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Contents |
Trainee’s Workbook |
Trainer’s |
Supervisor’s Guide |
| Overview of the OJT course | X |
X |
X |
| Responsibilities of the trainee, trainer and supervisor | X |
X |
X |
| Learning objectives | X |
X |
X |
| Syllabus | X |
X |
X |
| Course pre-test | X |
X |
|
| Course pre-test answers | X |
||
| Skill practice/assessment checklists | X |
X |
X |
| Course outline | X |
X |
X |
| Practice exercises | X |
X |
|
| Practice exercises answer key | X |
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| Course post-test and answers | X |
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| Course evaluation | X |
X |
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| OJT training skills information | X |
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| OJT supervisor skills information | X |
One of the keys to an effective OJT program is inclusion of a step-by-step guide for those involved in the course. In the Zimbabwe training package, this guide is referred to as the course outline (see Table 2). The course outline serves as a guide or map for the trainee, trainer, and supervisor. The primary focus is on the steps each trainee will follow as he or she works through the course. For those steps requiring interaction with the trainer or supervisor, there are directions about what should be done. Trainees check off each step as they complete them. This helps each trainee keep track of his or her progress through the course. At key points in the course outline, the trainer will sign the outline to indicate that the trainee is making satisfactory progress.
Table 2. Portion of an OJT Course Outline
Trainee Activities
Trainer Activities
Supervisor Activities
Day 1 INTRODUCTION __ Read the "Introduction" in the Trainee's Workbook.
NA NA __ Meet with your OJT Trainer. Meet with the trainee to discuss the OJT course goals and objectives, review the training package and then discuss the responsibilities of the trainee, trainer and supervisor. Review the OJT course outline and explain that the trainee should mark and date each step as it is completed. The trainer will sign off each section.
Discuss the pre- and post-training knowledge and skill assessments.
NA __ Complete the course pre-test. Administer and score the pre-test following the guidelines found in the Trainer's Guide. NA __ Complete the pre-training skill assessment (counseling). Administer and score the pre-training skill assessment (counseling) following the guidelines found in the Trainer's Guide. NA __ Complete the pre-training skill assessment (medical examination). Activities completed:
___________ ______
OJT Trainer DateAdminister and score the pre-training skill assessment (medical examination) following the guidelines found in the Trainer's Guide. When the trainee has completed the knowledge and skill assessments, sign and date this section.
NA Days 2-3 INTRODUCTION __ Read Chapter 1: Introduction to Medical Examinations in the reference manual.
NA NA __ Complete Practice Exercise #1. NA NA
By the conclusion of the materials development workshop, the participants had completed work on all components of the workbook and guides. Following the workshop, the materials were turned over to JHPIEGO’s materials development staff for editing and formatting. In addition, to ensure that the materials were clear, training experts who were not involved in the development process reviewed the draft materials. Copies were also returned to Zimbabwe for review by the individuals involved in the development workshop. Once all changes were made, copies were prepared for use during the training of the OJT trainers and supervisors.
The newly developed OJT package was presented at a meeting of key Zimbabwean policymakers and decision makers in February 1996 to orient them to the approach and to ensure their support for implementation of the OJT pilot test. Each participant received a copy of the OJT package for reference and review. Those ZNFPC and MOH/CH personnel who developed the materials conducted the following sessions:
- overview of clinical training to date
- overview of the OJT approach and the Zimbabwe-specific OJT model
- essential training elements and the OJT program
- criteria for OJT site and staff selection
- roles and responsibilities of OJT staff
- implementation plan
The recommendations that participants made during the course of the meeting were incorporated, as appropriate, into the OJT package and implementation plan.
Following the national orientation, the national OJT coordinator, in collaboration with technical resource staff at the ZNFPC, worked with the MOH/CW to identify appropriate sites and personnel for the OJT pilot test. Criteria for site selection were presented in the OJT package. The OJT supervisor at each site was the nurse-manager in charge of the site, who already had supervision responsibilities. The supervisor in conjunction with provincial management selected the OJT trainer, who was generally already proficient in the clinical skills in which he or she would be conducting training. The process of selecting trainees for the pilot test varied from site to site. At some locations, the supervisor of the site selected the trainee; at other sites, service providers interested in being trained completed applications and were then interviewed by the supervisor.
