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In testing a new type of training, there is a two-pronged approach to assessment of the
effect. In the short term, as described briefly under the “present pilot test
results” step of the model, the feasibility of implementing structured on-the-job
clinical training within existing clinic settings in various organizational types (for
example, MOH/CW, ZNFPC) was examined. The monitoring and evaluation strategy for this
focused on a mixture of data-collection methods. Baseline data established the conditions
at the work delivery site prior to the OJT pilot test. These data included documentation
of existing caseloads and existing clinic stocks as well as the usual work routine at the
site, and summaries of logbooks, stock records, and service statistics.
The monitoring activities (as described under “visit OJT sites”) documented
how the pilot-test implementation was proceeding. At each site, interviews of the OJT
supervisor, trainer, and trainee (and other personnel, as available) and site visit notes
from observations during the visit day documented attitudes toward the training process,
perceived and actual changes in the work routine during the training period, and changes
in client experience at the work site. Monitoring also included examination of the OJT
Trainee Workbook and analysis of the trainee’s progress to date through the dating of
the completed activities (that is, comparing expected versus actual completion of a
section) and review of the cases and experiences that support the structured OJT plan.
Key questions examined in the monitoring visits included the following:
Trainee progress: How long does each trainee take to complete the OJT
sequence?
Appropriateness of training topics and sequence: How does the training
sequence work? Are trainees having problems with a particular section, practice exercise,
trainer-trainee practice sessions, and the like?
Implementation problems: Are there problems with supplies, equipment, or
other site issues that hinder effective OJT?
Service delivery: What effect does OJT have on service delivery? What
strategies have clinics used to minimize the disruptions?
Evaluation of the OJT pilot test experience focused on feasibility of implementation,
answering the questions outlined above and using a variety of assessment tools.
Information from the Trainee Workbook documented the length of the trainee’s training
period, the numbers of cases (by type) seen during the training period, and any problems
arising that affected training. After the OJT supervisor’s review, this information
was submitted to the national OJT coordinator. The supervisor compiled the trainee’s
scores on the knowledge assessment and skills checklist and then submitted them to the
national OJT coordinator.
The pilot test results were compiled through the middle of 1997. Analysis involves a
synthesis of the quantitative data such as service statistics and date progression through
the training outline, scores on knowledge assessments, and demonstrated competency on the
skill checklist. This analysis is then supported with in-depth interview information,
documenting both knowledge and skill transfer along with the success of implementing this
training approach.
The longer term assessment, occurring three to six months after the pilot test, will
evaluate the ability of structured OJT to produce service providers competent in the
clinical skill offered in the training. This evaluation will compare and contrast
clinicians trained in group-based (traditional) courses and those trained through the OJT
mechanism to determine the advantages, disadvantages, and appropriate use of each training
approach in Zimbabwe. The hypothesis is that there is no difference between the training
approaches in producing competent clinicians.
The implementation of the structured OJT approach has gone very well at 15 sites in
Zimbabwe. Trainees are receiving training in a clinical skill needed for their work, and
they value the training because it provided them an opportunity to receive training when
they would likely never have been selected to attend a group-based training course. In
addition to elaborating the ways in which the approach is being applied, we have
identified the key elements that demonstrate its success and can lay to rest commonly
asked questions about training that takes place at the job site.
During the pilot test we identified three different models of how OJT is being applied:
true OJT, temporary OJT to train staff for other clinics, and site training for hospital
rotation needs. These three models occur at different kinds of clinic sites and thus are
an adaptive mechanism by the OJT trainers and trainees to use this innovative training
approach.
True OJT: The trainer and trainee are both at the same clinic and work
together in training.
Temporary OJT to train staff for other clinics: Staff travel from a
nearby location to the clinic for the training period.
Site training for hospital rotation needs: In some cases, trainees and
trainers are working together in a location where the trainee is not assigned. The trainee
has to free up time during the workday to leave the ward or clinic and go to a clinic area
either to work with the trainer or work on self-study materials.
The several elements that demonstrate and support the success of implementing
structured OJT in Zimbabwe can be categorized into two topics: the training approach of
structured OJT and the effect of the training on the work site. As the elements are
discussed under the relevant topic, the following issues and hypotheses, raised initially
in the planning stages for the OJT pilot test, are discussed and dispelled:
Trainees won’t be able to find time to do the training during work
hours.
Trainees will be reluctant to do self-study (for example, reading,
practice exercises).
Trainees won’t learn the theoretical knowledge first but will go
straight to the practical skills work.
Trainees won’t be able to do the work at their own pace.
OJT may have a negative effect on the work routine at the site.
A key element of the structured OJT program was the empowerment for many staff to be
involved in training. Ownership of the training has been decentralized to the work site,
and both the trainers and the trainees identify this training program as their own.
Although trainee selection was more formalized at some sites (with use of an application
process, for example), staff at the sites feel they are more likely to have an opportunity
for receiving training with the OJT strategy than for being selected to attend a
group-based training course.
