Providing participants with good counseling and clinical skills is one of the central
purposes of most family planning training courses. Being able to measure learning
progress satisfactorily and evaluate performance objectively are extremely
important elements in the process of improving the quality of clinical training.
It is the responsibility of the clinical trainer to determine whether each participant
has achieved the knowledge, attitudinal concepts and skills defined in the training course
objectives. This is accomplished through the use of knowledge and skill assessments. When
these assessments are based on the mastery learning approach to clinical training,
learning is measured through the following means:
- Initial assessment of each participant's and the group's general knowledge and skills in
the course topic. Such preliminary assessments guide the clinical trainer and participants
in their work together during the course.
- Continual assessment of each participant's mastery of the knowledge and skills defined
in the course objectives.
Assessment of knowledge (testing) is an important factor in determining the success
of training. Knowledge assessment is conducted to:
- Determine participant knowledge of the subject at the beginning of the course
- Motivate the participant to acquire new knowledge
- Determine whether progress has been made toward achieving the training objectives
Skill Assessment
The use of competency-based skill assessments (learning guides and checklists), which
measure clinical skills or other observable behaviors relative to a predetermined
standard, have made the task of determining a participant's competence much easier. While learning
guides are used to facilitate learning the steps or tasks (and sequence, if
necessary) in performing a particular skill or activity, checklists are used to evaluate
performance of the skill or activity objectively.
A learning guide contains the individual steps or tasks in sequence (if
necessary) required to perform a skill or activity (e.g., counseling a client or inserting
an IUD) in a standardized way.
Learning guides are designed to help the participant learn the correct steps and the
sequence in which they should be performed (skill acquisition). They also measure
progressive learning in small steps as s/he gains confidence and experience (skill
competency) in performing the procedure or activity.
The checklist is derived from the learning guide. Unlike learning guides, which
are of necessity quite detailed, competency-based checklists focus only on the key steps
or tasks. Well-constructed checklists should contain only sufficient detail to permit the
clinical trainer to evaluate and record the overall performance of the skill or activity
objectively.
Using learning guides and checklists in competency-based clinical training:
- ensures that training is based on a standardized procedure,
- ensures that all participants will have their skills measured according to the same
standard, and
- forms the basis for followup feedback (coaching) and evaluation.
Training clinical trainers to use competency-based performance instruments reliably,
such as those described above, provides an opportunity to assess competency based on
demonstrated performance and application of knowledge in the clinical setting rather than
"lecture time" or "number of practice cases performed."
Followup Monitoring of Training
It is recommended that, if possible, course graduates be observed and evaluated in
their own institution, within 3 to 6 months of completing the course, by a course
trainer using the counseling and clinical skills checklist that was used in the
course. (At the very least, the graduate should be observed by a skilled provider
soon after completing training.) This postcourse evaluation activity is important for
several reasons. First, it provides the graduate direct feedback not only on
her/his performance, but also provides the opportunity to discuss any startup problems or
constraints to service delivery (e.g., lack of instruments, supplies or support staff). Second,
and equally important, it provides the training center, via the clinical trainer, key
information on the adequacy of the training and its appropriateness to local conditions.
Without this type of feedback, clinical training easily can become routine, stagnant and
irrelevant to service delivery needs.
Source: JHPIEGO Fact Sheet. March 97.
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