Once sites and personnel were identified, ZNFPC technical resource staff visited each location to confirm the MOH’s information and to ensure each site’s readiness for training (for example, by assessing equipment and checking for adequate training space). ZNFPC staff also collected baseline information on the site and OJT personnel (supervisor, trainer, and trainee) that would eventually be used in evaluation of the pilot test. Key information gathered included statistics on delivery of the clinical method in which the trainee was going to be trained. ZNFPC hoped to see an increase in the number of clients accepting the family planning method following completion of training. Many of the sites selected for the pilot test were not currently offering the method. ZNFPC anticipated that this would change following training, however, and that service provision of this method would increase.
Essential to the success of an OJT course is the preparation of the trainer and, if applicable, the OJT supervisor. In some situations the trainer may be a proficient worker with little or no previous training experience who has been designated as an OJT trainer. In other situations this individual may be an experienced group-based trainer who is now conducting training one-on-one on the job. In both situations it is critical that these trainers be prepared to conduct OJT.
Although the individuals designated as trainers at the OJT pilot sites in Zimbabwe were practicing clinicians, many had little or no previous preparation as trainers. A workshop focusing on OJT training and supervisory skills was designed and conducted for the trainers and supervisors from the pilot sites. The schedule for the OJT implementation workshop contained a number of sessions and activities to prepare these trainers and supervisors to conduct the OJT program. Participants read supporting information in their training package and then attended sessions focusing on the following:
- an approach to clinical training
- creating a positive training climate
- using interactive training techniques
- using skill-development learning guides and skill-assessment checklists
- coaching in clinical training
- combining coaching with other clinical training techniques
Participants observed trainer demonstrations and then were given opportunities to present a clinical demonstration using anatomic models, coach another participant practicing a skill, and assess a clinician’s ability to perform a skill according to the steps in the skill checklist. Each participant was then given the opportunity to deliver one or more presentations and received immediate feedback from the trainers and other participants.
In addition to the sessions described previously for the trainers, sessions specifically designed for the OJT supervisors included:
- orienting site staff to the OJT program
- communicating with the national OJT coordinator
- conducting the final knowledge assessment
- conducting the final skill assessment
- conducting supervisor visits
A significant portion of the workshop was devoted to orienting the participants to the OJT approach. Participants reviewed the responsibilities of the trainee, trainer, and supervisor. There were lengthy discussions of the OJT site-selection criteria, equipment and supply requirements, trainee learning objectives, use of the OJT course outline, and use of the pre- and posttraining knowledge assessments. Participants were also afforded many opportunities to review and use the skill-development learning guides and skill-assessment checklists. The workshop training resulted in a group of OJT trainers and supervisors prepared to conduct the OJT pilot test.
During several sessions at the OJT supervisor and trainer workshop, participants discussed the status of their facility as an OJT site and set dates for site orientations. The OJT supervisor at the site conducted this orientation, which was made up of two parts: introduction of the new clinical method that would now be available at the site, and orientation to the OJT approach. Both JHPIEGO and ZNFPC felt it was crucial that to avoid misunderstandings regarding how a trainee would be spending his or her time, all staff at the site understand what would be taking place. Supervisors practiced giving these orientation sessions at the OJT supervisor and trainer workshop, and the trainers and participants gave them feedback.
After returning from this workshop, the OJT supervisors, with technical assistance from the ZNFPC, conducted the site orientations. The orientation involved all staff at an OJT site, and they had an opportunity to examine the training materials, review briefly the training schedule, and discuss how it might affect each of their roles in carrying out daily activities.
The pilot test focused primarily on examining the feasibility of implementing structured OJT for clinical training. The test was conducted at 15 sites in Zimbabwe and covered a period of four months so that at least two trainees could be trained at each site. The structure of the pilot test allowed for dealing with issues that could affect training during the first trainee’s learning period (such as logistics and scheduling) so that an accurate view of the feasibility of OJT could be compiled.