The formal recognition of the training at the site by all staff meant a positive
training climate and attention by all staff to ensure the success of the training. Key to
this were the site orientations held just prior to the launch of the OJT pilot test.
The guided training plan for the structured OJT provided a focus for supervisors to do
the training they consider part of their regular duties. Although the trainer in many
instances directs the training, both trainer and trainee feel comfortable with this role
and interaction.
There was a personal and professional commitment by the trainees to the training
process. Trainees were able to do the work at their own pace and were motivated to
progress through the training outline; they were finishing the training in about six
weeks, the expected schedule. In spite of some people’s skepticism that trainees
would do self-study, by reading, practice exercises, and the like, the trainees were
working systematically through the practice exercises, documented by the completion in the
Trainee Workbook and supported in some cases by the OJT trainer’s review and notes on
the exercises themselves.
There was concern as well that trainees would not learn the theoretical knowledge but
would go straight to the practical skills work. However, trainees did not go straight to
the practical training, in part because of the value they attached to being able to
receive training in the skill. The training was also a mechanism for them to interact with
other staff, a situation that doesn’t usually occur in their work. Interaction with
the OJT trainer was, for some, “permission” for them to ask questions.
The institutional commitment to the OJT process was also demonstrated. Despite the
expectation to the contrary, trainees were released during work hours to spend time
reading and practicing. Most clinics configure their own work routines so training time
was adjusted around the client flow and busy clinic times. This scheduling meant being
able to take advantage of varying clinic hours-time available when few clients come
(usually in the afternoon) so the trainee and trainer can work on practice exercises and
with anatomic models, and then switching to the busy clinic times when more clients come,
once the trainee is ready to work with clients.
The OJT taking place at each clinic has had a positive effect on clinic services and
has caused a change in the service profile, disputing the expectation that OJT would have
a negative effect on services because the training would take time away from the clients.
At almost every site, staff felt that OJT has been a positive influence. The number of
clinical procedures (the focus of the training) has increased. In some sites,
word-of-mouth about the training making a new service available has meant more clients
coming for this service. In addition, the trainees have added information about this new
service to their initial interviews and so are able to inform new clients about an
additional service. This practice within the work setting means that every client contact
is an opportunity for the trainees to apply their new skills as they expand the range of
services available at the clinic.
Structured OJT can be implemented in many settings. Many factors play a part in making
an OJT program effective. Some of those that contributed to the success of the Zimbabwe
OJT program include the following:
- development of the strategy paper
- adaptation of a group-based course
- recognition of the importance of consensus-building activities
- involvement of the end users of the program
- development of a comprehensive training package
- training of key personnel before the pilot test
- follow-up site visits
The development of an organizational strategy paper forced JHPIEGO staff to wrestle
with a number of design and philosophical issues before moving into development of
materials and training of trainers. This internal consensus-building effort helped staff
make key decisions before investing time and resources in other activities. Another factor
was the decision to convert an existing, instructor-led course to OJT instead of
developing a new course. This allowed staff to work with a proven training package and to
take advantage of existing materials. Also, the trainers in Zimbabwe were already familiar
with the group-based training package, thus it was easier to orient them to a converted
package than to introduce a new training approach and new materials at the same time.
One of the main lessons learned related to the importance of consensus-building
activities. Because OJT involves a number of job-site staff in the training process,
securing the support of key stakeholders at all levels was a significant factor in the
success of the program. Another important factor was the involvement of the end users in
the design, development, and implementation of OJT. Once again, when inserting training
into the workplace, it is important to involve both potential trainers and trainees in the
development of the training approach and materials. The development of a comprehensive
training package was also a significant factor that contributed to the effectiveness of
the OJT program in Zimbabwe. Ensuring that those involved in OJT had complete reference
materials, assessment instruments, and instructions on how to conduct training helped
learning to occur as designed. Also critical to the program’s success was the time
and effort invested in training the trainers and supervisors before the pilot test. This
helped to ensure that these key individuals understood their roles and responsibilities
and were prepared to follow the guidelines in the training package. Finally, the follow-up
site visits reinforced the importance of the new training approach and provided ZNFPC
trainers an opportunity to observe, coach, and assist the new trainers.
The use of structured OJT is a relatively new concept in international training of
health professionals. Can the lessons learned from this innovative OJT effort in Zimbabwe
be applied to other training situations? Yes! It is obvious from the design and
development process in Figure 1 that these same steps could be applied to
the implementation of structured OJT in almost any setting. Although the specific
consensus-building activities would change, the importance of involving key stakeholders
at various points along the way would not.
With the increasing use of electronic performance support systems, computer-based
training, Internet-based training, and a myriad of other technology-assisted learning
approaches, it is obvious that the shift from instructor-led training to self-paced,
on-the-job training will continue. The approach used to implement structured OJT
successfully in Zimbabwe can serve as a model for those interested in using structured
on-the-job training in their organization.
