Training Methodologies

This report summarizes key results of the evaluation of a distance learning course in the Standard Days Method. This course responds to a growing demand for low-cost options to training for family planning service providers. This option was considered as a potentially useful alternative to traditional class-room training, which can be both costly and time-consuming. [adapted from abstract]

The peculiarities of the scattered small states of the Caribbean region call for a model of training practitioners that is effective, relevant and sustainable. Distance education (DE) as an approach offers advantages that meet some of the challenges inherent in training family physicians for the region. This paper examines some of these challenges and shows where DE is being used to structure delivery of the programme. In particular, the need for context-specific training, managing time strictures and the cost issues of training are discussed. [from abstract]

This video clip is 6 minutes and 58 seconds and provides information on the training and retention of health workers in Cape Verde. The majority of the training is done abroad due to poor medical educational facilities in country, and the video communicates the policies and programs Cape Verde has used to ensure trained doctors return to the country as well as how they ensure deployment of doctors to rural areas.

This paper discusses a collaborative effort between two universities in Sri Lanka and Canada to create a distance education program to train nurses in Sri Lanka.

A comparison showed that two models for teaching maternal care skills to providers resulted in similarly modest improvements in knowledge and performance. However, maternal care skills remained weak overall. Training should incorporate the best elements of the two approaches while seeking improvements in basic knowledge of maternal care. [author’s description]

Today’s health professionals are inappropriately trained to address the health of the public, particularly the large proportion who are disadvantaged; they are also maldistributed by specialty and geography. Health disparities exist worldwide, but are of crisis proportions in developing countries where the magnitude of health problems far outstrips the available meager resources. Community-based education has the potential to train service providers, educators and researchers who can assist communities to identify their priority health needs and to implement feasible, affordable and sustainable interventions.

Community-based education (CBE) was developed thirty years ago in response to the maldistribution of physicians and subsequent inequity of health care services across geographical areas in developed and developing countries. Several medical schools in Nigeria report adopting CBE. This study seeks to identify and describe the CBE programs in accredited Nigerian medical schools and to report students’ assessments of the knowledge and skills gained during their community-based educational experience. [from abstract]

The aim of this study was to establish whether a web-based package on the diagnosis of respiratory disease would be as effective and as acceptable to final year medical students as tutor-led methods of teaching the same material. [from abstract]

Facilitator-led training of 20 healthcare providers in IMCI requires 11 days of lectures/practice and 6 facilitators, while the QA Project’s computer-based training requires 9 days and 4 facilitators. This study compared the cost-effectiveness of the two methods and found that both courses had equal effects on participants’ knowledge and skills, and retention after three to four months. The computer course was about 25 percent less expensive, excluding the cost of developing the software and for the computers used in the training. [publisher’s description]

There is a growing conviction among policy-makers that the availability of adequate numbers of well-trained and motivated human resources is a key determinant of health system’s capacity to achieve their health, responsiveness and fairness-improving goals. The objective of this study was to estimate the cost, effectiveness and incremental cost effectiveness ratios of various distance-education strategies for the health sector in Swaziland; and recommend the most cost-effective option. [abstract]

The experience of the Training in Health and Environmental Health in the Caribbean Community project has demonstrated that distance education techniques is an effective medium through which participants in more than eleven countries can be brought together to be educated on topics that are significant to both the region and to individual countries. This paper examines the means through which individuals are educated and meaningful communication among them facilitated. The discussion evaluates the experiences of participants in relation to the technology; designing of pre and post activities; selection and preparation of presenters; the setting and ground rules established; and the interactive process utilized for the project.

As part of the East, Central and Southern African College of Nursing’s 7th Scientific Conference, this presentation describes a distance education project in Kenya that was designed to upgrade the compentencies of enrolled nurses to registered level. It outlines the rationale behind the upgrade, why distance education was selected, the implementation of the program, challenges, achievements and future plans.

Electronic learning: a guide for nurse educators has been written by the Royal College of Nursing (RCN) Education Forum in response to growing interest in new learning technologies, both from individual nursing educators and as a result of education policy initiatives. The guidance sets out what we mean by e-learning, the skills that you as nursing educators, and your learners, will need for electronic learning, and the range of learning technology opportunities. [from introduction]

A participatory assessment process is a valuable starting point for involving all community members, including young people, in YRH and HIV/AIDS program development. YRH and HIV/AIDS program workers need skills in facilitating participatory assessments, especially when youth involvement is a key component. Supporting facilitators to learn by doing is an effective strategy to build skills in using participatory learning and action (PLA) approaches and tools during participatory assessment and throughout the project cycle. This guide aims to provide easy-to-follow guidelines for carrying out a participatory assessment with young and adult community members, and to outline how these tools and methods can be applied throughout the project cycle.

Training in communication skills for health professionals is important, but there are substantial barriers to individual in-person training for practicing clinicians. This study evaluated the feasibility and desirability of online training and sought suggestions for future courses. The conclusion is that online training in communication skills for pediatric mental health visits is feasible, desirable and associated with increased confidence in key skills. Positive feedback from clinicians suggests that a comparison of on-line versus in-person training is warranted. [adapted from abstract]

The Quality Assurance Project (QAP) has developed and twice tested a computer-based version of the Integrated Management of Childhood Illness (IMCI) training course. Earlier testing had shown that the computer-based training (CBT), which takes six days, was as effective as the 11-day training traditionally used to teach healthcare providers to use IMCI. This report describes more recent testing of the CBT, which is available on CD-ROM. The two training programs are equally effective in knowledge transfer, as demonstrated here through a knowledge test and observed performance with two simulated, standardized cases of childhood illness. Budgeted costs were $230 or 29% less per trainee for the computer-based training, largely because of the reduction in the number of days committed to training. [publisher’s description]

This presentation was part of the International Conference on Global Health session, “Innovations in Human Resources: Strategies to Address the Health-Care Workers Shortage.” It outlines the reproductive medical education project in Vietnam that aims to improve the quality of RH care through pre-service teaching in medical schools.

