Overview | Clinical Trainer | Advanced Trainer | Master Trainer | Clinical Preceptor | Classroom Faculty

Progression through the JHPIEGO FTD Pathway is as follows. 

1. First, a healthcare provider must acquire service delivery skills, such as counseling or IUD insertion, through clinical skills training and experience. Over a period of time, usually months or years of repeated practice, the healthcare provider becomes proficient in performing the clinical skill and providing services.
2. Once proficient, the healthcare provider who wants to become a clinical trainer must successfully complete a knowledge update, skills standardization and a clinical training skills (CTS) course for a specific clinical skill. They may be conducted as three separate activities or combined in various ways. The CTS course focuses on learning the skills necessary to effectively transfer clinical knowledge and expertise to others. During this course, the healthcare provider will learn coaching, humanistic training techniques and how to use competency-based skill assessments to evaluate participant performance. The healthcare provider will also learn how to present information more effectively through the use of illustrated lectures, demonstrations, role plays, case studies, group discussions, audiovisuals and other training aids. At the end of the CTS course, the healthcare provider is designated as a "candidate clinical trainer" if s/he has fulfilled the course objectives.
3. The candidate clinical trainer will complete a practicum, that is, conduct one or more clinical skills (CS) courses with an advanced or master trainer. The advanced or master trainer will assess training skills using the same criteria and skills checklists applied during the CTS course, and if competency is demonstrated, the status of the candidate clinical trainer is changed to "qualified clinical trainer," indicating that the clinical trainer may now conduct CS courses independently.
4. Once proficiency is achieved in conducting CS courses, the clinical trainer who wants to become an advanced trainer will focus on learning the skills necessary to effectively transfer training expertise to others by training them as clinical trainers. During the advanced training skills (ATS) course, the clinical trainer will learn group facilitation, problem-solving and clinical decision-making skills, how to teach them to others and how to effectively coach a new trainer. Upon completion of the ATS course, the clinical trainer is now a "candidate advanced trainer."
5. The candidate advanced trainer will then conduct one or more CTS courses (practica) with an advanced or master trainer. The advanced or master trainer will assess the training skills acquired in the ATS course, and when competency is demonstrated, qualify the candidate advanced trainer. Over a period of time the qualified advanced trainer strengthens and expands skills through delivery of both CS and CTS course. The advanced trainer will also be able to coach and qualify the participants from these CTS courses as they, in turn, conduct their first CS courses.
6. Selected advanced trainers may then pursue additional training in instructional design (ID) in order to become a master trainer. While this training focuses on designing appropriate training courses and materials, information is also included on needs assessments and evaluation of training. Those who successfully complete the ID course become "candidate master trainers." 
7. After a practicum in which an ATS course is conducted with a master trainer, the candidate master trainer achieves the level of "qualified master trainer." As a master trainer, this individual can conduct CS, CTS and ATS courses as well as materials development workshops independently, coach new trainers at all levels during their practica for qualification, develop/adapt courses and training materials, and participate in needs assessment and evaluation activities. To fully develop her/his skills as a master trainer, it is strongly recommended that s/he also conduct a materials development workshop with a master trainer as part of the qualification process or as soon as possible thereafter. Participating in a needs assessment or evaluation activity will also enhance the new master trainer's skills.

JHPIEGO's increasing focus on preservice education has required some modifications to the original Trainer Development Pathway. JHPIEGO’s definition of a clinical trainer is a proficient healthcare provider who has the ability to conduct both the classroom and the clinical portion of a training course. The clinical trainer is able to transfer both knowledge and clinical skills by working with models and clients. Throughout preservice systems, there are many individuals whose skills and abilities, as well as their job descriptions, allow them to follow the Pathway as presented above, that is, they are active as both classroom teachers and proficient healthcare providers on a regular basis. They follow the Pathway of clinical, advanced and master trainers.

There are other individuals, however, who work almost exclusively in either the classroom portion or the clinical portion of curriculum implementation. In JHPIEGO’s definitions, those who interact with students almost exclusively in the classroom are designated "classroom faculty," while "clinical preceptors" indicates those who work with students predominantly in a clinical setting (clinical preceptors can be found in inservice training systems as well). Because neither of these groups fully develop and use both classroom and clinical skills on a regular basis, their ability to progress past the first level in the FTD Pathway is limited. This does not exclude them, however, from participating in ATS and/or ID workshops because the information presented in these workshops may be very useful to them depending on their specific job responsibilities.

