Training Guide Final16Sep14old.moph.gov.af/Content/files/Training Guide Final16Sep14(1)(1).pdfGeneral Directorate of Human Resources ... HMIS Health Management Information System HRMIS

Training Guide

Ministry of Public Health General Directorate of Human Resources

Capacity Building and Organization Development Directorate In‐service Training Department

NATIONAL IN-SERVICE

TRAINING GUIDE

October 2014 Designed to Help In‐service Training Providers in the Planning, Management, and Reporting of In‐service Training Programs

National In‐service Training Guideline i

ListofAbbreviations IST In‐service Training TNA Training Needs Assessment LRP Learning Resources Package HRH Human Resource for Health HR Human Resources QI Quality Improvement IQHC Improving Quality of Health Care CBD Capacity Building Directorate GDHR General Directorate of Human Resources RHD Reproductive Health Directorate RH Reproductive Health USAID United States Agency for International Development MoPH Ministry of Public Health M&E Monitoring and Evaluation MIS Management Information System HMIS Health Management Information System HRMIS Human Resource Management Information System SWOT Strength, Weakness, Opportunity, Threat IMCI Integrated Management of Childhood Illness OSCE Observation or Objective Structured Clinical Examinations HQIP Health Quality Improvement Programs PTFU Post Training Follow‐up PPHD Provincial Public Health Directorate BPHS Basic Package of Health Services EPHS Essential Package of Hospital Services ICSC Independent Administrative Reform and Civil Service Commission JICA Japan International Cooperation Agency HPP Health Policy Project

National In‐service Training Guideline 2

TableofContents List of Abbreviations ....................................................................................................................... i

Table of Contents ........................................................................................................................... 2

Acknowledgement ......................................................................................................................... 3

Introduction ................................................................................................................................... 4

CHAPTER ONE: PRE‐TRAINING PHASE ............................................................................................. 5

I. Training Needs Assessment (Identify and Analyze the Training Needs)………………………………5 A. General Information…………………………………………………………………………………………………………..5 B. MoPH TNA Standard Forms and Coordination Procedures…………………………………….………..9 II. Pre‐Training Planning……………………………………………………………………………………………………….16 A. General Information…………………………………………………………………………………………………………16 B. MoPH Pre‐Training Phase Standard Coordination Procedures…………………………………………31

CHAPTER TWO: DURING‐TRAINING PHASE ................................................................................... 35

I. Training Delivery………………………………………………………………………………………………………………..35 A. General Information………………………………………………………………………………………………………….35 B. MoPH During‐training Standard Procedures……………………………………………………………………..38

CHAPTER THREE: POST‐TRAINING PHASE ..................................................................................... 42

A. General Information…………………………………………………………………………………………………………..42 I. Writing Effective Training Analysis Reports…………………………………………………………..…………………42 II.Post Training Follow up…………………………………………………………………………………………………………….42 B.MoPH Post‐training Standard Procedures…………………………………………………………………………..43

1.MoPH In‐service Training Reporting………………………………………………………………………………..43 2.Post Training Follow‐up…………………………………………………………………………………………………..44

Annexes ....................................................................................................................................... 45

Annex 1. Workshop/Training Plan And ChecklisT..………………………………………………………….……………..45 Annex 2. IST Quality Improvement Tool……………………………………………………………………………..………….45 Annex 3. Term of References for Quality Improvement Teams:………………………………………..…………..81 Annex 4. Health Facility/In‐service Training Centers Quality Improvement (HFISTCQI) Committee

Glossary…………………………………………………………………………………………………………………………………………….81


Acknowledgement This in‐service training guideline was developed through a participatory process that was initiated by the In‐service Training Department of the Capacity Building Directorate, GDHR, MoPH. A technical sub‐committee, called the in‐service training sub‐committee, was assigned by the capacity building committee to regularly review the compiled portions of the guide and provide feedback to the IST team for further improvement of guideline chapters. The IST sub‐committee members were selected from different IST stakeholders, including MoPH relevant departments/directorates, ICSC, national and international NGOs, and the private sector. A special thanks goes to Dr. Mohammad Masood Arzoiy, In‐service training Manager, and his team for their admirable efforts in leading the guideline development process. I am also thankful to all IST sub‐committee members for their commitment and contributions List of sub‐committee members:

1. Dr. Mohammad Masood Arzoiy, In‐service Training Manager 2. Dr. Ghutay Sadeq yaqubi, In‐service Training Adviser, GDHR, MoPH 3. Dr. Mohammad Muneer Sarwari, In‐service Training Adviser, GDHR, MoPH 4. Dr. Mohammad Nadim Kaihan Niazi, In‐service Training Adviser, GDHR, MoPH 5. Dr. Ghulam Sarwar Homayee, Senior HR Advisor, GDHR, MoPH 6. Dr. Abdul Shakoor Hatifie, In‐service Training Manager, MSH/LMG 7. Dr. Mir Omar Masoud Atefi, Technical consultant, JICA 8. Dr. Atiqullah Ebadi, Training Coordinator, RHD, MoPH 9. Dr. Rahila Juya, Gender Manager, HPP 10. Dr. Abdul Marouf Jalil, Head of Monitoring, M&E Directorate, MoPH 11. Dr. Sanaullah Sana, M&E Consultant, M&E Directorate, MoPH 12. Ms. Zakia Mohammadi, In‐service Training Officer, GDHR, MoPH 13. Dr. Lotfullah Shafa, MIS Manager, HMIS, MoPH

I extend my sincere thanks to Dr. Jan Mohammad Jebran, Capacity Building Director, for his overall guidance and support throughout the process. Finally, the General Directorate of Human Resources and the Capacity Building Committee express their appreciation for the financial support provided by USAID and the regular technical support by the MSH/LMG project.

Dr. Ihsanullah Shahir General Director of Human Resources Ministry of Public Health


INTRODUCTION During the last decade, almost all training programs for capacity building of health sector personnel were managed by different organizations; there was no proper planning for training programs at the national level. The quality of provided services has always been a challenge within the country, and there was a lack of standardized procedures to ensure the quality of training services. Another critical challenge towards in‐service training programs was the inadequate coordination of programs and existence of program duplication within different training areas. To ensure proper in‐service training program planning, implementation, coordination and follow‐up, the MoPH, led by the General Directorate of Human Resources, decided to develop the In‐service Training Guideline to assist in‐service training providers (Governmental and Non‐governmental) in providing quality and coordinated training services, as well as providing a more effective contribution to the improvement of HRH capacity. The In‐service Training Guideline also aims to enhance the quality of services provided by qualified health personnel at the national level. The main purposes of this guideline are to: 1) provide all in‐service training stakeholders with specific directions for the provision of standardized and unified in‐service training programs; 2) Improve national in‐service training planning, coordination, and management of training programs at the national level; 3) Ensure quality of provided in‐service training programs; and 4) Enhance the capacity of MoPH in‐service training data management and utilization. In general, the guideline focuses on three major phases of in‐service training, described in three chapters: the Pre‐training Phase in Chapter One, the During‐Training Phase in Chapter Two, and the Post‐Training Phase in Chapter Three. Each chapter is divided into two main sections: General Directions and MoPH Standard Procedures. In Chapter One, the document explains the pre‐training general directions and MoPH standard procedures, including the training needs assessment and pre‐training planning. Chapter Two discusses the general directions and MoPH procedures for the during‐training phase including the training logistics, roles, responsibilities, use of lesson plans, assessments, training evaluation, planning for post training follow‐up, and certification. Finally, the last chapter explains the general directions and MoPH standard procedures for the post‐training phase, including training assessments and evaluation analysis, reporting, and post training follow‐up.


CHAPTERONE:PRE‐TRAININGPHASE

I. Training Needs Assessment (Identify and Analyze the Training Needs)

A. General Information:

1. What is Training Needs Assessment (TNA)? Definition: A Training Needs Assessment (or TNA) is a systematic exploration of the way things are and the way they should be. These “things” are usually associated with individual or organizational performance. A TNA is conducted when an organization has decided as part of its own policy that training should be provided for its staff members or may be a solution to its problems.

A training/learning needs assessment is a review of learning and development needs for staff and volunteers within an organization. It considers the skills, knowledge and behaviors that staff need, as well as how to develop them effectively.

2. Why conduct a TNA? A TNA is the starting point for the decision about an intervention or an investment in human resource development. A TNA is conducted to identify training goals – areas of knowledge or skills that training should accomplish with learners in order to meet organizational goals (usually in terms of a performance standard). Usually this phase also includes identifying when training should occur and who should attend as learners. It makes sense to carry out a TNA to ensure that costs directly associated with training plus costs due to loss of work time are justified. It is tempting to overlook this question of cost justification when money provided is done so through a grant making process. However, the questions of opportunity cost and loss of work time are very serious ones for organizations working with vulnerable people in development situations and so should never be dismissed lightly.

3. How is it done? A TNA is comprised of following five basic steps:

1. Perform a gap analysis 2. Identify priorities and importance 3. Identify causes of performance problems and/or opportunities 4. Identify possible solutions and growth opportunities 5. Present your findings

The methods that can be used for gap analysis and identifying learning needs include:

1. Analysis of existing strategies and plan to identify what skills are needed for delivery 2. Questionnaires ‐ paper based or online 3. One‐to‐one interviews 4. Focus groups ‐ facilitated small group discussions with a representative sample of people

The outcome of the TNA should be a robust learning and development plan, based on research and linked to organizational, team, and individual objectives.

Some of the questions that you might like to ask before undertaking an analysis of learning needs are:

1. Do we have a strategic and organizational plan? 2. Do we have an appraisal system in place? 3. Do all staff have an up to date job description? 4. Do all staff have written objectives? 5. Do we have a competency framework in place? 6. Do we have a training strategy and/or a stated commitment to the value of learning and development

for our staff/volunteers and trustees?


7. Do we have processes (formal and informal) in place for effective consultation across the organization?

The more questions that you can answer yes to, the easier it will be to undertake a TNA.

Organizational TNA should ideally be undertaken at three levels: Organizational level Team/Departmental level Individual level

These three levels are inter‐linked, and using this structure will help ensure a balanced analysis that takes into account the big picture as well as the specific needs of individuals.

Organizational Level

Training/learning needs analysis at this level should start with a review of the organization’s strategic and operational plans. If you do not already have a strategic planning process in place, it is recommended that you carry out one using a tool such as a SWOT analysis. This analysis looks at the strengths, weaknesses, opportunities, and threats facing your organization. The more people that you can involve in identifying this data the better: managers, staff, and volunteers can all bring a different perspective and contribute to a deeper analysis.

Once you have a strategic picture of the organization’s objectives, performance, and future direction, you can review this from the perspective of the knowledge, skills, and behaviors that can help your organization to build on its strengths and address weaknesses.


Team/Departmental Level

Analysis of learning needs should also be undertaken at department/team level. If you are in a management role, this means reviewing the skills needs within your team and measuring those skills against the team’s own objectives.

It will involve taking into account both the needs of individuals, but also anything that can help your department or team to work together as effectively as possible.

A key tool for identifying learning needs at this level is appraisals or performance reviews. Normally undertaken annually, appraisal provides an opportunity to review work objectives for the previous year, and agree on objectives for the year ahead. Think about how you can support your staff (or volunteers if appropriate) in identifying learning needs related to these objectives. Appraisal form design should include a section dedicated to learning and development. This can be kept separate from other areas of the appraisal form, so that information on training requirements can be included in the training and development plan, without making confidential information from the appraisal available to whoever is working on the plan.

Relying on an annual appraisal to identify learning needs will not allow for the flexibility of addressing challenges as they arise, so think about how you might build in more frequent reviews, for example, as part of regular supervision sessions.

Skills for Managers

In order for training needs analysis to be effective, managers will need to have the necessary knowledge and skills to work with staff and/or volunteers to help them identify their needs and how to meet them. You might consider using a competency framework as a basis for job design, appraisal, and training needs analysis. Competencies are statements of effective behavior in meeting a particular outcome. You can develop competencies internally, or draw on existing competencies as a starting point. People may well have knowledge and skills that are not fully demonstrated within their current jobs, but which could be used in other ways – for example in mentoring new members of staff. It may be that many learning needs can be dealt with on a team level; for example, through cascading information at team meetings. However, this is more likely to be effective if it takes place within a system and culture that makes it easy for people to identify and ask for support from team members. Creating a Learning Culture A learning culture is one in which learning is valued and is embedded across an organization. It takes time and commitment to establish a learning culture. Here are some of the ways in which you can encourage and raise awareness of the value of learning: Leadership ‐ if senior management and managers can appreciate and become enthusiastic about the value

of learning and development for both themselves and others, this sets the tone for organizations. People learn a lot from teaching others ‐ encourage people to share what they know with others ‐ in

writing, at team meetings, at staff conferences and events, informally. Get involved with initiatives such as Learning at Work Day, which encourage people to participate in

“taster” sessions on topics which may be unrelated to their daily work.


Individual Level

Appraisal and supervision meetings allow individuals to reflect on their own learning needs in relation to their work objectives. What additional skills and learning do they need in order to improve what they do?

It is important to take into account people’s career ambitions and personal development objectives. With flatter organizational structures, there may not be endless opportunities to move up the career ladder, but people are unlikely to remain motivated if there is no progression or challenge built into their work. However, there is also a need to be realistic about what you can offer by way of development opportunities and not to raise expectations too high.