These guidelines…propose a set of questions that a prospective learner or purchaser of distance education can use for selecting suitable distance learning programmes. [adapted from introduction]

Modified computer-assisted learning (ModCal) is JHPIEGO’s newest option for implementing competency-based training (CBT) in reproductive health. A pilot test of ModCal for the intrauterine device (IUD), conducted in May 1996 at the Mpilo School of Midwifery in Bulawayo, Zimbabwe, determined the acceptability of computer-assisted learning (CAL) and the feasibility for implementing it in an institutional setting. The goal was to assess how participants with no prior computer experience responded to computer-based learning about IUDs. [publisher’s description]

Through its work with the Zimbabwe National Family Planning Council and the Kenya Ministry of Health/Division of Primary Health Care, JHPIEGO facilitated the adaptation of materials to improve the performance of IUD service providers through structured on-the-job training (OJT). In Zimbabwe, providers at 14 sites learned IUD/genital tract infection skills by means of structured OJT. At the same time, in August 1996, JHPIEGO began pilot testing this structured OJT in Kenya at six provincial hospitals. Although the pilot test was intended to train about 40 service providers in both countries (two per site), it actually produced 50 providers who achieved competency during 4 to 6 weeks of self-paced learning. [publisher’s description]

This study tested two low-cost alternatives to supervision-self-assessment and peer review-that may reinforce providers’ skills after training, in this case training in interpersonal communication and counseling (IPC/C). There were three study groups: the control group received no reinforcement after training, a “self-assessment” (SA) group performed SA exercises for 16 weeks after training, and a SA and peer review group also performed SA exercises for 16 weeks and met in small groups to peer review and guide each other in their efforts to improve their IPC/C skills. These reinforcement strategies taught providers how to work more efficiently so that they could shorten consultations yet provide high quality interactions with clients. An analysis of the cost-effectiveness of each intervention is included. [publisher’s description]

One of the goals of reproductive and child health program is to ensure high level performance among health workers and adequate efficiency of health system ensured by an effective system of accountability. In this context ANM/FHW who forms the huge work force in the country has to regularly participate in inservice training for upgradation of their knowledge and skills. Distance education technology can provide an effective strategy to enhance their learning and skills and extend educational opportunity mainly in the area of continuing education.

This guidance was developed to help staff of the ACQUIRE Project understand and explain to counterparts and field partners the improvement approaches and tools used by ACQUIRE. ACQUIRE brings together partners with proven, effective approaches to improving provider performance and the quality of services and to mobilizing communities to drive improvements in health care: performance improvement (PI), quality improvement (QI), and participatory learning and action (PLA). These approaches and tools can be used alone or in a complementary manner, depending on the situation and on the program level being addressed.

This publication is for training managers, trainers of health providers, decision-makers, and those who fund and support training actvities. It examines distance learning as an effective training approach for reproductive health providers in developing countries. In addition to describing the components of distance learning, this publication will provide illustrative examples for training health workers, outline steps for starting a distance learning program and suggest additional resources. It will help readers plan and implement effective distance learning. [author’s description]

The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care. Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo, a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals.

Health workers attending overseas universities may be less likely to return home. One response is to improve course provision and professional updating opportunities in-country. Leeds Metropolitan University, with funding from the Commonwealth Scholarships Commission under their distance learning initiative, runs a tailor-made MSc Public Health (Environmental Health and Health Promotion) in Zambia, for nurse tutors, clinical officers and environmental health workers. Using locally relevant curricula, with community-based, student centred, problem-solving approaches, retention may be improved. This paper will discuss how the course is delivered in Zambia, how the partnership developed such as to enable effective delivery of the course, and how sustainable learning can be achieved in a developing country in partnership with a UK University. [from abstract]

In 1993, USAID and the Ministry of Health (MOH) in Nepal approved a twofold family planning (FP) training strategy that called for the immediate strengthening of inservice training of health professionals to meet existing service delivery needs. As a secondary objective, the strategy recognized the need to develop a sustainable integrated (inservice and preservice) education and training network to meet future human resource needs. This technical report updates the 1993 strategy, reviews the rationale for both the inservice and preservice components of the training strategy, documents progress to date in achieving strategy objectives, describes modifications that have been made to the original 1993 strategy, and outlines future plans. [publisher’s description]

Infectious diseases kill more than 10 million people worldwide every year. It is therefore vital that doctors receive a good education in this field. Online learning is one way in which doctors can learn new knowledge and skills. We conducted this study to determine whether the infectious diseases interactive online learning packages enabled primary care professionals to increase their knowledge and skills in the area of infectious diseases. [from abstract]

Countries need high-quality human resources if they are to achieve more efficient, equitable sustainable health services. Teacher training, basic training and continuing education for health professionals, and upgrading of knowledge and skills (including health care management as well as clinical and public health skills) are a key strategic investment. In many countries, the need for skilled human resources is particularly acute because populations and health workers are dispersed and isolated. In such circumstances, the provision of effective high-quality continuing education through open learning may help to stem the migration of health workers to urban centres or abroad.

In this paper, a case study of the development of the University Department of Rural Health, Tasmania (UDRH) is presented to demonstrate how an open learning approach is used as a strategy to address a particular rural health issue – the problem of sustaining a rural health workforce. The aim is to provide an open learning approach to rural health education, training and research to achieve the goal of better health outcomes for rural and remote Tasmanians. [from introduction]