• Individuals who want to be qualified classroom faculty must first have their family planning/reproductive health (FP/RH) knowledge updated and, in those instances where they are also responsible for demonstrating and coaching students as they develop clinical skills on models, their clinical skills standardized on models as well. Next, they attend a CTS course in which they will learn effective classroom presentation skills for knowledge transfer, including illustrated lectures, demonstrations, role plays, case studies, group discussions, and the use of audiovisuals and other training aids. Those whose clinical skills were standardized on models, will also practice how to demonstrate, coach and assess skill development on models. These are the skills that will be assessed during the CTS course in order to establish them as "candidate classroom faculty." Skills required for working with clients are not stressed or assessed. Their practicum consists of being observed and coached by an advanced or master trainer as they present the classroom portion of the FP/RH curriculum, that is, as they use classroom presentation skills and demonstration and coaching of clinical skills with models, if appropriate. If competency is demonstrated, they are classified as "qualified classroom faculty." They can effectively provide classroom training (knowledge and, in some cases, skills on models), but do not work directly with clients.

• Individuals who want to be qualified clinical preceptors begin their preparation with a knowledge update and clinical skills standardization as clinical trainers do. Then, they attend a CTS course which includes classroom presentation skills, but emphasizes and assesses their skills in clinical demonstration and coaching and assessment of clinical skills with models and clients. At the end of this CTS course, they are designated "candidate clinical preceptors." When they have demonstrated competency in these areas during a practicum which consists of observation and coaching by an advanced or master trainer while working with learners in a clinical setting, they become "qualified clinical preceptors." In contrast to classroom faculty, clinical preceptors primarily transfer clinical skills to learners, using both models and clients.

It is important to note that regardless of any distinctions between clinical trainers, clinical preceptors and classroom faculty, the preparation of all three groups is essentially the same— updating knowledge, standardizing clinical skills (on models only, where appropriate) and completing of a CTS course. The focus of the CTS course may shift slightly, however, according to the job responsibilities of the participants, for example, clinical preceptors may spend more time practicing skill demonstration and coaching while classroom faculty may give more attention to classroom presentation skills. The practicum that each undergoes will also ensure further development of those skills required by their job responsibilities, and only those specific skills areas are assessed. For a clinical trainer, for example, the practicum ensures further development of and competency in both classroom presentation skills and clinical demonstration skills and coaching, while that of a clinical preceptor focuses on clinical demonstration skills and coaching only.

Two concepts related to the practicum required for qualification at each level of the Pathway should be emphasized.

• While in many cases qualification may be achieved after the first practicum experience, in others it may be necessary for a candidate to conduct several courses with an advanced or master trainer to reach competency. As with any skill in a competency-based approach to training, there is no specified number of courses that must be conducted by a candidate trainer with an advanced or master trainer, but rather qualification is dependent on the individual candidate trainer's ability to demonstrate competency in conducting the various aspects of a training course.

• The timing of the practicum is very important to its successful completion. In the following detailed description of the FTD Pathway strong recommendations are made regarding the maximum time period in which the practicum should take place following completion of a course (e.g., conducting a CS course with an advanced or master trainer following the CTS course). It is known that skill development and retention is fostered by immediate practice and feedback. Therefore, the practicum should take place immediately after the course. When this cannot be done, the practicum should be arranged for as soon after the course as possible. The greater the period of time between course and practicum, the greater will be the deterioration of skills.

• The times identified in the Pathway were chosen based on practical, logistical and financial considerations, while still trying to stay within a time frame that will ensure an acceptable level of skill retention. The time frames are not uniform for all levels of the Pathway because the frequency of the practicum event (e.g., conducting an ID workshop with a master trainer) decreases as the trainer advances through the levels; therefore, more time may be needed to schedule and complete it. Nevertheless, it is strongly recommended that the practicum always take place as close to the course as possible.