Assessment tools, such as 360‐degree feedback system, can be helpful in getting a more rounded picture of individual performance, and the impact that people are making at different levels within the organization.

Identifying learning needs at individual level is not just about what needs to be learnt, it is also about how best to do it. Find out how people have enjoyed and benefited from learning in the past.

What needs to be in place?

There are some basic supporting factors that will assist the process of conducting a TNA within any organization and that will also enhance its outcome: Clear organizational and/or project objectives. Clear organizational and/or project strategies and structure. Accurate job descriptions. Clear standards of performance. Training and development policy and senior level commitment to it. An organizational culture that values learning and does not view training as an ‘extra’ incentive or

reward not necessarily related to organizational need.

An organizational assessment process may determine the organizational development needs associated with this list and would itself contribute to the identification performance 'gaps' or needs. However, many organizations will not have all these elements formally in place nor be in a position to carry out a partial organizational assessment. This should not stop you from conducting a training need analysis; often information on organizational goals, standards of performance, etc. exists informally.

As with other aspects of development, the people with the needs are the best qualified to define precisely what these needs are. Any needs analysis that does not give a central role to those carrying out the work may result in poor decisions based on inaccurate information. The organizations that introduce the trainees


for any training are required to do the trainees’ selection on the basis of their regular training need assessment and analysis.

B. MoPH TNA Standard Forms and Coordination Procedures:

1. TNA Standard Forms: There are two components to this section – a description of the form itself and a description of the summary sheet. Examples of both are provided.

TNA Standard Form: Purpose of the form: This form is designed to be used for health staff training needs analysis, recording the individual health personnel TNA findings, and recording the need for different training programs. This form will be completed after an analysis of the staff training needs by the employee, his/her supervisor, and his/her Human Resources (HR) representative. The supervisor will then submit the form to department heads and managers for compilation at the department level and for further analysis.

Layout of the form: This document is a five‐page form, printed on A‐4 paper. Instructions: The form contains following sections in each row:

i. Personnel bio data ii. Education and work experience iii. Trainings Attended (workshops, seminars) iv. Language Skills v. Computer Skills vi. Knowledge of Civil Services Rules, Regulations, Directions and Guidelines vii. Analysis of training needs based on organization goals, team requirements, and staff personal development objectives

viii. Signatures ‐ Staff signature ‐ Supervisor signature: A direct supervisor should sign ‐ HR representative signature Personnel bio data: Under this section, general staff information will be recorded. The information contains the following:

i. Family Name ii. Father’s Name iii. Sex iv. Date of Birth v. Permanent Address vi. Current Address vii. Marital Status viii. ID Number (Tazkira) ix. HR ID (Human Resources ID) x. Contact number

Education and work experience: The supervisor will record the supervisee’s education and work experience information in this section. The required information under this section is comprised of the following:

i. Education: ‐ Institution(s) attended ‐ Education level ‐ Specialization ‐ Duration

ii. Current Employment: ‐ Current Position ‐ Job Grade ‐ Position Objectives (based on job description)


‐ Key Responsibilities (main responsibilities of this position, based on job description) ‐ Ministry/Office ‐ Directorate ‐ Duration of position (how long he/she has had this position)

Trainings Attended (workshops, seminars): Under this section, details of trainings (workshops, seminars) attended by the supervisee will be recorded. This information contains the following: Training Title Training Contents Duration: the duration should be written by date, not by number of days/months/years Organizer/Institution

Language Skills: The supervisor will record his/her supervisee’s language ability under this section. This section includes the language proficiency for national (Dari and Pashtu), international (English) and other languages. The supervisor will select the supervisee’s level of proficiency from the following scale: excellent, good, fair, or poor. The supervisor will select one rating for three separate categories: reading, writing, and speaking.

Computer Skills: Under this section, the supervisor will record staff computer skills ‐ especially the name of programs ‐ and level of staff competency.

Awareness of Civil Services Rules, Regulations, Directions, and Guidelines: Under this section, awareness level of supervisee using the rating scale of good, fair, or poor will be recorded by the supervisor. This portion of the form is to be used only for a TNA of government staff.

Analysis of training needs based on organization goals, team requirements, and staff development objectives: The supervisor will start the analysis of the supervisee’s training needs with a discussion on the following three questions: What organizational goals do you endeavor to contribute to? What are the areas that you need to improve your skills, knowledge, and attitudes in order to work

better in your team and contribute to achieving team objectives? What are the personal/development objectives you set during your performance review?

After completing the exercise and getting the answers for aforementioned questions, the supervisor and supervisee will come up with list of short and long‐term trainings for improvement of the supervisee’s performance. This list will aid the supervisee in achieving institution or organization goals, enhancing his/her teamwork and fulfilling his/her personal or development objectives.

Signatures: For documentation purposes, the form will need to be signed by all involved parties: the supervisee, his/her direct supervisor, and the supervisee’s HR representative.

Data Sources: The data source for this form will be the supervisees’ given information. The information received from supervisee will be recorded in this form without any addition or omission. Preparation: supervisors will complete this form during the TNA of their supervisees.




Submission Guidelines: The team supervisor is responsible for conducting a TNA of their staff. The supervisor and supervisee, in the presence of a HR representative, will analyze the supervisee’s training needs and will complete the standard TNA form. At the end of the TNA, all parties ‐ including the staff whose training needs were assessed, the supervisor, and the HR representative ‐ will sign the TNA form. The completed forms will be submitted to department/office managers/directors, who will then review and correct the sheet for missing data and other anomalies. The department /office managers/directors will compile the information in the TNA summary sheets for upward submission.

TNA Summary Sheet: Purpose of the form: This form is designed to compile and summarize the information previously gathered by supervisors in the TNA form. The summary sheet will be prepared by department/directorate managers/directors and will be submitted to the HR/HRMIS department for compilation and further analysis. The information will then be fed into a TNA database and submitted to provincial public health directorates at the provincial level and to HRMIS departments at the central level. The provincial public health directorate (a focal point for HRMIS) will submit the compiled data to the MoPH Central HRMIS Department. The information for all provinces will be compiled by the HRMIS department and will be shared to all technical departments for the purpose of planning trainings.

Layout of the form: The sheet is printed on A‐4 paper. The size of the sheet varies based on number of employees who complete the TNA.

Data Sources: The data source for this summary sheet is the TNA forms completed for the organization’s employees. The information in the TNA forms will be compiled and summarized into the summary sheet by managers and directors without any addition or omission.

Preparation: This summary sheet will be completed by the organization’s managers and directors.


Instructions: Once the TNA forms are complete, they will need to be complied and summarized into the TNA summary sheet. Information for each employee that underwent the TNA should be complied in the summary sheet and should include the following:

i. Name ii. Family Name iii. Father’s Name iv. Sex v. Title: Current title of employee’s job position vi. Grade vii. Directorate/Department employee works under viii. Phone: Work telephone number ix. Required training program title (as identified in TNA form)

Submission Guidelines: The TNA summary sheet will be submitted to an appointed HMIS/HRMIS focal person within the organization. After compiling and verifying that the information on the sheet is correct, the focal person will then submit the sheet to the central MoPH HMIS/HRMIS Department. The HRMIS Department will analyze and filter the TNA data by thematic areas, which will then be shared with relevant MoPH technical departments/directorates to be used for the planning of in‐service trainings.

Standard Coordination Procedures: The details of TNA coordination are detailed below.

General Steps: Supervisors will be responsible for undertaking the training needs assessment of their supervisees and

the analysis at all levels. After the analysis, the supervisors will summarize the information into the TNA summary sheet. The completed summary sheet will be submitted to the appropriate higher‐level organization

manager/director. The manager/director will conduct an analysis of the TNA results, compile the TNA summary sheets,

and submit to the information management focal point. The information will be fed into the TNA database, sent to the next reporting level, and then sent to

the central MoPH HRMIS and IST departments for further analysis and storage at the national level. The information will be shared with all technical departments for preparation of the in‐service training

thematic annual plan. The in‐service training thematic annual plan will be prepared through a joint effort of MoPH technical

departments and stakeholders, under the leadership of the in‐service training department.


TNA Frequency and Data Flow: The TNA will be planned and undertaken on bi‐annual basis. Each employee will be assessed once in every two years; the findings from this TNA will be used to determine organization, team, and personnel training needs. The findings will also aid in the preparation of staff in‐service training plans. Supervisors at all levels of the organization are required to conduct the TNA of their respective staff, analyze the information, summarize TNA information into the TNA summary sheet, and identify personnel in‐service training requirements.

Organizations (governmental, non‐governmental and private) working under the health sector umbrella will need to enter the TNA information into MoPH Training Database (hub) and submit the data to the MoPH, General Directorate of Human Resources, HRMIS Department. After this step is complete, the HRMIS Department, in coordination with the GDHR Capacity Building Directorate In‐service Training Department, will analyze and filter the TNA data by thematic areas. This information will then be shared with relevant MoPH technical departments/directorates to be used for the planning of in‐service trainings.

The final follow‐up in the coordination of the MoPH technical departments, IST providers, and IST receiver organizations is to develop an in‐service training thematic annual plan for each training area. The plans will be submitted to the In‐service Capacity Building Directorate’s Training Department for preparation of an in‐service training integrated annual plan, which will be shared with IST stakeholders.


Data banking, Cleaning, Analysis and Reporting at Different Levels:

The collected information from the annual TNA should be cleaned, analyzed, and utilized for planning at all levels. Each organization should have a focal point person to manage TNA information and reporting. The MoPH will maintain a database within the HRMIS Department, where national‐level TNA information will be complied and stored.

TNA Information Use for Planning:

The collected TNA information will assist organizations in identifying the in‐service training requirements for personnel. In coordination with available IST providers, organizations will develop an annual in‐service training plan for employees. The IST providers will then submit their final in‐service training annual plan to the relevant MoPH technical departments/directorates for approval on an annual basis. Based on the submitted IST annual plan, the MoPH technical departments will develop their in‐service training thematic annual plan that will be then submitted to the IST department for preparation of a IST integrated annual plan. Within this process, the information and prepared plans need to be analyzed; feedback should be provided to lower levels for improvement of IST planning at the national level.

II. Pre‐Training Planning


Pre‐training planning explores the planning of a specific training session and includes guidelines on setting objectives and content, identifying resources requirements and appropriate methodologies, and includes a pre‐formatted example of how a session plan might look on paper. The main steps in the pre‐training phase include the following:

1. Develop objectives for learning 2. Develop training course syllabus 3. Plan for trainee assessment 4. Select training methods 5. Select and adapt learning materials (having an MoPH‐approved Learning Resource Package) 6. Develop a course schedule 7. Prepare teaching environment

1. Develop Objectives for Learning

Write Course Objectives

The course objectives relate directly to the core competencies required for an academic program. A course objective is fairly broad and may encompass knowledge, skill, and attitude components. Consider the following course objective:

Objective: After completing this course, the trainee will be able to assess, classify, and treat a sick child in an effective and integrated manner.

Assessing, classifying, and treating a sick child will clearly involve specific knowledge. The trainee must also be able to perform specific skills; the interaction and communication with the sick child and family members will require certain attitudes. Note also that this course objective clearly indicates that the trainee will be able to treat a sick child, not just “know” how to do this. This means that the trainee must have access to sick children during the course in order to demonstrate competence. From the course instructor’s perspective, course objectives provide a great deal of information about what will be taught during the course. From the trainees’ perspective, course objectives provide a clear picture of what they should know and be able to do when they complete the course.


Each course objective should include the following three pieces of information:

1. When to demonstrate the knowledge or perform the skill: Course objectives should specify when the trainee should demonstrate the expected level of knowledge or skill for example: “After completing this course,” “After completing this clinical rotation,” and “After completing this lesson.”

2. Who will demonstrate competency: The course objective states the person who will demonstrate

competency. This will usually be the “trainee.”

3. What will be demonstrated? This is the heart of the course objective. It describes the knowledge, skills, and attitudes the trainee is expected to acquire during the course. These statements are based on the main topics being presented throughout the course. You may also base these statements on textbook content, specific assignments, or core competencies the trainee will acquire and demonstrate during your course. The statement should begin with an action word, for example: Assist with a normal childbirth

Assess and classify the sick child

Administer the chosen family planning method

Provide counseling and testing services for people with HIV/AIDS

The following example includes all three components of a course objective. Each component is in bold:

Example: After completing this course, the trainee will be able to assist with a normal childbirth.

In addition to its three basic components, a course objective may or may not include an evaluation criterion. This is a description of how well the performance must be demonstrated, or the performance standard. This evaluation component is known as the objective’s standard or criterion of performance. In any given area, expect that there will be some skills in which trainees should show a high degree of competence and others with which they may show only familiarity.

Consider these examples of standards: According to the standards presented in the course materials According to the clinical protocol or checklist With at least 97 percent accuracy

Example: After completing this course, the trainee will be able to assist with a normal birth according to the checklist for normal childbirth.

Many of the course objectives you write will not contain criterion statements, because overall assessment criteria and methods are often presented in the syllabus.

