Following manual preparation, on June 6 and 7, 2023, Andragogy Training of Trainers (ToT) orientation was conducted for selected obstetrics and gynecology specialists from renowned coach hospitals at Abebech Gobena MCH Center. Participants also included subject matter experts who were directly involved in the workshop that developed the advanced SPOUS training manual. During the two-day TOT training, the specialists were provided with detailed insights into the five modules of the SPOUS training manual and their valuable inputs incorporated in order to refine the final training document. The goal was to enable trainers to deliver modules effectively, accurately assess trainees' skill performance, and objectively measure competency and milestone achievements.

The methodologies employed comprised lectures, role-plays, and skill-based practice on volunteers. Additionally, trainers underwent a weeklong preparation phase before the official SPOUS training, becoming well-acquainted with the modules and refining their content delivery methods.