Clinical Trainer (also known as clinical skills trainer): A trainer who can transfer clinical skills to healthcare providers. A clinical trainer must demonstrate proficiency in the clinical FP/RH service(s) for which s/he will be providing clinical training as well as competency in CTS. This individual is competent in both classroom presentation skills and clinical skills demonstration and coaching and assessment with models and clients, that is, the trainer is prepared to facilitate both the classroom and clinical portions of a CS course. These trainers may be active in either the inservice training or preservice education arenas; many medical school faculty, for example, fall into this category as they provide classroom instruction and are also proficient in clinical skills. To become a qualified clinical trainer, the clinician must successfully complete a knowledge update, skills standardization and a CTS course and practicum (i.e., conduct a CS course with a qualified advanced or master trainer).

It is strongly recommended that the practicum experience needed to move from candidate clinical trainer to qualified clinical trainer take place within 6 months after completion of the CTS course. If it does not take place within 1 year, the candidate clinical trainer should receive a refresher in clinical training skills or repeat the CTS course before conducting a CS course with a qualified advanced or master trainer.

Candidate Clinical Trainer – a healthcare provider who fulfills the following requirements:

• Proficient in a specific skill area (e.g., IUDs, infection prevention [IP], maternal/neonatal health [MNH])

• Updated FP/RH knowledge in a specific skill area

• Standardized clinical skill(s)

• Completed a CTS course

• Qualification form submitted by the qualified advanced or master trainer following the CTS course resulting in the person being entered into the JHPIEGO Faculty and Trainer Database as a candidate clinical trainer

Qualified Clinical Trainer – a candidate clinical trainer who fulfills the following requirements:

• Successfully conducted one or more CS (e.g., IUDs, IP, MNH) courses while being coached by a qualified advanced or master trainer who has determined the clinical trainer to be competent (completed a practicum).

• Qualification form submitted by the qualified advanced or master trainer following the practicum resulting in the person being upgraded in the JHPIEGO Faculty and Trainer Database to a qualified clinical trainer.

A clinical trainer is qualified to train healthcare providers in a specific clinical skill (e.g., IUDs, IP, MNH). In order to add additional clinical skills for which the trainer is qualified to provide training, the trainer must successfully complete a knowledge update and skill standardization for the new skill, including a review and discussion of the standard course schedule for that skill (e.g., Norplant, minilaparotomy). Repetition of the CTS course is not required. The advanced or master trainer who conducts the knowledge update and skills standardization will submit a Qualification Form to add these areas of qualification to the clinical trainer’s file in the Faculty and Trainer Database

Advanced Trainer: A trainer who can transfer clinical skills to healthcare providers in an area(s) of specialty (e.g., IUDs, IP, MNH); conduct CTS courses for any area of FP/RH; and coach candidate clinical trainers and candidate advanced trainers as they complete their practicum. If, however, the advanced trainer is training trainers for a clinical skill in which s/he is not proficient and skills standardization is to be included as part of the CTS course, a proficient provider of that clinical skill must be available to conduct that portion of the course. The advanced trainer also should be knowledgeable and experienced in conducting various types of training courses in reproductive health. Generally, a JHPIEGO advanced trainer was a proficient healthcare provider first, then became a clinical trainer (e.g., IUDs, IP, MNH) and completed an ATS course and a practicum (i.e., conducted a CTS course with a qualified advanced or master trainer).

It is strongly recommended that the practicum experience needed to move from candidate advanced trainer to qualified advanced trainer take place within 6 months after completion of the ATS course. If it does not take place within 1 year, the candidate advanced trainer should receive a refresher in advanced training skills or repeat the ATS course before conducting a CTS course with a qualified advanced or master trainer.