Write Supporting Objectives

As noted earlier, supporting objectives outline the knowledge, skills, and attitudes a trainee must master to achieve a course objective. Supporting objectives are used to determine the content of the course, the teaching methods and materials needed to deliver the content, and the methods and materials to assess the competency of trainees.

The format for writing supporting objectives is quite simple. There are two basic components that make up supporting objectives:

Specific action to be taken. The specific action describes what the trainees must do to demonstrate competence. Common action verbs for learning objectives are shown below table. The table also includes words or expressions to avoid because they are open to interpretation and are difficult to measure.

Object of the action. The object of the action is the specific information, skill, or attitude the trainees are expected to know or demonstrate to meet the course objective.


Following are some examples of supporting objectives: Demonstrate how to put a condom on a penis model. Identify the signs and symptoms for each severe classification in the Integrated Management of

Childhood Illness (IMCI) clinical guidelines. Action Verbs for Learning Objectives

KNOWLEDGE AREA SKILL AREA ATTITUDE AREA WORDS TO AVOID

ADOPT, ANALYZE, CATEGORIZE, CLASSIFY, COMPARE, COMPILE, CONTRAST, DESCRIBE, DEVISE, DIFFERENTIATE, DISCRIMINATE, ESTIMATE, EVALUATE, EXPLAIN, INTERPRET, LIST, ORGANIZE, PREDICT, RECOGNIZE, SHOW, SOLVE, SUMMARIZE, TABULATE

ADJUST, ARRANGE, ASSEMBLE, DEMONSTRATE, FOLLOW, IDENTIFY, INSERT, INSPECT, LOCATE, MODEL, ORGANIZE, PERFORM, PLACE, POINT TO, PRACTICE, PREPARE, REMOVE, SORT

ACCEPT, ASK, ASSIST, ATTEND TO, CHOOSE, COMPLY, CONFORM, CONTRIBUTE, COOPERATE, DEFEND, DEMONSTRATE, DISPLAY, FOLLOW, HELP, INITIATE, JOIN, LISTEN, OBSERVE, PARTICIPATE, PRACTICE, PROPOSE, REPORT, SHARE, SUGGEST, SUPPORT, USE

APPRECIATE, BELIEVE, INTERNALIZE, KNOW, REALIZE, UNDERSTAND

The action verbs you select for your supporting objectives have a direct link to the assessment methods you will use to determine whether trainees have achieved the supporting objectives. For example, if the supporting objective states: “Demonstrate how to give a Depo‐Provera injection,” the trainees will be expected to give the injection. If the objective is written as “Select correct statements concerning the Depo‐Provera injection,” the trainees would need to correctly answer a series of questions about the process. If both of these were listed as supporting objectives, the trainees would be expected to do both in order to demonstrate achievement of the objectives.

Answering the following questions will help you to determine the number of knowledge, skill, and attitude objectives you will have for your course:

How many trainees are in your course? Is there a practical component of your course (i.e., development of skills in a simulation lab, working

with patients in a clinical setting)? Are there other course instructors or advanced trainees who can assist with skills demonstrations and

skills practice sessions? Are there other course instructors who can assist with administering knowledge and skills

assessments? Are there clinical instructors or preceptors who can assist with skills demonstrations, practice, and

assessments during clinical rotations? Answering these ‐ and similar questions ‐ will help you finalize the supporting objectives for knowledge, skills, and attitudes for your course.

Organize Supporting Objectives

After you have written the supporting objectives for a course objective, place the objectives in an appropriate order. What is best to teach when? Ask yourself, “What is the first thing the trainees will need to know or do to begin to meet the course objective? What is the second? The third?” Remember that the order of the objectives will be similar to the order that you use to teach the content during your course. Think carefully about the specific order used for organizing the supporting objectives. Options include:

Simple to complex ‐ Begin with simple objectives and move on to more complex objectives (the way information is often presented in a textbook).

Performance order – Place the learning objectives in the order in which the skills would be performed on the job (as in the steps to perform a medical procedure or test).

Related objectives – Combine related objectives (such as counseling and family planning administration) so that the information given builds on the previous sessions.


2. Training Syllabus (Lesson Plan)

A training course consists of a series of learning sessions on a particular topic (e.g., emergency obstetric care or basic newborn care) within an academic/training program (e.g., Newborn Care Certificate). A syllabus serves as the design document for a training course and provides all the basic information about the course. A syllabus is typically given to trainees on the first day of class and includes the following information:

Training course title and description Training course main and supporting objectives Training course prerequisites Training course logistics:

Location

Length

Dates of the course Description of teaching methods Description of learning materials Description of assignments Description of trainee assessment method Attendance criteria Course schedule

The syllabus should accurately describe the course content and objectives. This helps you plan a course that will meet the needs of the trainees, helps trainees understand what to expect, and also what will be expected of them.

You may be responsible for planning an entire course or a portion of a course, such as a focus on a special topic or a 1‐week clinical rotation. Ideally, you will coordinate with other course instructors involved in the course to develop a combined syllabus using the information below. If that is not possible, you may create a syllabus for the portion of the course for which you are responsible. Apply the same principles, whether creating a syllabus for a complete course or only a portion of a course.

3. Plan for Trainee Assessment

Assessing trainees’ achievement is one of your most important tasks as a course instructor. It is a challenge, because there should be a direct relationship between learning objectives and the trainee assessment. Have you ever taken a test that did not address the information you learned in the course? This happens quite often and is very frustrating for trainees. The course instructor has the responsibility to focus examinations on expected learning objectives and balancing the assessment of knowledge, skills, and attitudes using a variety of appropriate assessment methods.

The main purpose of an assessment is to improve trainees’ learning. This is more likely to happen if the assessment is closely integrated with the teaching content and is guided by a basic set of criteria.

As a general guide, effective assessment requires: Clear definition of learning objectives Use of a variety of appropriate assessment procedures or methods Close agreement among the learning objectives, assessment tasks, and assessment methods An adequate sample of trainees’ performance Procedures that are fair to everyone Clear criteria for judging successful performance Feedback to trainees that emphasizes strengths of performance and areas to be improved

Support of a comprehensive grading and reporting system Historically, trainee assessments have focused on measuring the trainees’ knowledge through written assignments and tests. It has now been recognized that trainees also need to demonstrate appropriate skills


and attitudes in order to provide high‐quality health services. Skills and attitudes generally cannot be assessed through written examinations. Instead, they must be demonstrated by the trainee and either reported by trainee or observed by another person. In addition, assessment can:

Help course instructors decide if trainees should progress to the next stage of study

Motivate trainees by providing feedback on their progress

Determine if the course is meeting its objectives

Ensure that important subjects are given priority within the course

Offer evidence to national regulating authorities that standards are being met

Assessment has a direct effect on trainees’ learning. When the progress of trainees through a course is based on their passing assessments, they will focus on learning the material on which they will be assessed. If material is taught but trainees are not assessed on it, trainees will see no reason to focus on that material. Therefore, from the trainees’ perspective, if the content is in the examinations, it is important; if it is not in the examinations, it is not important. Assessment can be used to improve teaching. If many trainees perform poorly in the same part of the course, the content may be confusing due to the inadequate definition of learning objectives, inappropriate teaching methods, poorly designed learning materials, or poorly developed knowledge and skills assessments. These weaknesses should be addressed in order to improve teaching and trainees’ learning.

In self‐assessment, trainees assess their own performance. Of course, self‐assessment should be used only for part of the course, and course instructors or external examiners will decide whether trainees should pass or fail. Nevertheless, self‐assessment gives trainees experience in assessing themselves, something that they will need to do on the job after graduation. The ability to make realistic evaluations of the quality of one’s work is a skill that every graduating healthcare professional should have. This form of evaluation is usually a fundamental component of problem‐based learning. In addition, it helps save time and gives trainees a greater sense of responsibility. To do self‐assessment, trainees need clear guidance about the tasks required and the standards to be met. For example, you might ask trainees to plot the weight of 10 children on a weight for age chart. Trainees can compare their results with the correct answers and learn if their work was satisfactory. Cheating is not a problem, because the purpose of self‐assessment is to learn, not to score points on an examination. Maintaining a journal or log of clinical experiences, which is shared with the course instructor at designated intervals, also provides an opportunity for trainees to gauge their progress in all types of learning objectives (i.e., knowledge, skills, and attitudes).

In addition to self‐assessment, trainees can assess each other. This is called peer assessment. Again, this method cannot be used to determine whether trainees pass or fail at the end of the course, but it is a very good method to help trainees learn. For example, you may ask trainees to follow written instructions ‐ such as those for a competency‐based learning tool ‐ for performing a skill. While one trainee attempts to perform the

Who Should Assess Trainees? Typically course instructors, tutors, clinical instructors, or external examiners assess trainees. The more frequently trainees are assessed, the more opportunities they have to learn and improve their performance. But frequent assessments require that course instructors spend a lot of time and effort planning and organizing them. One way to increase the frequency of assessments is through self‐assessment and peer assessment.

Why Do We Assess Trainees? Assessment is used to determine whether trainees have achieved the learning objectives for a course. In other words, we assess trainees to find out if they have acquired the expected knowledge, skills, and attitudes.


skill, the other watches and comments. The trainees then switch roles. Peer assessment can give more meaning and relevance to field experiences, because trainees can watch, advice, and supervise each other.

Assessment Terminology: On the surface, trainee assessment seems easy. Course instructors simply write exams and give them to trainees. It is more complex than that, however. Planning and administering trainee assessments require an understanding of some key terms and concepts. In this section, the following terms related to planning and administering trainee assessments are defined:

Validity

Reliability

Feasibility

Objectivity

Criterion‐referenced

Formative assessment

Summative assessment

Two of the most important characteristics of a well‐designed assessment or test are validity and reliability, as described below.

Validity: Does the test measure what it is supposed to measure? Validity is concerned with getting test results that are appropriate, meaningful, and useful. An assessment is valid if it adequately measures whether the knowledge, skill, and attitude objectives of the course have been met. Therefore, when planning for an assessment, the first question to ask is, “What are the learning objectives?” If you clearly define the learning objectives of the course, carefully outline the related subject matter, and then construct a representative sample of relevant test items, the results of the examination are likely to be valid.

To check the validity of an examination, ask the following questions: Does the assessment reflect the course objectives? In other words, can test items be traced back to the

learning objectives for the course? Does the assessment cover the content in a representative manner? If you use several assessment

methods (e.g., written test, observation of trainees, trainee reports), does the combination of methods address the content in a comprehensive manner?

Do the test items have the appropriate balance? For example, if you spent 25 percent of the course time on one course objective, trainees would expect that approximately 25 percent of the assessment would relate to that objective. Assume that during your course you demonstrate several clinical skills. If one of these skills is rarely performed on the job and was demonstrated for information only, trainees would not expect to demonstrate competence in this skill during an assessment.

Is the assessment method appropriate for the objective? For example, if a learning objective states that trainees must be able to perform a specific skill competently, the appropriate assessment method would be to observe the trainees performing the skill. It would not be appropriate to use a written test to measure the trainees’ competence in a skill.

Reliability: Does the test produce consistent results? An assessment is reliable when it consistently measures what it is designed to measure. A reliable assessment should obtain similar results if the same trainees take the exam more than once. For example, if a trainee scores 80 percent the first time taking a written test, the trainee should achieve a similar score on retaking the test shortly thereafter. In addition, a reliable assessment should obtain similar results when different observers or examiners assess the same trainee. For example, if one course instructor gives a grade of 40 percent to a trainee’s answer to an essay question, and another course instructor gives the same answer a grade of 85 percent, that question is not a reliable assessment. Reliability is closely linked to objectivity (see below).

Features of Valid and Reliable Assessments


Desirable Features of Valid and Reliable Assessments

There is a clearly specified set of learning outcomes.

Assessment tasks are matched to the stated learning outcomes.

Assessment tasks are a representative sample of the stated learning outcomes.

Assessment tasks are the appropriate level of difficulty.

Assessment tasks effectively distinguish between achievers and non‐achievers.

There are a sufficient number of assessment tasks (or opportunities for assessment) to produce an adequate sample of achievement, provide dependable results, and allow for meaningful interpretation of results.

Clear instructions are given for the administration, scoring, and interpretation of the assessment results.

Feasibility: Is the test practical in terms of the time and resources needed? In addition to being valid and reliable, assessments should be relatively easy to administer. Some assessment methods such as direct observation or objective structured clinical examinations (OSCE) require individual observation and can be challenging with large numbers of trainees. Written examinations may require less effort to administer and score, but do not address skills competency. The aim is to carefully select an appropriate combination of assessment methods that can be feasibly implemented.

Objectivity: An objective assessment is one that is free of bias. For example, two different course instructors can score a response to a multiple‐choice question and the results should be the same. The same two instructors may score a response to an essay question and arrive at different results, because their backgrounds and personal judgments or opinions will influence the process. An assessment method is considered objective if the instructor’s judgment or personal opinion cannot affect the score. Some assessment methods, such as observing trainees as they perform certain skills, will have an element of subjectivity. Objectivity can be increased, however, by using scoring aids such as skills checklists, examples of answers to questions, and the like. Objective tests are preferred and improve the reliability of assessments. Criterion‐referenced assessment: A criterion‐referenced assessment is scored based on clear criteria; these criteria are found in the learning objectives for the course. In other words, the trainee is being tested against predefined performance criteria and not against other trainees. A norm‐referenced test is one in which the trainees are compared with one another to develop a ranking of trainees. Although there are some appropriate uses of norm‐referenced tests, criterion‐referenced tests are recommended. Below are some of the benefits of a criterion‐referenced assessment: It aids learning by clearly defining learning expectations. Trainees pass because they meet a standard,

not because they perform better in relation to their peers. It encourages cooperation rather than competition. Trainees help one another to meet the objectives

rather than compete against one another. It assists course instructors to become better educators by encouraging them to define in writing their

expectations and standards for performance.

