Planning for a Training Course: Selecting a Clinical Site for a Clinical Skills Course - Part 3 (Part 2)
(February 2001)

The following was excerpted from JHPIEGO's newly revised Clinical Training Skills manual. This is the third of three parts on planning for a training course.

A successful training course does not come about by accident, but rather through careful planning. This planning takes thought, time, preparation and often some study on the part of the clinical trainer.

In part one of this article, we gave some guidance about selecting participants for a clinical skills course. In part two, we discussed identifying adequate space for classroom activities. After identifying adequate space for classroom activities, the trainer should identify an appropriate site for clinical activities by following the recommendations outlined below.

Situation

On the third day of the course, you take the 12 participants for a tour and introduce them to the staff in the clinic where they will have their practice sessions. You meet the clinic supervisor and learn not only that staff did not know that you and your participants were coming, but also that there will probably be an insufficient number of clients with whom the participants can work. What could have prevented this problem? What should you do right now? 

Write your responses on a piece of paper, and then compare your responses with the ones found at the end of this article.

Selecting a Clinical Site

The key to the success of clinical practice sessions is to begin planning for them as early as possible. The effort expended in identifying the strengths and weaknesses of the site(s) and developing a relationship with the staff will be paid back many times over when the participants have clinical experiences that allow them to become competent, or even proficient, in the skills they need to complete the course successfully. 

The clinical trainer may be asked to select or assist in the selection of clinical training sites. The pertinent information to collect regarding site selection is detailed below. If a site(s) have already been selected, the trainer must visit the site(s) well before the course begins and review this same information to determine whether the facility is capable of providing the clinical practice required.

Adequate client caseload. 
Will clients request the family planning service for which training is being conducted? The number of clients should be sufficient to provide all participants with adequate opportunities for counseling as well as service provision. A good client mix will provide participants with additional clinical and problem-solving experience. If no single site has enough clients to accommodate all the participants, you may need to divide them into smaller groups that can go to different sites. A clinical trainer who is skilled in the clinical procedure being learned must be present at each clinical site for each clinic session.

Adequate space. 
The clinical training site should have the capacity to accommodate the participants and trainer(s) without sacrificing the quality of services. For example, clients, staff and participants should be able to move through the clinic without impeding client flow and service provision. Dividing the participants into smaller groups and using a number of sites will avoid overcrowding one clinic but will, of course, require additional clinical trainers to accompany each group.

Adequate supplies. 
Clinical facilities must have enough instruments and supplies to provide services to clients on an ongoing basis. You may be need to supplement the clinic's basic supplies of consumable items (e.g., chlorine bleach) or provide additional instruments needed for the procedure. The need for supplemental supplies must be determined in advance so that supplies can be procured before the course begins.

Appropriate service provision practices. 
It is critical that the site already be providing services, including counseling and recommended infection prevention practices, in a manner consistent with what will be taught and practiced. Although it may not always be possible to use sites that follow these procedures exactly, it is best to use clinics with practices that are as similar to them as possible. Using these kinds of sites will make the trainer's job as coach easier because the staff can serve as role models and guide participants in their practice. The participants will feel more comfortable if what they are learning is supported by what they see happening around them in the clinic.

Sites similar to those in which the participants work. 
Using sites similar to participants' work places makes the learning situation more real for them and demonstrates that what they are learning can actually be put into practice in their own work sites.

Staff who are receptive to having the participants. 
Most clinic staff members are open to the idea of participants coming to their work site to apply new skills?they have been in that situation themselves and may be again. If staff members are opposed to hosting participants, it is best not to use these sites because negative staff attitudes will undermine the creation of a positive learning environment.

Few clinic sites will meet all of these criteria. One of the most challenging issues will be differences between how services are routinely provided in the clinic and the standardized procedures and practices that are being taught in the course. The clinical trainer should work with the staff, explaining how the learning guides and checklists were developed and why the steps and tasks outlined are the safest and most efficient way to provide services, for both clients and clinicians. It probably will not be possible to change service provision practices immediately, but the trainer should make sure that the staff understands that the participants will be required to follow the checklists. The trainer should reassure the staff that the clinical trainer will be there to supervise the participants and make certain that clients are served safely and promptly.

Developing a good relationship with the staff will allow the clinical trainer to help overcome some of the other problems that may exist (e.g., lack of supplies to accommodate the additional staff in the clinic). Staff members need to know the objectives of the clinical experience, who the participants are and what they are capable of doing. This knowledge will help staff members to understand and carry out, as effectively as possible, their roles in training and supervising the participants.

Setting a good example for the staff is extremely important. It will take time and effort on the part of the clinical trainer, but every change that the staff comes to accept will improve the quality of the experience for the participants and the quality of services for the clients. Increasing the potential for improved quality is one of the most important reasons for beginning preparations for the clinical practice early.

Situation Response

This situation is a major problem and could have been avoided if the trainer or faculty member had visited the site in advance, talked with the supervisor, toured the clinic and discussed course objectives, number of participants, client caseload and related matters. Given that the course is underway, a solution needs to be found fairly quickly. First and foremost, apologize to the supervisor and explore any alternatives within that clinic. Second, consider looking for another clinic site (which may require additional transportation and an additional clinical trainer). Third, consider dividing the participants into two groups. One group can work in the clinic while the others practice in the classroom (e.g., working with models, participating in role plays).

Summary

Many of the problems encountered during a clinical skills course can be avoided through careful planning. Giving thought to participant selection, and then communicating with those attending and with their supervisors, will help ensure that the appropriate participants are present. Making arrangements concerning classroom and clinical facilities is the next critical step in planning the course. Reviewing the course materials and adapting them as necessary are also key components of the planning process. When the training course begins, the trainer will find that this careful planning was well worth the effort, and has helped to create an environment in which the successful transfer of knowledge, attitudes and skills can occur.

For more information about conducting a clinical skills course, contact Rick Sullivan.

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