Candidate Advanced Trainer – a clinical trainer who fulfills the following requirements:

• Proficient clinical trainer

• Completed an ATS course

• Qualification form submitted by the qualified advanced or master trainer following the ATS course resulting in the person being entered into the JHPIEGO Faculty and Trainer Database as a candidate advanced trainer

Qualified Advanced Trainer – a candidate advanced trainer who fulfills the following requirements:

• Successfully conducted one or more CTS courses while being coached by a qualified advanced or master trainer who has determined the advanced trainer to be competent (completed a practicum)

• Qualification form submitted by the qualified advanced or master trainer following the practicum resulting in the person being upgraded in the JHPIEGO Faculty and Trainer Database to a qualified advanced trainer

 Master Trainer Qualification Criteria

Master Trainer: A trainer who can transfer clinical and advanced training skills as well as clinical skills to healthcare providers, clinical trainers and advanced trainers. The master trainer also should be knowledgeable and experienced in adapting or developing courses (instructional design), conducting various types of training courses in reproductive health and evaluating training. The master trainer may assist with the development and/or implementation of training programs, assist JHPIEGO in developing new approaches to training, refine prototypic JHPIEGO materials or serve as a master trainer in a specific activity, including coaching candidate clinical, advanced and master trainers during their practica. Generally, a master trainer first has been a proficient healthcare provider, then a clinical and advanced trainer and completed an ID course and practicum (i.e., conducted an ATS course or workshop with a qualified master trainer). It is strongly recommended that the candidate master trainer also conduct a materials development workshop with a master trainer and participate in needs assessment and evaluation activities as part of their qualification process or as soon thereafter as possible in order to further enhance her/his skill development.

The ATS practicum experience needed to move from candidate master trainer to qualified master trainer should take place within 1 year after becoming a candidate master trainer. If it does not take place within 1 year, the candidate master trainer should receive a refresher in advanced training skills or repeat the ATS courses. The other recommendations for qualification as a master trainer (i.e., conducting a materials development workshop with a master trainer, and assisting with a needs assessment, followup intervention or evaluation activity) should ideally be completed within 2 years.

Candidate Master Trainer - an advanced trainer who fulfills the following requirements:

• Proficient advanced trainer

• Completed an ID course and developed course materials

• Qualification form submitted by the qualified master trainer or technical expert following the ID course resulting in the person being entered into the JHPIEGO Faculty and Trainer Database as a candidate master trainer

Qualified Master Trainer - a candidate master trainer who fulfills the following requirements:

• Successfully conducted one or more ATS courses or workshops while being coached by a qualified master trainer who has determined the master trainer to be competent (completed a practicum)

• Qualification form submitted resulting in the person being upgraded in the JHPIEGO Faculty and Trainer Database to a qualified master trainer

It is strongly recommended that a newly qualified master trainer also:

• Successfully conduct one or more materials development workshops while being coached by a qualified master trainer

• Participate in one evaluation activity (needs assessment, followup of participants to improve job performance, or evaluation study)

Clinical Preceptor: A proficient healthcare provider who can transfer clinical skills to others. The clinical preceptor’s work generally focuses exclusively on the clinical area. Although classroom presentation skills were included in the CTS course s/he attended, they were not assessed and as a result the clinical preceptor is not qualified to impart knowledge to others in a classroom setting as a clinical trainer does (i.e., by virtue of the preceptor’s position, does not do classroom teaching [lectures] and, therefore, has not been assessed and qualified in presentation skills). These individuals are frequently found in preservice programs, but are also active in inservice programs; they may be called "clinical instructors."

To become a qualified clinical preceptor, the healthcare provider must be proficient in the clinical FP/RH services(s) for which the preceptor will be providing clinical training and successfully complete a CTS course, which includes classroom presentation skills but emphasizes clinical demonstration, coaching and assessment of clinical skills. The clinical preceptor then must complete a practicum consisting of observation and coaching by a qualified advanced or master trainer while using these skills in a clinical setting.

It is strongly recommended that the observation and coaching needed to move from candidate clinical preceptor to qualified clinical preceptor take place within 1 year after completion of the CTS course, preferably during the FP/RH portion of the preservice curriculum. If it does not take place within 1 year, the candidate clinical preceptor should receive a refresher in clinicaltraining skills or repeat the CTS course before observation and coaching by a qualified advanced or master trainer.