Formative assessment: Formative assessment measures trainees’ progress throughout the course. The purpose of formative assessment is to help trainees improve their performance. It gives trainees an opportunity to apply new knowledge, skills, and attitudes and to receive feedback from course instructors. Formative assessment also reinforces important or difficult content areas. It can be done in nearly all learning environments, including the classroom, simulated practice environment, and clinic. Course instructors should use a variety of formative assessment methods to help trainees prepare for summative assessments.


Summative assessment: Summative assessment is the formal assessment of a trainee’s achievement at scheduled points during the course. Summative assessments assign a grade or mark to the trainee’s level of competence in key learning objectives. Typically, the results of summative assessments are used to decide whether a trainee can complete a course, move on to another course in the academic program, or graduate.

What is the difference between formative and summative assessment? Actually, the same assessment procedures or methods can be used for both. The factor that distinguishes formative from summative assessment is how the results of the assessment are used. In a formative assessment, the results are used to give feedback to trainees, help them improve their performance, and help them prepare for later assessments. In a summative assessment, the results are recorded and used to determine if the trainee should pass the course. A good assessment strategy will involve frequent formative assessments of key or difficult knowledge, skills, and attitudes before the trainees complete a summative assessment.

With both types of assessment, course instructors should give clear feedback to trainees about what they have done well and what they need to improve. Remember that the goal of assessment is to improve trainees’ learning. If a trainee fails an assessment, provide the trainee with feedback, additional practice opportunities, and, if possible, another attempt to master the material.

Select Assessment Methods

The learning objectives for your course should guide the selection of appropriate assessment procedures or methods. Will the assessmentmeasure understanding of a subject (i.e., knowledge), or the ability to dosomething (i.e., skills)? Will it measure opinions or feelings (i.e., attitudes)?Or will it assess a combination of these? Will it help trainees to improve their performance by providing feedback (i.e., formative assessment), ordetermine if a trainee should move to the next stage of studies (i.e., summative assessment)? Because it can be very difficult to assess attitudes separately (e.g., the trainee is respectful of patients), it is recommended that attitudes be assessed as part of the demonstration of skills (e.g., thetrainee’s ability to greet patients in a respectful manner).

Assessing Attitudes

Our goal is to develop future healthcare providers who demonstrate appropriate knowledge, skills, and attitudes. Attitudes are opinions or feelings. How do we assess attitudes? As individuals, healthcare providers will have their own attitudes and opinions. For example, a nurse might disapprove of sexual intercourse outside of marriage, but her job may require that she provide family planning methods to unmarried adolescents. Healthcare providers have a right to their own opinions, but they must demonstrate through their behavior a nonjudgmental and accepting attitude toward all patients. For this reason, demonstrated attitudes, rather than personal thoughts and opinions, should be assessed. Do trainees demonstrate acceptance and respect through their verbal and non‐verbal behaviors with patients? Demonstrated attitudes usually can be measured with the same types of assessment methods as those used for skills.

How do you choose which learning objectives to assess? Ideally, you should assess all of the supporting objectives of a course. That, however, can be challenging. For example, the course may have a large number of skills objectives, or a large number of trainees. Will it be possible to observe each trainee performing every skill? Probably not. To help you decide what to assess, look at each supporting objective and think about the best way to measure whether or not trainees have achieved the objective. As you do this, you may discover that it would be very difficult to adequately assess all of your learning objectives. In this case, you might need to revise some of the supporting objectives for the course.


In the Develop Objectives for Learning section, you developed a series of supporting objectives for a course. It is now time to look at all of the objectives to decide how you will assess whether each trainee achieved every objective. Answering the following questions may help you decide how to assess trainees’ achievement: Among the learning objectives, which can you measure through formative assessment? Which learning objectives can you measure through summative assessment? Which assessment procedures and methods should you use? Is it feasible to measure all of the objectives using the assessment methods identified?

You can see some of commonly used assessment methods in following table. Note that these methods are appropriate for both formative and summative assessments. Commonly Used Methods to Assess Trainees’ Knowledge

KNOWLEDGE METHODS* DEFINITION

Drills, quizzes, and practice tests Drills are verbal question and answer periods during a classroom or practical session. Quizzes and practice tests are short versions of written examinations, and are designed to help prepare trainees for a summative assessment.

Written exercises Written exercises involve asking trainees to read and then answer questions to check their understanding of the reading. They can also involve asking trainees to read a case study, or view a video, slides, or photographs and then respond to related questions.

Case studies, clinical scenarios, and patient management problems

A brief case or situation is provided with information about a situation and several objective questions (e.g., multiple‐choice, short‐answer) are asked. The trainee reads the scenario and then answers the series of questions.

Project reports The trainee completes a project (e.g., read a chapter or article, interview a patient) and then writes a report.

Essay examinations An essay question can be written on any subject and is a common type of written examination. Essay questions are easy to write and can test the trainees’ ability to organize and express ideas.

Objective written examinations These include multiple‐choice, true‐false, matching, and short‐answer assessment items. Note that course instructors may work together to develop a set or bank of test items linked to learning objectives so that different items can be used on each test.

Structured practical examinations The structured practical examination can assess knowledge, skills, and attitudes. It is not really an assessment method but rather an administrative structure in which a variety of assessment methods can be incorporated. Typically trainees rotate through a series of stations where they answer questions (orally or written), or perform tasks under observation.

Oral examination Examiners interview one or more trainees about what they know about specific topics or what they would do in specific situations. This may take place in a classroom setting or when working with patients. Oral exams have poor reliability unless well‐structured with standardized questions and case studies. Course instructors tend to consider these examinations valid, but trainees often do not.

Clinical rounds While making rounds in the patient ward, the teacher asks the trainees questions.


Commonly Used Methods to Assess Trainees’ Skills

SKILL METHODS* DEFINITION

Direct observation The assessor observes a trainee performing a skill. This may take place in a simulated situation (e.g., role play, anatomic model) or with patients.

Structured feedback reports A structured feedback report is a standardized way to give feedback to trainees on their performance. Because a feedback report covers a period of time, the sustained performance is assessed rather than a “snapshot” obtained from an examination.

Logbooks (casebooks), learning journals, and care plans

The logbook (also called a casebook) contains a list of skills or tasks that trainees should be able to perform. These tasks are the learning objectives for the course. The trainees are responsible for learning how to do each of the tasks, and when they are ready, they can ask a course instructor, tutor, or clinical instructor to assess their performance.

The trainee maintains a learning journal. Learning journals are documents that include a brief description of the problem encountered, care or management of the problem, and education received. After recording information regarding one or more patients, the trainee may be asked to write notes or a brief report.

A care plan is used to document the patient’s problems, care required, and expected outcomes.

Structured practical examinations Objective Structured Clinical Examination (OSCE) is a form of structured practical examination that can be used to assess knowledge, skills, and demonstrated attitudes. It is an approach to assessment that involves creating a series of stations through which trainees rotate and where they perform certain tasks.

Now that you have written learning objectives, started to develop your course syllabus, and selected trainee assessment methods, you will select the teaching methods that you will use to help your trainees achieve the objectives.

4. Select Teaching Methods

Some trainees may learn better through listening, others by reading, and still others by viewing and doing something at the same time. The next important step in planning for teaching is to select the methods you will use to help trainees learn. The two most critical factors in selecting teaching methods are choosing a variety of methods, and choosing methods that are appropriate for achieving the learning objectives.

There are a number of teaching methods from which you may choose; many are covered in this guideline. Review these methods and think about how each might be used to achieve the supporting objectives for your course. For example, if the learning objective is for trainees to list the immunization schedule for children under five, an interactive presentation is an appropriate teaching method. However, if the learning objective is for trainees to give immunizations according to the schedule, trainees will need opportunities to practice giving the immunizations, preferably on models first and then with patients.

When selecting teaching methods, consider the following questions: Is the method appropriate for the learning objective? Certain teaching methods are more effective for

helping learn new skills; others are more useful for developing trainees’ knowledge. For example, when teaching how to give an injection, you should demonstrate the skill and provide opportunities for practice rather than only give a lecture. For introducing the concepts of anatomy or physiology, presenting information using an interactive presentation would be appropriate. Consider which method will best help trainees to meet the learning objective.


Are the resources that this method requires available? Some methods require additional materials, supplies, and equipment. Consider if the required resources are available or obtainable.

Are special facilities required? Examples include hospital wards, clinics, skills labs, small rooms for group work, and an area for practice with simulated patients, other trainees, anatomic models, or computers.

What is the projected size of the class? Some teaching methods are more appropriate for a small group than for a larger group. However, if the classroom is large enough, large groups can be divided into small groups to carry out specific learning activities. In addition, some teaching methods, such as case studies and role‐plays, can be adapted for use in larger groups.

Is a special room arrangement needed for this method? Some methods require a special room arrangement (e.g., chairs arranged in small groups). If the room cannot be rearranged, look for another room that can be used instead.

Will the methods selected stimulate interest and provide variety? Even the most exciting teaching method becomes boring if it is used all the time. Select a variety of methods that will stimulate interest, and change methods as needed.

Refer to the bellow table for a list of common teaching methods, their definitions, and an indication of the domain(s) of learning for which each method can be used. This is not a comprehensive list of teaching methods, but a summary of some common methods used in educational settings.

Commonly Used Teaching Methods

METHOD DEFINITION DOMAIN(S)

Brainstorming Method in which a list of ideas, thoughts, or alternative solutions that focus on a specific topic or problem is generated. Brainstorming stimulates thought and creativity and is often used along with group discussions.

Knowledge

Case Study Method using realistic scenarios that focuses on a specific issue, topic, or problem. Trainees typically read, study, and react to the case study individually or in small groups.

Primarily knowledge and attitude

Clinical Simulation A representation of a real or hypothetical patient management situation.

Knowledge, skill, and attitude

Demonstration Method in which the teacher presents the steps necessary for the completion of a procedure or clinical task or activity.

Skill

Discussion Interactive process in which trainees share their ideas, thoughts, questions, and answers in a group setting with a facilitator.

Knowledge and attitude

Facilitated Practice Opportunity for trainees to practice or apply (with models, simulated patients, or real patients) the content presented in theoretical sessions. The teacher explains procedures or routines, demonstrates tasks, models the correct performance of the skill, and observes and interacts with trainees while providing ongoing feedback.


Game Learning activity that usually has a set of rules and is often competitive. The purpose of the game must relate to the objectives.


Guest Speaker Presentation related to the objectives conducted by an expert in the field.


Individual or Group Tutorial Study of information by one or more participants under the instruction of a tutor or mentor.


Interactive Presentation Verbal presentation of information by the teacher, in which presentation of content is supplemented with a variety of questions, interactions, visual aids, and

Primarily knowledge


instructional materials. Also known as a lecture or illustrated lecture.

Panel Discussion Discussion related to the learning objectives presented by a panel of individuals or content experts.

Knowledge

Role Play Learning activity in which trainees play out roles in a simulated situation that relates to one or more learning objectives.

Knowledge, some skills, particularly communication skills, and attitude

Study Trip Learning situation outside the regular classroom, in which trainees travel to another location in a facility or outside the facility.

Primarily knowledge

Ensure Opportunities for Practice

Imagine taking a course that consists of listening to a series of lectures andthen being given a test, and finding that you had no opportunity to practiceor apply the expected knowledge, skills, and attitudes before the test. This is not an effective way to learn. Trainees need opportunities to practice or apply new knowledge, skills, and attitudes. The design and development ofpractice activities—or learning experiences—has two essential features: practice and feedback. Practice and feedback will also help trainees to develop appropriate attitudes.

Throughout the course, schedule practice activities including reading, homework, or other assignments, to help trainees apply new knowledge, skills, and attitudes. In addition to providing learning opportunities for trainees, practice activities are opportunities for formative assessment in which course instructors can give feedback to trainees to help them improve their performance.

Practice opportunities can occur individually or in groups. They can be conducted in the classroom in simulated environments or at a clinical practice site. Try to use a variety of practice exercises to maintain interest. Different practice activities will be appropriate for different learning objectives, as illustrated below.

Knowledge: Solve a series of problems.

Answer a series of questions.

Label a drawing.

Locate information in a manual.

Make a drawing or sketch.

Complete a case study.

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Skill: Practice a skill with an anatomic model, simulated patient, another trainee, or with an actual patient.

View a video, slide show, or photographs, or use a computer‐based learning program (e.g., to identify signs and symptoms of illness or malnutrition).

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Attitude: Participate in a role play.

Conduct an interview.


