The goal of clinical training is to assist health professionals in learning to
provide safe, high-quality family planning and selected reproductive health services to
clients through improved work performance. Clinical training should focus on essential,
need-to-know information and skills that can be used immediately in the provision of
quality services. Such training involves the transfer of knowledge, attitudes and skills
from a proficient clinical trainer to course participants.
For the past several years at JHPIEGO we have been developing a more effective approach
to training. The mastery learning approach to clinical training assumes that all
participants can master (learn) the required knowledge, attitudes and skills provided
there is sufficient time and appropriate training methods are used. While some health
professionals are able to learn new knowledge or a new skill immediately, others may
require additional time or alternative learning methods before they are able to
demonstrate mastery. Not only do people vary in their abilities to absorb new material,
but individuals learn best in different ways— written, spoken or visual means.
Effective learning strategies, such as mastery learning, take these differences into
account and use a variety of learning methods.
This approach enables each participant to have a self-directed learning experience.
This is achieved by having the clinical trainer serve as facilitator and by changing the
concept of testing and how test results are used. For example, in courses that use
traditional testing methods, teachers administer pre- and post-tests to document an
increase in the students knowledge, often without regard to how this change affects job
performance. The philosophy underlying the mastery learning approach, however, is quite
different. It is based on continual assessment of participant learning. To be
successful, it is essential that the instructor regularly inform students of their
progress in learning new information and skills and not allow this to remain the
instructor's secret.
Key features of effective clinical training are that it is designed and conducted
according to adult learning principles—learning is interactive, relevant and
practical and:
- Uses behavior modeling,
- Is competency-based,
- Incorporates humanistic training techniques.
Behavior modeling is based on the social learning theory which states that when
conditions are ideal, a person learns most rapidly and effectively from watching someone
perform (model) a skill or activity. This is a central concept of competency-based
training. This involves the clinical trainer clearly demonstrating the skill or activity
so that participants have a clear picture of the performance expected of them.
Competency-based training (CBT) is learning by doing. It focuses on the specific
knowledge, attitudes and skills needed to carry out a procedure or activity. How the
participant performs (i.e., a combination of knowledge, attitudes and, most important,
skills) is emphasized rather than just what information the participant has acquired.
Moreover, CBT requires that the clinical trainer facilitate, guide and encourage learning
rather than serve in the more traditional role of instructor or lecturer. Competency in
the new skill or activity is assessed objectively by evaluating overall performance.
To successfully accomplish CBT, the clinical skill or activity to be taught first must
be broken down into its essential steps. Each step is then analyzed to determine the most
efficient and safe way to perform and learn it. This process is called standardization.
Once a procedure, such as insertion of an IUD, has been standardized, competency-based
skill development and assessment instruments can be designed to make learning the
necessary steps or tasks easier and evaluating the participant's performance more
objective.
An essential component of CBT is coaching which uses positive feedback, active
listening, questioning and problem-solving skills to ensure a positive learning climate.
Providing detailed and specific verbal feedback about individual performance enhances
learning. Each time the participant practices the procedure there are three separate
opportunities to provide feedback—before, during and after practice.
The use of more humane (humanistic) training techniques is also important in
improving how clinical training is conducted. A major component of humanistic training is
the use of anatomic models, which closely simulate the human body, and other learning aids
such as videos to correctly demonstrate and practice a new skill. Using models facilitates
learning, shortens training time and minimizes risks to clients. Their effective use is an
important factor in improving the quality of clinical training. For example, by using
anatomic models initially, participants more easily reach the performance levels of skill
competency and beginning skill proficiency prior to working in the clinical setting with
clients.
When mastery learning, which is based on adult learning principles and behavior
modeling, is integrated with competency-based training, the result is a
powerful and extremely effective method for providing clinical training. And, when humanistic
training techniques such as using anatomic models and other training aids are
incorporated, training time and training costs can be reduced significantly.
Source: JHPIEGO Fact Sheet. March 97.
