information.

Through OPENPediatrics, healthcare professionals can access peer-reviewed content, including accredited and non-accredited courses, expert lectures and demonstrations, interactive device simulators, protocols and medical calculators. Verified users can also form and join groups, share digital resources, and engage in online discussions of key aspects of pediatric care.

OPENPediatrics has received many honors and awards for our innovative work, and we comply with the HONcode standard for trustworthy health information