5. Select and Adapt Learning Materials

Learning is more effective when a variety of appropriate materials are used. The materials used by course instructors and trainees will differ from course to course. In most courses, the materials will include textbooks, workbooks or exercise books, handouts, videos or slide sets, CD‐ROMs, or computer‐based educational programs. Materials may also include learning packets that contain reference materials, exercises, checklists, assessment tools, and transparencies or computerized presentations.

Select Learning Materials

Some materials are more effective for teaching and learning concepts andprinciples, while others are more effective for demonstrating and practicing skills. Having a variety of learning materials is important for meeting thelearning needs of different trainees. For example, to demonstrate a clinical procedure, showing a videotape and demonstrating the skill with a simulated patient or anatomic model would be more effective thandelivering an interactive presentation. Keep in mind that, just as forteaching methods, the excessive use of any one type of material willdecrease its effectiveness. Before deciding on new materials or adapting existing ones, carefully evaluate the materials to be sure that they areappropriate.

Consider the following when evaluating materials: Are the materials appropriate for meeting the learning objectives? Is the information contained in the materials up‐to‐date, unbiased, factual, consistent, and technically

correct? Will visual aids work with the equipment that is already available? Are the format and quality of the materials consistent with those of the other course materials? Are the materials relevant and culturally sensitive? Is the reading level of the materials appropriate for the trainees? Is the cost of the materials reasonable?

There are four general classifications of learning materials. These include: Handouts Handouts Printed materials Visual aids Computer‐based materials

The following are descriptions and definitions of each, with examples of the most common types of materials found within each classification:

Handouts: Handouts are worksheets, pre‐printed notes, or other information on paper that support a learning session. There are several benefits of handouts: they allow trainees to pay better attention because they have to take fewer notes, they support or emphasize main points, and they serve as a permanent record of facts.

This simple handout helps make the presentation more interactive by providing a structure for the presentation and helping trainees organize their notes while they listen and participate. The handout also reminds you, the course instructor, of the main points.

Printed materials include text to be read, studied, and used by trainees. These materials may already be available or you may identify or develop them yourself. They may be given to trainees, purchased by trainees, or made available in the library. The most common forms of printed materials include:


Textbooks Reference manuals Memory aids or job aids (e.g., Integrated Management of Childhood Illness (IMCI) chart booklets Workbooks or exercise books Written exercises such as case studies, role plays, and assignment sheets Checklists, logbooks, or other procedure protocols Assessment and Evaluation Sheets

Computer‐based materials such as educational CD‐ROMs with text, video clips, and exercises can be used for practice, research, and other self‐directed learning. In most computer‐based learning, the trainee interacts with the computer with little or no help from the teacher. The computer, not a person, presents the information, provides feedback on completed exercises, and assesses the trainee’s achievement. Adapt Learning Materials

Standardized learning materials help to ensure consistency in developingknowledge, skills, and attitudes, and provide the basis for an objectiveassessment of performance. Often the teaching institution chooses and provides the basic learning materials, especially the textbooks or referencematerials. Nevertheless, course instructors and tutors can influence the selection of these basic materials. You may also improve or supplementbasic materials to suit the learning objectives of your course. The beginningof this section gives a list of examples of learning materials you may haveavailable. You may need to adapt some of these to fit your courseobjectives. There are a number of reasons to adapt the learning materials for a course:

You may need to add new information or skills to a course (e.g., adding a procedure such as oxytocin

administration during active management of the third stage of labor). Materials provided may have been originally used in an in‐service training setting and now need to be

adapted for use in teaching trainees at your institution (e.g., integrating a course on reproductive health for adolescents).

Learning materials may need to be adapted for country‐specific situations (e.g., essential drug lists, immunization schedules, and feeding recommendations for IMCI all must be adapted to the national situation).

National authorities may have supplied supplemental reference manuals or booklets on topics such as family planning, maternal and newborn health, or adolescent reproductive health that need to be incorporated into an existing course.

Adapt the materials to match the learning objectives. If you are uncertain about the learning materials, return to the learning objectives and ask yourself, “Will these materials help trainees meet the learning objectives for the course?” or “How can I adapt these learning materials to better help trainees meet the learning objectives?”

Once you have written your learning objectives, planned for trainee assessment, and selected teaching methods and learning materials, you can finish your course syllabus. The last item you will need to develop to plan your course is a course schedule.

6. Develop A Course Schedule

The course schedule is a session‐by‐session summary of learning activities and topics for the course. If you are responsible for only a portion of the course, work with the other course instructors to create a combined schedule. If that is not possible, create a schedule for the portion you will be teaching. The course schedule should include the dates of the course sessions, as well as due dates for assignments, details on planned activities, and times scheduled for practice, activities, and tests. The course schedule can be broken down weekly (e.g., Week 1, Week 2) for a semester‐long course and daily (e.g., Day 1, Day 2) for a portion of a course. This allows trainees to see the sequence of course and clinical activities.


Because the syllabus states the objectives, assessment methods, teaching methods, learning materials, and assignments, use it to guide development of the course schedule. Past experiences with the course may provide the information you need to prepare the schedule. For each block of time (week or day), note the topic, any assignments due, and learning materials required.

The sequence of activities in the schedule should reflect the process of developing knowledge, skills, and attitudes. Organize classroom and clinical activities to provide the theoretical background or introduction of skills first, move on to provide opportunities for practice in a safe (or simulated) environment, and provide opportunities to integrate knowledge, skills, and attitudes in a clinical setting.

7. Preparation of Teaching Environment:

You should prepare for both classroom and clinical teaching by remembering that classroom and clinical experiences build on each other, from the introduction of theory, explanation and demonstration of skills, practice of skills in a safe environment, and finally to practice with patients. Prepare the classroom environment by ensuring that trainees are able to see demonstrations and any presentations involving visual aids and complete any assigned group learning activities. Prepare any homework or classroom learning activities for your class. Create a simulated environment for demonstration and opportunities for small group activities and practice with feedback. Select and prepare the clinical environment by ensuring adequate supplies for the related skills, adequate and appropriate patient caseload and flow, and informed clinical instructors. Refer to the diagram below illustrating the process of learning from the classroom to the clinic.

Figure 4‐2. The Process of Learning

Introduce theory and provide opportunities to develop understanding through activities, such as work in small groups and demonstrations.

Provide opportunities to apply new knowledge and develop skills through practice in a simulated environment with feedback.

Apply new knowledge and skills under supervision with patients.


You may also use a checklist as a reminder as you prepare for classroom teaching and clinical practice. A sample checklist is on the following page.

Checklist for Preparing the Teaching Environment

STEPS FOR PREPARING THE TEACHING ENVIRONMENT Check () when completed

Preparing the Classroom Environment

1. Is the space large enough for the number of trainees?

2. Is the room properly heated or cooled? Does it need a fan or space heater?

3. Is there enough lighting?

4. Does the seating need to be rearranged?

5. Is the audiovisual equipment available and working?

PREPARING THE PHYSICAL ENVIRONMENT

1. Is the space large enough for the number of trainees?

2. Has a room been reserved for gathering trainees for discussion or small group activities?

3. Are essential drugs, supplies, and equipment available?

LOGISTICS

1. Is the clinical practice session scheduled at a time convenient for clinical staff and when appropriate patients are available?

2. Have the administration at the clinical practice site and related staff been notified of the trainees’ arrival times?

PATIENTS

1. Will there be enough patients for the number of trainees?

2. Will the appropriate patients be available? Are they scheduled, if necessary, or will they attend the clinic during practice?

3. Are alternative but related exercises or activities prepared in case there are periods of inactivity for the trainees?

When the pre‐training phase activities are completed, you need to organize a pre‐training meeting, inviting the technical (training coordinator, facilitators, and co‐facilitators) and non‐technical (logistics and finance) staff. There are two reasons you should have this meeting prior to conducting training:

1. Making sure all necessary technical/logistics/financial arrangements are done and ready to launch. 2. Review of the training materials before printing.

This meeting is to be held at least one week prior to the actual meeting date.

B. MoPH Pre‐Training Phase Standard Coordination Procedures:

1. Coordination of National In‐service Training Programs (Provincial and Central)

In‐service Training Department of the Capacity Building Directorate, in coordination with other MoPH technical departments/directorates, will act as the central body for coordination of in‐service training programs at the national level.


The IST Department will have the responsibility of developing IST strategies and policies for proper implementation of programs, and ensuring the quality of delivered in‐service training programs at the country level. The MoPH technical departments/directorates will work directly with relevant IST stakeholders to ensure proper IST planning and implementation. They will also have the responsibility of working closely with IST providers to ensure proper use of training materials and delivery of quality training services in their respective subject areas.

Considering the MoPH (central and provincial) and stakeholder’s roles and responsibilities in the provision of sustained and quality in‐service training throughout the country, the following are suggested mandatory standard procedures for the coordination of national in‐service training programs:

a. Submission of bi‐quarterly/annual in‐service training plan of all IST providers to relevant MoPH

technical departments: To ensure quality and need‐based national in‐service training program planning, implementation, monitoring, and supervision, and to avoid program duplication, all in‐service training providers should submit their in‐service training plans to the relevant MoPH technical departments/directorates for technical review and approval on either a bi‐quarterly or annual basis.

b. Approval of submitted bi‐quarterly/annual IST providers’ plans by relevant MoPH technical

departments/directorates: The submitted IST providers’ bi‐quarterly/annual in‐service training plans should be reviewed and approved by relevant MoPH technical departments/directorates and their technical taskforce. Feedback should be provided to the IST providers for further improvement and prevention of program duplications.

c. Development of bi‐quarterly/annual thematic in‐service training plan by MoPH technical

departments: The finalized IST bi‐quarterly/annual plans that are submitted by IST providers will be reviewed and approved by relevant MoPH technical departments/directorates. The approved IST plans will then be compiled into the MoPH technical departments/directorates’ thematic IST annual plan. As a result, all technical departments/directorates will have their annual thematic IST plans, which will reflect programs that will be implemented during the year. The MoPH technical departments, in coordination with the Capacity Building Directorate IST Department, will have the responsibility to oversee the smooth implementation of the developed thematic plan throughout the year. They will also be responsible for providing feedback to IST providers based on assessments of their performance.

d. Development of integrated in‐service training plan that reflects all planned in‐service training

programs at the national level: The final annual thematic IST plans developed by MoPH technical departments will be submitted to the Capacity Building Directorate IST Department. The submitted plans will be then compiled into the annual/bi‐annual integrated in‐service training plan by the IST Department, and will be shared with all stakeholders and IST providers for better coordination of planned programs and activities at the national level.

2. Recognition/certification and use of certified national in‐service trainers for planned in‐service training programs:

The Capacity Building Directorate, General Directorate of Human Resources is the leading body for the process of national trainers’ identification, selection, training, and certification. This directorate will also oversee the process for all in‐service training areas. MoPH technical departments will have the responsibility to coordinate the process for their respective areas of in‐service training programs. The mechanism, in general, is comprised of the following procedures that need to be completed in order to identify, select, train and certify national trainers for different training areas and establish a network amongst certified trainers from different regions and provinces:

a. Coordination of national trainers’ identification, selection, training and certification: Generally, the

in‐service training programs are implemented by different organizations, which include the MoPH, NGOs, and private entities. Each of the mentioned organizations has their own trained trainers for


each type of in‐service training programs; there are currently three major types of in‐service trainers utilized for the facilitation of in‐service training programs at the national level: MoPH, NGO, and private sector trainers. To ensure that all qualified trainers, irrespective of their type, have the opportunity to be selected as a national trainer, the MoPH technical departments/directorates and the Capacity Building Directorate, GDHR IST Department will identify, select, and certify qualified trainers by completing following steps: Assess in‐service training programs and availability of national in‐service trainers: The MoPH

technical departments/directorates will have the responsibility to conduct an assessment of their relevant in‐service training programs and the number of national in‐service trainers available for the assessed in‐service training programs. Doing the assessment, departments/directorates will find out the need for additional national in‐service trainers for their relevant training programs. Selection of the national in‐service trainers is subjected to availability of standard and approved Learning Resource Package.

Prepare a list with the number of additional voluntary national in‐service trainer positions: Based on requirements of departments/directorates’ relevant in‐service training programs, the department will be responsible for preparing a list of additional voluntary national in‐service trainer positions.

Develop Terms of Reference (ToR) for different categories of national in‐service trainers: Using a standard ToR template, MoPH technical departments/directorates are responsible for developing ToRs for various categories of national in‐service trainers. These ToRs will later be submitted to the Capacity Building Directorate, GDHR, IST Department, along with a list of voluntary national in‐service trainers’ positions.

Announce the national in‐service trainer voluntary position through MoPH standard GDHR procedures: The voluntary national in‐service trainer positions will be announced through the GDHR standard procedure and the relevant technical department. In coordination with the GDHR, this technical department will complete the hiring process.

Prepare a shortlist of qualified trainers that applied for the announced national in‐service trainer voluntary positions: A committee comprised of MoPH relevant technical departments/directorates, an IST Department representative, and a GDHR representative, will be formed to review applicants’ submitted documents and shortlist potential candidate for the interview and testing process.

Select qualified in‐service trainers for certification: The MoPH technical departments will work closely with the aforementioned committee to complete the interview and testing process of shortlisted candidates, and to select trainers based on their interview and test result. The standard GDHR procedures need to be complied and completed for the interview and testing of shortlisted trainers.

