High Yield Pedagogy: A Novel and Translational Tool for Gap Analysis and the Collaborative
Acceleration of Multi-Disciplinary Child Sexual Assault Services in Guyana.

Introduction
Historically, Child Sexual Assault (CSA) services training in Guyana has been sporadic, almost
completely compartmentalized and comprised of internal individual agency staff, e.g. Medical,
Forensic, Law Enforcement, Legal, and Patient Advocacy. While arguably necessitated by the
time frame and complexity of the training involved, this self-contained approach does not
promote interagency cooperation or an integrated medico-legal psychosocial approach to patient care and case resolution. Here we discuss a highly successful and potentially
translational model wherein regular reoccurring multidisciplinary training, strategically
combined with High Yield Pedagogy has successfully served as an interagency Idea Accelerator for Gap Analysis and Process Improvement, and ultimately promoted integrated and streamlined Child Sexual Assault services within Guyana.

Methods
Reoccurring training address both the time and staffing limitations that often preclude
development by providing ongoing continuity of mentoring. High Yield Pedagogy, an
educational approach tailored to time constraints in resource limited environs, further
addresses these limitations and promotes development by mentoring local staff as ClinicianEducators and Transformational Leaders from the outset. High Yield Pedagogy has its roots in U.S. Navy Aviation, as well as Special Operations Medicine Force Multiplier Train the Trainer strategies. Key Concepts are taught via culturally sensitive and student driven Scenario Based Training (SBT) in an environment emphasizing Psychological Safety, High Performance Teamwork, and Dynamic Process Improvement.

Results
In conjunction with reoccurring workshops, in depth interagency Scenario Based Training in
Child Sexual Assault was provided to over 75 multidisciplinary team members in several cadres in multiple regions of Guyana. This CSA SBT covers multiple cases from law enforcement
initiation, through medical and forensic roles and responsibilities, to ultimate legal resolution
with an emphasis on reinforcing interagency handoff and communication/ cooperation. During
training, individuals were evaluated as Individuals and as Team Liaisons. Following training, improved didactic and clinical outcomes were consistently observed throughout all cadres and regions, with self-sufficient didactic and clinical training, knowledge translation, and dynamic process improvement subsequently observed across a continuum of multiple training sessions and stakeholder practice environments.

Conclusions
Reoccurring interagency child sexual assault (CSA) workshops in combination with High Yield
Pedagogy is a valid and reproducible strategy for developing sustainable multidisciplinary CSA
Capacity. Our results suggest this approach would successfully translate to other settings and may also serve as useful model for promoting global health equity and forensic science goals.