What factors led to the recognition of the need for a structured OJT
course instead of a traditional instructor-led course?
Describe the importance of the consensus-building activities that
paralleled the design and development activities.
What was the purpose of developing the organizational strategy paper
focusing on OJT before developing the OJT materials?
Why was the development of the OJT-training package such a critical
factor in the success of the OJT course?
This case took place in Zimbabwe. How could the approach used in this
case be applied to organizations outside of international health?
Rick Sullivan completed his Ph.D. in vocational-technical
teacher education at the Ohio State University in 1982. Following this, he served as a
professor in the Occupational and Technology Education Department at the University of
Central Oklahoma, where he was responsible for the training and development degree
program. Sullivan has developed training presentations and programs for numerous
organizations including the Marine Spill Response Corporation, Exxon Research and
Engineering Company, United States Postal Service, Exxon Company USA, and the
International Ironworkers Union. He served as a training skills consultant for JHPIEGO
before joining the corporation in 1994 as director of training, where he is responsible
for overseeing the design and delivery of training activities for medical professionals in
a number of countries. Sullivan has written several books and over 50 articles and other
publications in a variety of professional journals. He has presented papers and
presentations at many national conferences of organizations such as the American Society
for Training & Development and the American Vocational Association. He can be reached
at JHPIEGO Corporation, 1615 Thames Street, Baltimore, MD 21231-3447; phone: 410.614.3551;
e-mail: rsullivan@jhpiego.org.
Sue Brechin completed her doctorate in public health
(Dr.P.H.) at Tulane University in 1993, having finished her MPH there in 1983. She
received her Bachelor of Science in nursing from the University of Rochester School of
Nursing in 1973 and her family nurse practitioner certificate from the University of Miami
School of Nursing in 1979. She has lived and worked in nine countries over the past 20
years, with experience ranging from clinical nursing and ambulatory care to rural-based
health program activities, operations research, training materials development, and
program management. Brechin has served as a consultant for a number of international
development organizations. In 1995, she joined the JHPIEGO Corporation, where she is
director of research and evaluation, responsible for monitoring and evaluation of the
organization’s programs in 30 countries and applied research activities to support
country training program needs. She has published articles, made conference presentations,
and written operations papers and evaluation reports on health aspects of international
development work.
Maryjane Lacoste has worked since 1992 in the design,
implementation, and management of reproductive health training programs. She currently
serves in two key roles at JHPIEGO. As program development officer for the East and
Southern Africa Office, she is responsible for all programming efforts in Zimbabwe, where
she has played a key role in introducing on-the-job training. She also works on the
development and implementation of evaluation tools for training. As a trainer, Lacoste
facilitates clinical-training-skills courses both regionally for the West Africa Office
and for specific countries in East and Southern Africa.
Jacobs, R., & Jones, M. Structured on-the-Job Training. San Francisco:
Berrett-Koehler, 1995.
Levine, C. Harnessing the Power of OJT Training: Getting It Right the First Time. Paper
presented at the American Society for Training and Development Technical and Skills
Training Conference and Exposition, September 13–15, 1995.
Marsh, P., & Pigott, D. "Turning a New Page in OJT." Technical and Skills
Training, 3(4): 13–16, 1992.
Martin, B. "A System for on-the-Job Training." Technical and Skills Training,
2(7): 2–28, 1991.
Mullaney, C., & Trask, L. "Show Them the Ropes." Technical and Skills
Training, 3(7), 8–11, 1992.
Pacquin, D. "Skilled Trades Programs: Apprentice to Master." In L. Kelly
(editor), The ASTD Technical and Skills Training Handbook. New York: McGraw Hill, 1995.
Reynolds A. "Individualized Instructional Approaches." In L. Kelly (editor),
The ASTD Technical and Skills Training Handbook. New York: McGraw Hill, 1995.
Rothwell, W., & Kazanas, H. Improving on-the-Job Training: How to Establish and
Operate a Comprehensive OJT Program. San Francisco: Jossey-Bass, 1994.
Sullivan, R., Magarick, R., Bergthold, G., Blouse, A., & McIntosh, N. Clinical
Training Skills for Reproductive Health Professionals. Baltimore: JHPIEGO, 1995.
Swanson, R., & Torraco, R. The History of Technical Training. In L. Kelly (editor),
The ASTD Technical and Skills Training Handbook. New York: McGraw Hill, 1995.
Smith, T. "On-the-Job Training Approach: Kenya Country Program." Unpublished
paper, Baltimore: JHPIEGO, 1995.
Linking HRD Programs with Organizational Strategy may be
purchased from ASTD. Order Code: PHLH. List price: $50.00; ASTD Member Price: $34.95.
Order by phone: 1.800.628.2783 or +1.703.683.8100; order by fax: +1.410.516.6998; order
via the Website: http://www.astd.org ; or mail order to:
ASTD Books, PO Box 4856, Hampden Station, Baltimore, MD 21211.
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