Share the list of selected candidates for different categories of voluntary national in‐service trainers with the GDHR IST Department: The technical departments/directorates should submit the list of selected candidates for various categories of voluntary national in‐service trainers with the Capacity Building Directorate, GDHR, IST Department.

Certify selected candidates as national in‐service trainers: The IST Department has the responsibility to record the selected trainers as national in‐service trainers into a national database. The department will also certify all selected trainers issuing them certificate, which will be valid for a period of four years. The issued certificates will lose validity after that point, and trainers will be required to re‐certify, which requires completion of the process described above..

b. National in‐service trainers’ capacity building and networking: Capacity building, training, and

network establishment of certified national in‐services training is as follows: Capacity building of certified national in‐service trainers: Performance of certified national in‐

service trainers will be regularly appraised on an annual basis by their relevant MoPH technical department. Based on the annual performance appraisal, the trainers will set personnel development objectives that will help the technical departments develop a capacity building plan for each trainer. The technical departments, along with IST Department, will advocate with all stakeholders to mobilize resources for the implementation of national in‐service trainer capacity building annual plans.


Training new national in‐service trainers based on technical departments/directorates requirements: If a technical department/directorate needs a national in‐service trainer in a specific area of training and cannot find a qualified trainer for certification, they can train new trainers to be certified as national in‐service training for that specific training area. To receive the national in‐service trainer’s certificate, the newly trained trainers need to complete the certification procedures recommended above.

Establishment of networks amongst different categories of national in‐service trainers from different regions: To create a learning environment and replicate the best practices amongst national in‐service trainers, the MoPH technical departments, in coordination with the IST Department, will establish a professional in‐service training network for different training areas. They will also a share best in‐service training practices and lessons learnt through physical and net‐based virtual meetings and discussions.

3. Using Approved Learning Resource Packages (LRPs) for regular training programs and obtaining approval for newly developed/updated LRPs:

A LRP is a set of standard training material that is required for all types of in‐service training programs. To ensure utilization of standardized and unified LRPs for all in‐service training programs in the health sector, all LRPs used by IST providers should be reviewed and approved by relevant MoPH technical departments/directorates. The following procedures are to be followed for review and approval of LRPs used for all in‐service training programs in the health sector:

a. Submission of LRPs to relevant MoPH technical departments/directorates for technical review and

approval: The in‐service training programs that are designed for health personnel should have an LRP approved by the relevant MoPH technical department. Therefore, approval of any in‐service training by MoPH technical departments/directorates will be subjected to MoPH standard and approved LRP. The submitted LRPs to the MoPH will be reviewed by relevant technical departments/directorates through their technical taskforces, in coordination with IST department. The relevant technical department will issue the approval after the finalization of the reviewed document.

b. Banking and sharing of approved LRPs through MoPH central and provincial resource centers: The

approved LRPs will be submitted to the IST Department for banking and sharing through MoPH central and provincial resource centers.

c. Validity of in‐service training LRPs’ approval and regular updates: The MoPH approval for all

approved LRPs will be valid for three years. After this time period, the organization/IST provider will be required to update the LRP and submit the updated version to the relevant MoPH technical department for technical review and approval. Once the approval of the updated LRP is obtained, it will be submitted to the IST department for banking and sharing through central and provincial resource centers.

4. Training financing policy, including the participants’ per‐diem and trainers’ incentive policy: The in‐service training costing will be different for the MoPH and other IST providers. MoPH will follow the MoPH per‐diem policy for their training financing, while the other providers (NGOs and private sector organizations) can use their organization’s policy for their training resources allocation. For information about MoPH training financing please refer to MoPH National Per Diem Policy Guideline.

5. Procedures for inviting participants: To ensure that participants are physically and mentally ready for the planned training, the IST providers should:

a. Send the invitation to all participants at least one week prior the training starting date.

b. Include brief information about the training program in the invitation letter: Training course title


Training course main and supporting objectives Training course prerequisites Training course logistics (location/address of training venue and accommodation, duration of

training program, and starting/completion dates of the course) Attendance criteria Course schedule

c. Share the training‐related materials and handouts with participants at least one week prior to the

training starting date.

6. Procedures for procurement of IST programs from IST providers: As with other services, the training services should also be procured based on Afghanistan’s Procurement Law.

CHAPTERTWO:DURING‐TRAININGPHASE

I. Training Delivery


Using a training/workshop checklist a training/workshop focal point can ensure that all training activities are properly undertaken. The following section details key components of proper training activity management:

1. Logistics and Registration 2. Roles and Responsibilities 3. Use of Lesson Plan 4. Pre‐ and Post‐tests (Assessments) 5. Training Process Evaluation 6. Preparation of Plan for Post Training follow‐up and Training Replication 7. Certification

1. Logistics and Registration

The training focal point and training coordinator have the responsibility of handling and managing workshop/training logistic issues, including: training materials, equipment, anatomic models, etc. In addition, the training coordinator has the responsibility of organizing the registration and undertaking the log‐in process of trainees before the training starts. For proper logistics management, the coordinator and focal point are to follow their activities according to the training/workshop checklist (Please refer to Annex 1).

2. Roles and Responsibilities

The roles and responsibilities for those who are actively involved both in teaching and the learning process are outlined below:

a. Supervisor/Training Focal Point: Participate in/observe training Protect learner from interruptions Plan post‐training debriefing Provide supplies and space and schedule opportunities for learner to practice

b. Trainers:


Provide work‐related exercises and appropriate job‐related directions Give immediate and clear feed back Help learners develop realistic action plans Conduct training evaluations

c. Learners: Actively participate in the course Develop a realistic action plan for transferring learning, if applicable

d. Co‐workers and others: Complete learners’ reassigned work duties Participate in learning exercises at the request of learners

3. Use of Lesson Plan:

Having a comprehensive lesson plan for the training/workshop, which spells out the details of all sessions, is crucial for during‐training management; all facilitators should have a copy of it during the training. For detailed information about lesson plans, please refer to the Pre‐Training Phase section.

4. Pre and Post‐Tests (Assessments)

Whether creating questions for use in large examinations, creating a completely new test for your session/ course, or adapting an existing test, make sure that the assessment measures the objectives in a valid, reliable, and feasible way. Use results from methods such as quizzes, written exercises, and objective written examinations to help trainees identify areas in which they need to improve. Use the checklist below as a reminder of how to administer and score knowledge assessments.

CHECKLIST TO ADMINISTER, AND SCORE SUMMATIVE KNOWLEDGE ASSESSMENTS

Administer Knowledge Assessments Check () when completed

1. Ensure that the room and physical environment where the examination is being given are appropriate.

2. Provide clear oral directions to the Trainees, including the time allowed, how and where to record their answers, and how and when the examination will be scored.

3. Remain in the room during the examination and move around the room as needed.

Score Knowledge Assessments Check () when completed

1. Use an answer key.

2. Decide what percentage of correct answers is needed for a passing score.

3. Maintain a consistent mental state when scoring assessments.

4. Grade all assessments in the blind (i.e., without being aware whose test or paper it is).


5. Training Process Evaluation:

The evaluation of process is not concerned with precise measurements of success or failure. The purpose is to describe how teaching and learning were implemented in order to identify ways to increase trainees’ competency at the end of the academic program. A process evaluation should describe: how the academic program was implemented; methods and materials used for teaching, learning, and trainee assessment; and how course instructors and trainees reacted to the program, methods, and materials. For effective training and learning evaluation, the principal questions should be: To what extent were the identified training needs objectives achieved by the program? To what extent were the learners' objectives achieved? What specifically did the learners learn or be usefully reminded of? What commitment have the learners made about the learning they are going to implement on their

return to work? And, back at work: How successful were the trainees in implementing their action plans? To what extent did their managers support them in this? To what extent has the action listed above achieved a Return on Investment (ROI) for the organization,

either in terms of identified objectives satisfaction or, where, possible, a monetary assessment. An example of a standard evaluation sheet for a training/workshop is follows:

TRAINING/WORKSHOP TITLE

EVALUATION FORM

Kindly take some time to fill this form and provide us your valuable comments/suggestion by marking strongly agree, agree and disagree and provide us with your suggestions for improvement.

No Statements Strongly agree

Agree DisagreeIf disagree,

please explain why?

Your suggestion for improvement?

1

The topics included in the workshop were clear and related to workshop objectives?

2 The objectives of the workshop were fulfilled?

3

You are satisfied with different teaching methodologies used in the workshop?

4 You are satisfied with the facilitators?

5 The time given for discussion during facilitation was enough

6 The time given for group work was enough

7 The workshop was according to your expectations

8 The venue was appropriate

9 The time allocated for this workshop was enough


10

Please give your valuable comments and suggestions for improvement of the workshops in future

6. Plan for Post Training Follow‐up and Training Replication

As part of competency‐based training, an action plan for training replication and first post training follow‐up of each trainee should be decided upon and prepared at the end the training. This will ensure that the team can properly plan for follow‐up of all trainees after the training is complete.

7. Certification Criteria for Training Certification: Certification criteria should be identified and established prior to conducting the training. Participants will receive certification only if they have met the established criteria. Training Scope and Scale: The certification rules, the training scope, and the participant’s scale in each area of training should be briefly stated on the back of the training certificate.

B. MoPH During‐Training Standard Procedures: During‐training supervision, use of the training quality improvement procedures, tools for improvement of training delivery: To ensure the quality of in‐service training programs, all IST providers should have a comprehensive training supervision and quality improvement system in place. The MoPH recommends the MoPH Training Quality Improvement Methodology, as well as tools for supervision and quality improvement (QI) of IST training provider programs. The IST QI tools can also be used for regular IST programs, and internal/external supervision at all levels. Please refer to Annex 2 for an example of the QI Tool. In‐service Training Quality Improvement: The IST quality improvement process is adopted from the MoPH quality improvement Field Implementation Guide, developed by the Improving Quality of Health Care Department, MoPH. IST quality improvement is an integrated part of the entire quality improvement process in Afghanistan, and will be coordinated through the Improving Quality of Health Care Department of MoPH. Methodology: According to the MoPH’s Field Implementation Guide, stakeholders at the provincial level will plan the implementation of the IST quality improvement approach. They will prioritize in‐service training centers/providers for the implementation phases.

The provincial plan may enroll two to five IST centers/providers at the first round of the implementation and gradually scale it up to four to ten IST centers/providers each year. The quality improvement team will be formed at the provincial level; they will then decide which QI teams will be established at the selected IST centers/providers.

An assessment of standards and outcome indicators will be conducted at baseline in order to establish a clear picture of the current provision of quality IST services at selected IST centers/providers. The assessment will also aid the QI teams in defining the aim for improvement activities. Learning sessions will be conducted to further orient the representatives of the QI teams on Harmonized QI methodology, problem identification, and analysis; problem solving methods, tools, and scoring; and measurement components of the harmonized approach. Conducting learning sessions is an important part of the harmonized quality improvement approach. This approach is collaborative; the teams get together to share their achievements, lessons learnt, and challenges


faced. Action periods between the two assessments and learning sessions (which are approximately three months apart) will provide an opportunity for the IST centers/providers QI teams to directly implement the corrective actions with high confidence and low cost of failure, while also testing the changes in more complex situations. Overall, the typical implementation period for selected IST centers/providers lasts for two years. This implementation period consists of a series of assessments, learning sessions, and three‐month action periods (See the HQIP Implementation Model in the HQIP Field Implementation Guide). However, the length of the overall implementation period may be longer than two years, depending on the collective and individual progress of IST centers/providers in a given province, constraints and challenges, and availability of resources. Thus, each batch of IST centers/providers will implement the HQIP for at least two years to be able to take over the HQIP on their own (sustainability) and establish a continuous system for improvement of their quality of services. In summary, the entire IST quality improvement process is comprised of following phases:

1. Preparations for the HQIP Implementation 2. Orientation Workshops on Harmonized Quality Improvement Approach/Program 3. Overall Implementation Plan at Provincial Level 4. Formation of Quality Improvement Teams at Provincial and Health Facility/IST Centers Levels 5. Baseline Assessment of Standards and Outcome Indicators 6. Conducting Learning Sessions 7. Providing Technical Support through Regular Coaching Visits 8. Reward and Recognition Mechanism 9. Problem Identification, Analysis and Solving Methods and Tools 10. Monitoring and Evaluation of the Harmonized Quality improvement Program

For more information about the aforementioned steps and corresponding implementation, please refer to the Harmonized Quality Improvement Program Field Implementation Guide. The template for the provincial implementation plan and the ToR for IST quality improvement for provincial and in‐service training centers/providers committee can be found in Annex 3 and Annex 4.


