Alternative Learning Methods: Group-Based Learning 
(Part 2 of 5) (October 2001)

The most common approach to learning new knowledge, attitudes and skills is the group-based course. In this approach, whether it is an inservice course or a preservice class or lecture series, there is a group of participants and one or more trainers. The trainers deliver interactive presentations and demonstrations based on an existing learning package or curriculum. The participants interact, take notes, participate in classroom exercises (e.g., case studies, role plays, practice with models) and demonstrate mastery of the learning objectives. In the clinic, the trainers demonstrate skills and coach and assess participants as they practice and demonstrate competency in these skills while working with clients.

This group-based learning approach for a clinical skills course is described more fully below.

• In order to focus training on essential (need-to-know) information, trainers and participants use a learning package that contains the reference manual, course handbook for participants, course notebook for trainers, course-specific audiovisuals (e.g., videos) and other learning aids (e.g., anatomic models).
• Trainers at the course site transfer knowledge and skills to the participants through a series of classroom presentations based on the reference manual. These sessions are highly participatory, interactive and use a variety of learning materials, including anatomic models and audiovisuals.
• Pre- and midcourse questionnaires are administered to ensure that the process of transferring knowledge is effective.
• Learning guides and checklists are used to measure progress in learning skills or other observable behaviors relative to a predetermined standard. Learning guides facilitate participants' learning of the steps or tasks in performing a particular skill. Checklists objectively evaluate participants' performance of the skill.
• Progress through the course is based on participants demonstrating their competence rather than on performing a specific number of procedures or spending a certain amount of time in the clinic.
• The trainer demonstrates service delivery skills (e.g., counseling, IUD insertion and removal) using clinical role plays and anatomic models. The steps in performing these skills are outlined in learning guides that participants follow during demonstrations and practice sessions.
• As participants practice their newly acquired skills during role plays and with anatomic models, the clinical trainer functions as a coach to observe, provide feedback and ensure that the transfer of skills is successful. In addition, participants guide and assess one another using learning guides and checklists for practice. The checklist for practice is the same checklist the trainer uses as a final evaluation tool for determining if the participant is competent in performing the counseling and clinical skills.
• When participants have attained skill competency using models, they move to the clinic. The trainer demonstrates the procedure with clients while one or more participants observe and refer to the checklist as a reminder of key steps. As participants apply their newly acquired skills with clients, the clinical trainer continues to function as a coach and observes, provides feedback and ensures that the counseling and clinical skills are being performed correctly.
• During the last 2 to 3 days of the course, the trainer uses a checklist to evaluate each participant's competency in performing counseling and clinical skills.
• Participants who demonstrate mastery of information (i.e., achieving at least 85 percent correct on the midcourse questionnaire), skills (i.e., correctly performing the steps in the checklist) and practice (i.e., providing services competently to clients in the clinic) receive a statement of qualification that identifies the knowledge and skills mastered during the course.
• Although group-based training is the approach with which most healthcare professionals are familiar, it is not necessarily the best method for transferring knowledge, attitudes and skills. The advantages and limitations of group-based training are listed below.

Advantages

• Being part of a group can generate excitement and a feeling of camaraderie among participants.
• Participants learn from one another.
• Interaction among participants can add richness and depth to the learning experience.
• Participants are available to take part in demonstrations and role plays and assist with coaching one another.
• The trainer is able to focus full attention on the learning process.
• The trainer is able to ensure the quality of the learning experience.
• It is easier to standardize knowledge and skills because all participants receive the same information in the same way (if the course is delivered as designed). 
• The courses are highly visible events, often providing positive recognition for both the clinical training site and the participants.

Limitations

• Individuals requiring training must wait for the next scheduled course.
• A minimum number of participants is needed, and there is usually a maximum number that can be accommodated.
• Participants must temporarily stop providing services at their clinical sites in order to attend training.
• Primarily, the trainer determines the pace of learning.
• Each trainer may deliver training differently or emphasize different aspects of the information (if the course is not delivered as designed).
• It can be difficult for the trainer to accommodate each participant's learning style.
• Trainers may have limited options when an inappropriate participant attends the course.
• A large client caseload is needed at one time so that all participants can have adequate clinic experience.
• The arrival of a large number of participants at a clinic may create challenges for clinic staff.
• Large quantities of materials and supplies must be obtained and stored.
• There may be costs associated with participant attendance (e.g., travel and per diem) and facilities rental.

Relying solely on group-based learning can severely tax the limited resources of a national training system. As mentioned above, only small numbers of providers can be trained at one time, making it difficult to have an immediate impact on meeting the demand for trained providers. In addition, the quality of the training may lessen as trainers give the same course repeatedly. Finally, it is often a better use of resources to have a trainer working with learners in the clinic as services are being delivered, rather than spending time in the classroom. These constraints have led trainers to look for alternative learning approaches, particularly for how to deliver the knowledge portion of a course. Most of these other approaches use a form of self-paced learning. 

The next installment will review the advantages and limitations of self-paced learning as an alternative learning method. 

For more information about alternative learning methods, contact Rick Sullivan.

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