Top 10 in Training: Reflections from the Best Practices in Training Conference
(October 2002)

In May 2002, a conference entitled, "Training: Best Practices, Lessons Learned and Future Directions," was held in Washington, D.C. The focus of the conference was to examine best training practices used in international healthcare settings, with particular emphasis on family planning and reproductive health. In addition, training practices that have been employed successfully in sectors other than healthcare were examined and discussed for their applicability to reproductive health programs. The conference was organized by JHPIEGO Corporation in collaboration with the Office of Population and Reproductive Health of the United States Agency for International Development (USAID) and a number of USAID Cooperating Agencies.

The goals of this conference were to:

• Examine training practices identified as the best according to evidence and objective data
• Share lessons learned from implementing training in a variety of settings, and
• See what the future holds for training.

The 2-day conference featured three general session speakers and approximately 30 concurrent session speakers for an audience of about 200.

The next series of training articles will summarize some of the key presentations made during the conference. To begin, Dr. Rick Sullivan, Director of Learning and Performance Support at JHPIEGO Corporation, compiled a list of the top 10 best practices and lessons in training learned at the conference. The Top 10 items appear below, as well as an explanation of terminology used in the list.

Terminology

1. Learning: acquisition of new knowledge and skills (attitudes integrated with skills)
2. Education: acquisition of new knowledge and skills for application in the future (e.g., nursing preservice education)
3. Training: acquisition of new knowledge and skills for immediate application on the job (e.g., inservice training) 
4. Best Practices: practices that have been shown to produce superior results; selected by a systematic process; and judged as exemplary, good or successfully demonstrated.
5. Lessons Learned: Crosscutting observations and conclusions that apply to a specific practice. Lessons are drawn from positive and negative experiences with specific training practices, processes and methods. Evidence supporting the lesson is clear and objective.

Best Practices and Lessons Learned

1. Training interventions should be designed and implemented within the performance improvement (PI) process.

This process can be summarized as:

• Obtain and maintain stakeholder agreement
• Consider the institutional context
• Conduct a performance needs assessment (desired performance actual performance, identify gaps)
• Find root causes
• Select interventions
• Implement interventions
• Monitor and evaluate performance

2. Training interventions and materials should be designed, developed and implemented using principles of instructional design.

What is Instructional Design?

• Instructional design (or instructional systems design -- ISD) is the systematic development of instruction using adult learning and design theories and techniques.
• The 5 phases of most ISD models are:
  • Analysis
  • Design
  • Development
  • Implementation
  • Evaluation

What are the similarities between PI and ISD?

• Comparing PI and ISD, we see:
  • PI: Performance Needs Assessment and Root Cause Analysis = ISD:Analysis
  • PI: Select Interventions = ISD: Design and Development
  • PI: Implement Interventions = ISD: Implementation
  • PI: Monitor and Evaluate Performance = ISD: Evaluation

3. Training interventions should be implemented using a variety of learning approaches.

These approaches include:

• Group-based learning
• Individual learning
• Structured on-the-job training (OJT)
• Distance learning
• Technology-assisted learning
• Self-study (print, computer-based)

4. Training interventions should include well-designed learning materials.

Learning materials may consist of:

• Reference manual or document to keep
• Guide for the participant (e.g., syllabus, schedule, pre-test, exercises, performance checklists)
• Guide for the trainer (e.g., outline, post-test, answers, training exercises, checklists)
• Supporting audiovisuals (e.g., PowerPoint presentations, posters, training aids, suggestions for flip charts)
• Simulations (e.g., instructions for role plays, anatomic models)

5. Training interventions should include a variety of interactive learning methods.

These methods include:

• Interactive presentations
• Questioning
• Case studies and role plays
• Brainstorming and discussions
• Problem-solving activities
• Guest speakers
• Simulations
• Work with clients/patients
• Variety of audiovisuals

6. Training interventions focusing on clinical skills should require providers to demonstrate competency in a simulation before working with clients and patients.

What skills are included in demonstrating competency?

• Skills demonstrated within a simulation (anatomic models, role plays)
• Skills practiced and assessed within a simulation (including feedback from the trainer)
• Skills demonstrated followed by practice and assessment with clients and patients

7. Training interventions to improve provider performance should be linked to the preservice education system.

Why link provider performance with preservice education?

• The goal is to strengthen preservice education and reduce need for inservice training.
• Clinical training sites can be shared to serve both inservice and preservice needs.
• Learning materials can be used within both inservice training and preservice education.
• Faculty development is an additional benefit (including development of clinical preceptors).
• Linking preservice and inservice leads to strengthened curriculum and/or courses.

8. Training interventions should be implemented by qualified trainers.

Use of qualified trainers results in:

• Structured development process
• Clear criteria (e.g., clinical, advanced and master trainers)
• Development of supporting materials (e.g., train-the-trainer courses)
• Opportunities to conduct training while being observed, coached and provided feedback

9. Training interventions should include transfer of learning strategies.

What is Transfer of Learning?

• Transfer of learning is ensuring knowledge and skills acquired during training are applied on the job.
• Key players include the supervisor, worker as learner, trainer and the co-workers.
• Specific strategies are implemented before, during and after training.

10. Training interventions should include the first three levels of Kirkpatrick's four-level evaluation model(1).

These evaluation levels are:

• Level 1: Participant reaction (feedback form)
• Level 2: Participant learning (tests, checklists)
• Level 3: On-the-job performance (follow-up and transfer)
• Level 4: Effect of training (long-term impact)

For more information about the Training: Best Practices, Lessons Learned and Future Directions Conference held in the U.S. in May 2002, contact Rick Sullivan at rsullivan@jhpiego.net

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(1) Kirkpatrick, D.L. (1959). Techniques for evaluating training programs. A four part series beginning with the 1959 issue of Training Director's Journal, USA.

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