Baseline Assessment

* Developing the

change

package of

evidence

based best

practices

* Scale up to new

geographic

areas

* Review and

modification

of standards

and outcome

indicators

The IQHC

Department of

MoPH is

responsible for

coordination of

overall

implementation

of the

Harmonized

Quality

Improvement

Program (HQIP)

nationwide

* Setting Vision & Mission for the HQIP * Finalization of Standards checklist and list of outcome indicators * Selection of Quality tools for Problem identification, analysis and solving * Provincial QI team Formation * Selection of the HFs for the demonstration and spread phases * Development of Training materials * TOT for HQIP * Development of data collection & data flow system * Establishment of Coaching and monitoring mechanism

Learning Session

3 months Action

First Assessment

Learning Session

3 months Action

Second Assessment

Learning Session

3 months Action

Third Assessment

Learning Session

3 months Action

Implementation Model for Harmonized Quality Improvement Program

Next Steps Implementation Preparation

…

…

…

Training Guide 41

Post Training Follow‐up and Training Replication: To ensure that the post training follow-up of all conducted trainings are taking place on time and are properly replicated, a session needs to be scheduled for all in‐service trainings at the end of the training course. During this session, the participants should be assisted in developing a plan for post training follow‐up and replication of the training they participated in. The recommended template for post training and replication plan is below:

Post Training Follow‐up and Replication Plan

Organization: Province:

Training Title: Participant's Name:

Health Facility Name and ID: Action Plan Preparation Date:

No Activities Responsible Timeline Remarks

1

Number of relevant staff the training will be replicated to

2 Post training follow‐up

Training Guide 42

CHAPTERTHREE:POST‐TRAININGPHASE

A. General Information I. Writing Effective Training Analysis Reports

1. Analysis and Comparison of Pre‐ and Post‐Training Assessment Results

Prior to writing the training report, the training focal point needs to conduct the analysis of assessments and compare the pre‐ and post‐training assessments; this will help establish if the trainees acquired the required competencies and if the training objectives were achieved.

2. Analysis of Training Evaluation

Interpret the evaluation results: Teaching staff should review evaluation information and compare the expected results of a course with the actual results. They should then identify the gaps between what was expected and what was actually achieved, and try to determine the causes of those gaps. Finally, they should decide what actions might be needed to reduce those gaps. When identifying what actions are needed, answer the following questions: “What were the successes or strengths?” “How could they be extended?” “What were the problems or limitations?” “How could they be addressed?”

Plan for future changes in teaching: The actions identified to reduce gaps should be incorporated into a plan of action for strengthening teaching. This could happen during review and re‐planning when a teaching institution revises its plan of action, or it could happen as part of the process of monitoring and refining activities. It is important to recognize that action needs to be taken and to formalize that action as an addition or revision to an overall plan of action. When planning for future changes, answer the following questions: “What action should be taken?” “What changes should be implemented?” “What is needed to make those changes? When? By whom?” “What is needed in terms of resources and further information?”

II. Post Training Follow‐up: There are several primary factors that support good performance in a workplace, such as: job expectations, performance feedback, physical environment, tools, motivation, skills, and knowledge required to do the job. The last factor is primarily addressed through training. Even the best training does not always result in improved performance; however, if the health care provider is not able to apply new knowledge and skills on the job, continued skills support through coaching and providing feedback, demonstration, and discussion can help strengthen skills and knowledge in order to maintain competency and proficiency. In order to ensure provider’s continuous performance improvement and provision of quality health services, it is crucial to always conduct a follow‐up of completed trainings and help health care providers apply their newly earned knowledge and skills for performance improvement. Post Training Follow up objectives:

The objectives of post‐training follow‐up system are as follows: To assess knowledge and skills confidence in current practices of providers after training; To provide additional coaching in clinical skills, if needed; To work with supervisors to ensure that providers have the support needed to apply new knowledge

and skills at their job site; and To collect information about provider performance into effectiveness of training.

Training Guide 43

B. MoPH Post‐training Standard Procedures: MoPH In‐service Training Reporting Parts of MoPH Standard In‐service Training Report: For an effective and proper information management, sharing, and reporting, the in‐service training providers are to follow the same reporting recommended by the HMIS Department of the MoPH. Based on the recommended reporting system for in‐service training programs, the training/workshop reports should be comprised of following: Training needs assessment In‐service training providers’ profile National trainers’ profile Training course information Facilitators’ information Participants’ information Post‐Training follow‐up report

Training Information Flow

Private

Training

Centers

NGO Training

Centers

MoPH

Training

Centers

Private IST

Provider/Organi

zation

Non‐

Governmental

Organization

Provincial

Public Health

Directorate

Central MoPH

(Relevant

Technical

Department)

Central MoPH

(Relevant

Technical

Department)

Central MoPH

(Relevant

Technical

Department)

Human Resource Management

Information System (TMIS)

Reports Feedbacks Reports Feedbacks Reports Feedbacks

Reports Feedbacks Reports Feedbacks Reports Feedbacks

GDHR, Capacity Building Directorate

(In‐service Training Department)

Reports Feedbacks

Reports Feedbacks

Reports Feedbacks

Feedbacks

Reports

Provincial

Coordination

through

Provincial

Public Health

Coordination

Meetings

Central

Coordination

through

capacity

Building

Committee

Meetings

Training Report Submission: The training report should be prepared and submitted to related supervisors within two weeks after completion of training.

For more information about in‐service training reporting, please refer to the training database guidelines.

Training Guide 44

Post‐Training Follow‐up

To assess knowledge and skills confidence in the practices of providers post‐training, provide additional coaching in clinical skills, ensure that providers have the support needed to apply new knowledge and skills at their job site, and collect information about provider performance/effectiveness of training, it is mandatory to conduct a post‐training follow‐up (PTFU) of all trainees after the completion of the training. The PTFU mechanism and tools should be included in the Learning Resource Packages for all types of trainings conducted for health personnel. The PTFU and training replication mechanism for all types of trainings should be comprised of:

1. PTFU training replication standard procedures 2. PTFU tools 3. Reporting and feedback mechanisms 4. Data processing levels and procedures

Training Guide 45

Annexes

Annex 1. Workshop/Training Plan Checklist

WORKSHOP/TRAINING PLAN AND CHECKLIST

Instructions: Below are the standard activities related to planning and implementing a workshop. Use this template and add or remove rows as necessary. In the “Type” column, T refers to technical or programmatic activities, F refers to financial activities, L to logistics, and O for other. In the deadline column, the technical monitor, who is managing the workshop, should in collaboration with the workshop coordinator where appropriate, determine the appropriate deadline for each activity, as well as the person responsible for completing each activity (or ensuring its completion). This information shall be recorded in the Responsible column. Finally, once the activity has been completed, the responsible party or the technical monitor should tick the column with the check mark. This allows anyone to see the checklist on the shared drive and check the status of the workshop planning and implementation. Finally, after any change or update to the table, the Last Updated section should be changed to the current date and time, for example “Last Updated: 7 Jan 2014; 17:15”.

Last Updated: [ ]

Type Activity Deadline Responsible √ Prior to the Workshop

T Share workshop idea with technical team. Consider the activities of other teams and partners then thinking about dates. Decide what other stakeholders, if any, should be involved in the process.

T Draft a workshop proposal and submit to manager for approval. Proposal should include the following: ‐Objective ‐Participant selection criteria & recommended # of participants (be sure to consider and request gender balance) ‐Recommended format / session plan ‐Draft agenda ‐Draft workshop budget (using template)

L/ T Pick venue and date(s) for workshop after confirming availability of venue and key participants/facilitators

T Coordinate Training/workshop with related stakeholders (at least one month before the training date)

L Speak to security about the venue (officer and outdoor guards) L Check on the parking situation and ensure that instructions to participants are clear and

accurate

L Visit and reserve venue. Ensure that it has appropriate space, facilities, etc. Arrange to have the room set up in a way that best suits your needs

L Arrange for refreshments and snacks. Be sure that the venue can actually respond to the workshop needs. Check their kitchen, etc. if necessary. If we have to bring our own snacks and refreshments, make sure arrangements are made ahead of time.

T Identify and confirm presenters & trainers/facilitators, including timekeeper T Finalize workshop agenda and session plan, including time for PTFU, logistics and M&E to

orient participants

T Send to participants any read‐ahead documents, if applicable T/L Inform the workshop coordinator of your plans and solicit his/her support T Consult with relevant departments regarding branding of materials, banners, etc. Remember

that a manager must approve banners to ensure branding compliance.

T Draft invitation letter to participants. Be sure to request confirmation of attendance and that participants provide (and bring) their MoPH ID numbers

L Prepare a list/table of invitees and follow up F/L Determine what allowances, if any, will be provided to participants, such as per diem, travel

reimbursement, lodging allowance, etc.

T/L Send invitation letter (with directions, per diem and lodging info, etc.) to participants, reminding them to bring their MoPH ID numbers

T/L Confirm participation, with phone calls, if necessary T/L Determine supply needs and place order with admin team L Prepare name badges‐ be sure to have someone double‐check the spelling of names and

approve. Also, print extra blank badges.

L Gather support materials, such as projector, laptop, printer, paper, markers/pens, folders, flip charts and paper, meta cards, post‐its, scissors, etc.

T Draft presentations

Training Guide 46

Type Activity Deadline Responsible √ T Finalize presentations T Translate presentations, if needed send materials out for translation. L Print presentation handouts. Remember to select black and white printing and handout print

format.

L Photocopy appropriate number of handouts and presentations L Prepare workshop packets, including agenda, handouts, etc. T/L Prepare certificates, if applicable Day before the Workshop

L Set up at the venue and do a final check. Put up signs for restrooms, etc. L Set up the registration area Ensure there is proper place for participants children (kindergarten) F Get money for reimbursements L Have all supplies and equipment available and working (good idea to have IT person on hand

during the workshop)

L Bring several copies of documents L Set up welcome signs in lobby or outside, if necessary

T Confirm availability of facilitators and co‐facilitators for the workshop/training

During the Workshop

L Collect registration info from participants, including MoPH ID#s. Ensure that information is legible.

O Greet participants when they arrive and make them feel welcome. T Start on time and provide a brief overview of the agenda, including when breaks and lunch

will be. Stay on schedule!

T Ensure all participants received the relevant training materials and used provided models and equipment.

T/L Allow time for an orientation to how to fill out forms T Ensure that each participant has filled out the evaluation form T Certificates, if applicable F Time for administrative issues, such as paying per diems, etc. After the Workshop

T Gather all of the materials and feedback. Record results/feedback electronically and share with workshop technical monitor

L Gather spare/ left over materials for the next workshop T Ensure participants develop the PTFU and training replication. (Collect PTFU and training

replication action plans, if appropriate, and convert to electronic copies (scan or type) to share with NGOs and participants’ supervisors

T Share action plans with IST department T Within 2 weeks, workshop technical monitor should write workshop report and share draft

with other facilitators

T Finalize workshop report and any next steps identified during the workshop T Submit the training report with IST and HRMIS departments of MoPH and Share a copy of

workshop report/ findings with participants

Training Guide 47

Annex 2. In‐service Training Plan

Training Guide 48

Annex 3. IST Quality Improvement Tool COMMENTS/ REMARKS/ RECOMMENDATIONS:

Please remember to fill out this part at the end of your assessment of the relevant area.

1. What are the positive points related to this in‐service training area, which you observed in the training center but were not captured in your assessment?

2. What are the problems/issues related to this in‐service training area, which you observed in training center but were not captured in your assessment?

3. What are your recommendations for building upon positive points or overcoming problems/issues, which you mentioned in the answers to Question 1 and 2?

AREA: IN‐SERVICE TRAINING

NAME OF TRAINING: _______________________________________ TRAINING CENTER NAME AND CODE: __________________________________ TRAINING CENTER LOCATION: _______________________________ TRAINING DURATION: From _________________ To ________________ NAME OF TRAINING ORGANIZER (ORGANIZATION): ___________________________ NUMBER OF PARTICIPANTS: ____________________________ NUMBER OF FACILITATORS: ___________________________ NAME AND SIGNATURE OF ASSESSORS: ____________________________ ASSESSMENT TYPE: (BASELINE / EXTERNAL 1 2 3) ASSESSMENT DATE: _____________

PERFORMANCE STANDARDS

VERIFICATION CRITERIA Critical Important COMMENTS

Instructions for the assessor: For any verification criteria fill in each unblocked cell with one of the following options “1” if the verification criteria is met, “0” if the verification criteria is not met or partially achieved, “NA” if Not applicable. Any cells left unfilled will be considered as missing data.