The ZNFPC monitoring activities were a key part of the pilot test. Monitoring technical assistance from the ZNFPC was multifocal. There were site visits made at the beginning of the pilot test, often concurrent with the site orientations to launch OJT. Communication (often by telephone) was maintained regularly during the pilot test, and at least two site visits were made, once during each trainee’s training period. The ZNFPC, usually with a representative from JHPIEGO, visited the OJT training site, primarily to ensure that needed midcourse corrections could be made in the OJT implementation strategy if assumptions were not holding true. In fact, during these visits, we determined that trainees were closely paralleling the time estimates made for completing the OJT program (six weeks) through a variety of work-routine scheduling adaptations and that all logistics had been ensured.
Synthesis of the results of the pilot test includes examining both the feasibility of implementation as well as identifying potential problem areas when scaling up to full implementation. In Zimbabwe during late 1997, these results were presented at a national forum of key decision makers in the field of reproductive health training (policymakers, program implementers, trainers, service delivery managers, donors, and implementing agencies). Key decision makers at the forum reviewed the pilot test experience, focusing on the effect of the OJT on the daily work routine (that is, service delivery), and recommended ways to expand the structured OJT approach into appropriate settings and topics for additional OJT packages.
The recommendations of the key stakeholders who attended the forum to review the results of the pilot test were then reviewed by senior managers within each agency to determine how the expansion of the existing OJT program could be effected. The process for agency approval includes determining the demand from the field sites and the appropriateness of the OJT strategy already defined for their agency.
In Zimbabwe, the national OJT coordinator has received numerous requests from other sites that have heard about this training approach and have asked to be designated as OJT sites. If the decision is made to continue this training program, these sites will be assessed for adequacy as OJT sites (by applying the same criteria used to select the pilot test sites), OJT staff will be selected, the OJT supervisor and trainer will be oriented and trained, and the site will be oriented to the approach and the clinical method, following the same implementation plan used in the pilot test.
The purpose of the pilot test was to implement OJT in a small number of sites to ensure that it was a viable approach to training. Based on the results of the pilot test, revisions to both the strategy and the training materials were recommended. Fortunately, due to the time and effort invested in the design of the strategy and development of the materials, the necessary revisions were minimal.
In terms of the OJT strategy, there were two primary revisions. The first related to the way that OJT was implemented within each of the pilot sites. The approach as originally designed offered only one way for the trainee to move through the course. The course outline gave detailed steps outlining what the trainee and trainer should do at each step in the learning process. In reality, three variations on the OJT approach evolved during the pilot test. For example, the approach as designed was based on the assumption that trainees would be working within their own sites. In several sites, however, trainees traveled a short distance to a neighboring site to participate in the course. These trainees carried their materials back and forth and completed all the reading assignments and practice exercises at home. All skill aspects of the training course were completed at the pilot site. As a result, the OJT program descriptions will now include several implementation options.
The second revision to the basic strategy related to follow-up and monitoring once an OJT course has been implemented. It appears that two of the most critical elements in an OJT approach are the interaction between the trainer and trainee, and between the trainer and supervisor. To help improve these interactions, additional information will be added to the training package and to the workshops for the trainers and supervisors.
The revisions to the training materials included the following:
Revision of the trainee’s instructions for use of the course outline. Some trainees did not understand how to use the course outline. Although the trainer could explain it to them, it was felt that the instructions should be self-explanatory.
Revision of the practice exercises. In light of the trainees’ discussions with their trainers about the practice exercises, the trainers recommended several ways to improve the relevance of the exercises.
Correction of mistakes in the Reference Manual. Even after several editions of the reference manual, minor errors were identified. This was viewed as a good sign that trainees really were reading the Reference Manual.
After a sound strategy has been developed, training materials have been revised, and support of the key players has been achieved, it is time to move ahead with full implementation. The implementation plan will likely include many of the steps presented in Figure 1. The primary steps in the implementation plan include:
- identifying training sites and staff
- training the trainers (and supervisors if applicable)
- establishing an implementation timeline
- monitoring the phased implementation of OJT
- evaluating the effectiveness of the OJT training course
(continued)