JNHRC Vol. 20 No. 1Issue 54 Jan-Mar 2022 147 INTRODUCTION Many countries of the world are facing critical shortages of health workers particularly in rural areas, which hinder the provision of essential health services 1 . There is a projection of 18 million health workers shortfall to accelerate universal health coverage by 2030, particularly in low- and lower-middle income countries. 1,2 Non physician clinicians working as substitutes or supplements for physicians in defned areas of care after pre-service or in-service training can maintain the quality of care and patient outcomes 3-9 Nepal has a very low physician density, 0.7 physicians per 1000 which is fairly below World Health Organization’s recommendation of 2.3 physicians per 1000 population. 10 Competency assessment for mid-level paramedics of Nepal suggests 14% to 31% gap. 11 Nepal government is providing Mid-Level Practicum (MLP) training to fll the observed competency gap. 12 This study aims to explore clinical competency retention at their work place after MLP training. METHODS This was an observational study that used retrospective data. A total of 180 MLP training graduates (MLPs) working at Health Post (HP), Primary Health Center (PHC) and District Hospital of 18 districts of Nepal during the time period July 2015 to June 2019 AD were included. The study area represented all three ecological regions, 7 provinces and east to west part of Nepal. (Fig 1) Follow up assessment was carried out by MLP trainers who were trained and certifed by National Health Training Center (NHTC), health training conduction and certifying apex body of Nepal. The competency score Background: Mid-level health workers are deployed in a large proportion with the expectation of similar patient outcomes as with physicians. Mid-level practitioners are Health Assistants and Auxiliary Health Workers who provide clinical care at remote locations. National Health Training Center has been providing 60 days in-service Mid-level Practicum training since 2009 AD for the mid-level practitioners with the aim to enhance quality of patient care in Nepal. Methods: An observational study conducted using retrospective data from onsite follow-up assessment of 180 Mid- level Practitioner from 18 districts of Nepal between July 2015 to June 2019. The retention of competency onsite follow-up was calculated as percentage of assessment score at the end of Mid-level Practicum training. Percentage retention of competency and association of retention with factors were analyzed using independent t-test. Results: Majority of participants were male (85.6%), and working in a Health Post (84.4%). Average clinical competency retention in each domain at their work place was 68.79% in knowledge, 73.80% in patient encounter skill, 82.84% in clinical decision-making skill and 87.58% in clinical procedure skill. Higher age groups, longer years of experience and participants from Terai region found to be associated with lower retention of knowledge. A better enabling environment and higher case load retained higher patient encounter skill. Conclusions: The competency retention among Mid-level Practicum trained mid-level health workers was found to be higher. Factors found associated with competency retention were age, geographic region, years of experience, case load and enabling environment. Keywords: Competency retention; knowledge; MLP; skill. Clinical Competency Retention after Mid-Level Practicum Training and It’s Associated Factors among Health Workers of Nepal Madhab Raj Bhusal, 1,2 Jonu Tamang Pakhrin, 2 Deepa Chitrakar, 2 Amita Pradhan, 3 Suresh Tamang 2 Correspondence: Madhab Raj Bhusal, National Open College, Pokhara University, Nepal. Email: madhavdai43@gmail.com, Phone: +9779851190622. Author Affiliations 1 National Open College, Lalitpur, Nepal, 2 Nick Simons Institute, Lalitpur, Nepal, 3 Peoples Dental College and Hospital, Kathmandu, Nepal. ABSTRACT Original Article J Nepal Health Res Counc 2022 Jan-Mar; 20 (54): 147-53