Much controversy surrounds the issue of determining qualification in clinical
training. Most trainers believe that clinicians are qualified to perform a procedure
or activity only when they have demonstrated a defined level of skill competence and can
maintain that level after training. In practice, objective measurement of clinical
competence during training may be very difficult, and it is still more difficult to
measure competence after training.
Because of this, in the past many organizations equated being qualified with completion
of a specified number of supervised procedures. Clearly, while some participants can
achieve competency after only a few practice cases, others may require several more, and a
very few may never achieve an acceptable level of competency. Therefore, determining
whether or not a participant is qualified should be based on observed and measured
performance using competency-based (knowledge, attitude and skill) assessments rather than
on the number of procedures performed.
When anatomic models and other competency-based training aids are used for initial
skill acquisition (e.g., training in IUD insertion), nearly all participants will be
judged to be competent after only a few cases with clients. Proficiency,
however, invariably requires additional practice. Therefore, when training participants
who will become new service providers (i.e., they have had no prior experience), each
participant may need to perform the procedure with at least 5 to 10 clients in order to
feel confident about her/his skills. Thus, the judgment of a skilled clinical
trainer is the most important factor in determining whether the participant is qualified.
Qualification usually is based on the participant's achievement in three areas:
- Knowledge. A recommended score of at least 85% on the Midcourse Questionnaire
- Skills. Satisfactory performance of clinical counseling activities and skills as
evaluated by the clinical trainer using a competency-based skills checklist. In
determining whether the participant is competent, the clinical trainer(s) will observe and
rate the participant's performance for each step of the skill or activity.
- Practice. Demonstrated ability to provide client services in the clinical
setting. During the course, it is the clinical trainer's responsibility to observe each
participant's overall performance in providing client services. This provides a key
opportunity to observe the impact on clients of the participant's attitude—critical
component of quality service delivery. Only by doing this can the clinical trainer assess
the way the participant uses what s/he has learned.
Qualification is a statement by the training institution(s) that the participant has
met the requirements of the course in knowledge, skills and practice. Qualification does not
imply certification, which is granted only by an authorized organization or agency.
Source: JHPIEGO Fact Sheet. March 97.