Candidate Clinical Preceptor – a healthcare provider who fulfills the following requirements:

• Proficient in specific skill area(s) (e.g., IUDs, IP, MNH)

• Updated FP/RH knowledge in specific skill area(s)

• Standardized clinical skill(s)

• Completed a CTS course

• Qualification form submitted by the qualified advanced or master trainer following the CTS course resulting in the person being entered into the JHPIEGO Faculty and Trainer Database as a candidate clinical preceptor

Qualified Clinical Preceptor – a candidate clinical preceptor who fulfills the following requirements:

• Successfully demonstrated clinical skills, coached skill development and assessed skill competency while being observed and coached in the clinical setting by a qualified advanced or master trainer who has determined the clinical preceptor to be competent (completed a practicum)

• Qualification form submitted by the qualified advanced or master trainer following the practicum resulting in the person being upgraded in the JHPIEGO Faculty and Trainer Database to a qualified clinical preceptor

A clinical preceptor is qualified to train healthcare providers and/or students in specific clinical skills (e.g., IUDs, IP, MNH). In order to add additional clinical skills for which the clinical preceptor is qualified to provide training, this person must successfully complete a knowledge update and skill standardization for the new skill, including a review and discussion of the standard course schedule for that skill. Repetition of the CTS course is not required. The advanced or master trainer who conducts the knowledge update and skills standardization will submit a Qualification Form to add these areas of qualification to the clinical preceptor’s file in the Faculty and Trainer Database.

Because clinical preceptors have not had their classroom presentation skills assessed and, therefore, have not been qualified to conduct classroom presentations to transfer knowledge, they cannot move on to become advanced and master trainers according to the established JHPIEGO definitions. They can, however, participate in ATS and ID workshops. If at a later point in time they acquire and demonstrate competency in classroom presentations, they can then be qualified as clinical trainers and continue forward on the clinical trainer development pathway to become advanced and master trainers. A clinical preceptor who has been qualified and functions as a clinical trainer (imparting knowledge and transferring clinical skills to others with clients) should be reclassified as such in the Faculty and Trainer Database.

Classroom Faculty: A faculty member who can impart knowledge to others, but who does not train others in clinical skills in a clinic or hospital setting. They may be able to demonstrate certain clinical skills on models in the classroom. These health professionals usually function in preservice settings, most commonly in nursing and midwifery schools, and are frequently called "tutors." To become qualified classroom faculty, the individual completes a CTS course emphasizing classroom presentation and demonstration skills and is then observed and coached by a qualified advanced or master trainer while presenting the classroom portion of the FP/RH component of the preservice curriculum.

It is strongly recommended that the followup observation and coaching needed to move from candidate classroom faculty to qualified classroom faculty take place within 1 year after completion of the CTS course, preferably during the FP/RH portion of the curriculum. If it does not take place within 1 year, the candidate classroom faculty should receive a refresher in clinical training skills or repeat the CTS course before followup by a qualified advanced or master trainer.

Candidate Classroom Faculty – an individual who fulfills the following requirements:

• Updated FP/RH knowledge

• Standardized clinical skill(s) with anatomical models (where appropriate, i.e., where they will be called upon to perform classroom demonstrations on models of specified clinical skills)

• Completed a CTS course that focuses on classroom presentation and demonstration skills. Any CS training is conducted on models only.

• Qualification form submitted by the qualified advanced or master trainer following the CTS course resulting in the person being entered into the JHPIEGO Faculty and Trainer Database as candidate classroom faculty

Qualified Classroom Faculty – a candidate classroom faculty who fulfills the following requirements:

• Successfully presented the FP/RH component of the curriculum while being observed and coached by a qualified advanced or master trainer who has determined the faculty person to be competent (completed a practicum)

• Qualification form submitted by the qualified advanced or master trainer following the practicum resulting in the person being upgraded in the JHPIEGO Faculty and Trainer Database as qualified classroom faculty

Because qualified classroom faculty have not been assessed on their ability to perform and teach clinical skills with clients, they cannot move on to become advanced and master trainers according to the established JHPIEGO definitions. They can, however, participate in ATS and ID workshops. If at a later point in time they acquire competency in specific clinical skills and demonstrate competency in working with models and clients to transfer these skills to others, they can then continue forward on the clinical trainer development pathway detailed earlier. A faculty person who has been qualified and functions as a clinical trainer (imparting knowledge and transferring clinical skills to others with clients) should be reclassified as such in the Faculty and Trainer Database.

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