SECTION 1: INFRASTRUCTURE, EQUIPMENT AND SUPPLIES

1. The training site has the basic infrastructure setup to support clinical/non‐clinical training.

Observe that the site is clean, functioning, well‐lit and well‐maintained:

Specific building allocated for

training site

The building allocated for training site is made of concrete

Training Guide 49



Sufficient clinical practice sites to ensure adequate experience with clients

Training hall within walking distance to clinical practice site (or safe transportation to transfer participants from classroom to clinical practice site)

Space for demonstration of clinical skills

Training coordination room near the training hall

Area for tea and lunch breaks

Hostel/hotel/stay arrangement

Secured storage space for models, equipment, training supplies and books

Inverter (power‐converting device) for coordination room and classroom

Computer

Internet access (please

comment: reliable,

intermittent, or not possible)

Total Score

2. The training site has space for simulations using models.

Observe that the site has space for practice either in or near the training hall and:

Is set up according to clinical training conducted

Is large enough to accommodate 3–5 Trainees at a time

Has a practice schedule posted if needed

Is lockable

Has relevant job aids and IEC materials

Total Score

Training Guide 50



3. The training site has a toilet near the training hall.

Observe the toilet facilities:

Is there separate toilet available for male and female

Are clean and functional

Located close to the training hall

Have running water

Have soap and soap dish

Have mirror

Are well‐ventilated

Have lockable doors

Total Score

4. The site has the basic classroom equipment and furniture to support training.

Observe the classroom has:

Whiteboard with stand or wall mounted

LCD projector in working condition with voltage stabilizer

Computer (laptop/desktop) with all wires to connect to LCD projector

Projection screen

Video conference equipment (if the site is a videoconference center)

TV

DVD player

Pen (USB) drive

Flip chart easel

Air conditioning facilities (cooling and heating)

Potable water

Presentation pointer

Training Guide 51



Total Score

5. There are adequate supplies to conduct training sessions.

Observe there are sufficient supplies and materials to support at least 3 training courses:

Flip chart paper

Flip chart markers

Whiteboard markers

Participant paper, pen and folder sets

Tape or pins to hang up flip charts

Total Score

6. The training site has enough training materials during the course.

Verify by interviewing or reviewing records that during the last course:

All participants received a reference manual

All participants received a participant handbook

All participants received copies of the presentation graphics

All trainers had reference manual, participant handbook and trainer notebook/facilitator guide

Total Score

7. The training organizing body has sufficient teaching/ learning materials to conduct clinical training.

Examine training materials for at least two different training courses and verify that they include the following:

Reference manual/modules

Trainer notebook/facilitator guide

Participant handbook

Presentation graphics (PowerPoint presentations) electronically available

Training Guide 52



Clinical skills videotape/VCD/DVD

Required anatomic models

Record‐keeping and reporting form relevant to the service delivery of the skills being imparted as approved in the state

Other teaching aids including job aids

Total Score

8. The training body has latest additional reference materials relevant to the trainings conducted.

Observe that the following materials are available for participants and trainers to use:

A set of training materials for each training being conducted at the site

9. The clinical practice area is conducive for training clinical skills practice.

Observe the clinical practice site area in the hospital or other clinical facility for participants to see that:

The clinic practices are the same standards of services as covered in the training

Sufficient client flow to support clinical practice

Clinic is big enough to allow participants to observe/provide services

There are enough supplies to allow participants to practice skills

The clinical practice area is similar to where the participants work

The staff are receptive of participants coming for clinical practice

The clinical practice area is within 30 minutes of the training site

Training Guide 53



Safe transportation/escort is available for night duty or shift

Total Score

10. The hostel/hotel/stay arrangements are adequate.

Observe OR ask the training course participants that hostel/hotel/stay arrangement:

Is clean

Is safe for women to stay

Is enough for all out‐station participants at once if rooms are shared by two participants

Has attached toilet and bathroom

Is well‐ventilated

Total Score

11. The training body has a designated locking store room/storage space for models, equipment, training supplies and books.

Observe if the store room/storage space has:

Locking door

Adequate space for supplies

The stock is well‐lit and ventilated

Shelves for sorting and storing different training materials

Visible sign in/out sheet

Visible routine inventory sheet that is completed

Cabinets for locking training supplies and equipment (one per course)

Total Score

Training Guide 54

TOTAL Verification Criteria for Infrastructure, Equipment and Supplies: Critical

Important

Remarks

A. Total Verification Criteria ACHIEVED:

B. Total Verification Criteria OBSERVED:

C. Percentage of achievement (A/B x100):

Training Guide 55



SECTION 2: TRAINING MANAGEMENT

12. The training body training activities are well coordinated.

Observe if there is/are:

Training plan is shared with MoPH relevant department at least one month in advance

Training plan is shared with relevant training centers at least one month in advance

Regular meetings between training coordinator and clinical sites management staff (Administrator, Chief Medical Superintendent or Superintendent in Chief, and trainers)

Regular monthly meetings between training coordinator and trainers

A meeting of the training coordinator and trainers a week before training

A hospital training team meeting before and after each training event when relevant

A schedule for follow up calls or visits is available or posted

Total Score

13. The training body has good financial systems and management.

Observe if the training body:

Follows any established financial procedures to support clinical/non‐clinical trainings

Reviews the past training event related to participants to confirm that:

- All participants received per diem and travel expenses as per the state rules

- There are receipts of all payments made

Training Guide 56



- The financial transactions have been entered in required documentation

- Participants were paid on time

- The expenditure report is sent to the higher authorities as per guidelines for the training course

Review the last training event to confirm that:

- All trainers were paid honorarium as per any guidelines

- There are receipts of all payments made to the trainers

- The financial transactions have been entered in the book of accounts by training event

- Payments were made within a week after training.

There is a record of pending payments to participants, trainers or other vendors as appropriate

The total training expense is within the budget approved for the training

Total Score

14. The training body has adequate record‐keeping systems.

Discuss with the training site coordinator and observe the records to see if:

There is a focal point for training management information system.

MoPH approved training database available and used for data banking and reporting

Training Guide 57



There is a file for each training course/batch

Each file contains training report including:

- Title of the training course

- The dates of training

- Names of the trainers

- The list of participants

- The agenda for the training

- Participant’s registration forms as required, including MoPH ID #s

- A brief description of training including: assessment and evaluation of participants; and any significant event that trainers want to report.

- Training evaluation forms completed by the participants

Total Score

15. Training body has an annual training plan and quarterly training calendar.

Observe if:

Systematic training needs assessment is regularly conducted

Standard training needs assessment tool is being used for TNA process

TNA data is locally analyzed at regional level and used for in‐service training planning purpose

There is an annual training plan

The copy of the plan is sent to any stakeholders as required

There is a quarterly training calendar that shows start and end dates for all courses

Training Guide 58



A copy of the quarterly training calendar is sent to any stakeholders at the beginning of each quarter as required

Total Score

16. Participant selection criteria are followed for all trainings.

Review the participants registration forms, or discuss with the training coordinator or trainers that:

Participant selection criteria as described in the training materials are followed

More than 90% of participants met the selection criteria in the last 3 trainings

Total Score

17. Class size and trainer support is appropriate.

Through review of training records, observe if:

At least 2 trainer was always available during classroom and clinical practice

The training facilitators are the MoPH certified national in‐service trainers

Training batch does not exceed as per the recommendations in course syllabus

Total Score

18. Trainer performance assessment is regularly conducted.

Interview the training coordinator and training staff and review administrative documents to find out if:

There is standardized format to assess trainer performance

Trainer performance is measured on a regular basis, at least once a year

Feedback to trainers includes participant evaluation forms

Training Guide 59



Trainers periodically have refresher training (every 4 years)

Total Score

19. Participants and trainers know participant course completion requirements.

Observe/review records materials or guidelines to determine if:

Requirements for learners to “pass” each course are outlined in training materials

Clear steps if a participant does not meet passing requirements exist in guidelines or trainers’ tools

The type of certificate that participant will receive and conditions for issuing certificates are outlined in materials or trainers’ tools

Total Score

20. Course completion requirements are met before any participant can be certified.

Through the record reviews, observe that:

Course completion requirements are explicitly stated and participants informed of requirements

All participants who have received certificates during the last training have met these requirements

Participants who have not met certification requirements are provided with additional practice and assessment opportunities

Total Score

21. The clinical training is routinely monitored for effectiveness.

Through interviews with trainers and by review of administrative records, observe that clinical training is monitored for effectiveness:

Standardized course evaluation form is used

Training Guide 60



Trainers and training coordinator meet to review course evaluation forms at the end of training to get participants’ feedback on training

Course evaluation feedback that requires action is resolved and documented

22. The training organizer allocated adequate time for (full/part time) training course.

Training organizer allocated 8 or 7 hours for full time training per each day (8 hours for spring and summer months, 7 hours for autumn and winter months)

Training organizer allocated 4:30 or 4 hours for part time training per each day (4:30 hours for spring and summer months, 4 hours for autumn and winter months)

Training participants spend least 1 hour for lunch and pray per each day.

Total Score

23. Training facilitators have the required qualifications.

Observe/interview training organizer to verify that:

Is facilitator/trainer a National trainer

Training facilitator/s has/have accredited certificate

Training facilitator/s has/have MoPH – ID number

Trainer use native language according to knowledge level of participants

Facilitators are off or don’t stay for night duty the during of clinical training/workshop

During days of training/workshop, facilitators don’t have any other responsibilities out of training or workshop.

Training Guide 61



Trainers’ invitation letters were sent at least 3 weeks before the training.

The training coordinator confirmed the trainers 2 weeks before the training.

Total Score

TOTAL Verification Criteria for Training Management: Critical

Important

Remarks



C. Percentage of achievement (A/B x 100)



SECTION 3: TRAINING PLANNING AND PREPARATION STANDARDS

24. The training body provides adequate preparation for a training course.

Interview the training coordinator and physically observe to verify:

Trainers and other staff:

– The trainers for the course were informed and booked.

– Staff in clinical area was informed about training dates.

– The accountant was informed about the dates of training.

Supplies and logistics:

– Stationery materials available in the training site.

– Specific anatomical models available in the training site.

– The instrument and equipment for classroom practice were prepared.

Training Guide 62



– Training materials were ordered and procured.

– Audio visual aids were checked and available in the training site.

– The certificate prototype was prepared for review.

– Dietary needs, travel and transportation, lodging and per diem are finalized and oriented to trainers and participants

– Ensure transportation to clinic site is arranged (if needed)

Total Score

25. The training body prepares for blended learning activities appropriately.

Interview the trainers to verify that prior to conducting training they:

Reviews any existing training needs assessment information available.

Review the course syllabus, course schedule and course outline.

Revises course schedule and outline based on training needs information available when indicated

Assign topics/session to individual trainers as needed.

Review content materials and prepare for each session to be delivered.

Review and update presentation graphics as appropriate.

Visit classroom to confirm availability of the audiovisuals and power supply.

Meet with clinical staff and management

Training Guide 63



Ensure that client scheduling is arranged with clinic staff or management as needed

Total Score

26. Participant invitations include essential information and arrive on time.

Review the records and interview the training coordinator and participants to verify:

Participant invitation letters were sent at least 2 weeks before the training.

The training coordinator confirmed the participation of participants 1 week before the training.

The number of invitations is consistent with the course syllabus recommendations.

The invitation letter included:

– Course syllabus

– Course schedule

– The expectation that participants collected the first day of the training.

Total Score

27. The training body ensures everything is ready immediately before the training starts.

Interview the training coordinator or observe the following:

The classroom was set up.

Participant accommodations were ready.

Training materials were available.

Audio‐visual equipment was set up.

A backup plan was in place in case of power failure.

Training supplies were available.

The training budget was available.

The trainers reviewed the preparation for training.

Training Guide 64



The clinical staff was ready to receive the participants for clinical practice.

Total Score

TOTAL Verification Criteria for Training Planning and Preparation Standards: Critical

Important

Remarks



C. Percentage of achievement (A/B x 100):



SECTION 4: CLASSROOM TRAINING STANDARDS

28. The trainer makes the training relevant and participatory.

Observe/interview trainer to verify:

Participants are involved in the process of learning by:

– Making agenda, giving daily summaries and other activities

– Objective and agenda

– Questioning and feedback

– Group and individual activities

– Timely energizers

Participants are treated as individuals:

– Use participant names as often as possible.

– Treat participants with respect.

Trainer reviews participant expectations at the beginning of the each day.

Training Guide 65



Time is allotted for the trainer to review participants’ individual learning plan/Action plan when they exist.

Total Score

29. The trainer creates a positive situation

Observe/interview trainer to verify:

Various audiovisual aids are appropriately used

A variety of learning activities and training methods are appropriately used:

Positive, corrective and positive feedback is provided frequently

The trainer models a positive attitude

Trainers create atmosphere of safety for participants to freely communicate with one another and trainers.

Total Score

30. The trainers provide constructive feedback to participants.

Observe/interview trainer to verify that:

Feedback is positive.

Feedback includes specific suggestions for improvement.

After coaching or assessment activities the trainer asks participant to self‐ assess before providing feedback.

Total Score

31. The trainer uses effective session introduction and summary skills.

Observe the trainer during the session to verify that he/she:

Introduces session using an engaging technique

States objectives as a part of introduction.

Presents effective summary:

– Keeps summary brief.

Training Guide 66



– Draws the main points of presentation.

– Links to next topic.

32. The trainer uses effective facilitation skills.


Uses trainer notes or a personalized reference manual during presentation.

Maintains eye contact with the participants.

The trainer keep walking inside class for effectiveness of teaching

Trainer their voice adapted to the size of training class and number of participants.

Maintains energy.

Total Score

33. The trainer uses effective questioning skills.


Asks questions of the entire group.

Targets question to individuals.

Asks questions at a variety of level.

Responds to participants’questions.

Total Score

34. The trainer effectively manages the group dynamics

Observe the trainer during the training course to verify that he/she:

Manages the communication in the classroom.

Manages the discussion in the classroom.

Encourages/creates a friendly environment in the room.

Training Guide 67



Facilitates the development of group norm at the group activates and training.

Total Score

35. The trainer uses audiovisual aids appropriately.

Observe the trainer:

Makes sure aids are visible

Makes sure aids are easy to read and not crowded

Underlines or emphasizes important info.

Prepares any complicated materials before hand

Always faces the learners

Always checks equipment ahead of time

Total Score

36. The trainer uses transparencies and/or PowerPoint presentations appropriately.

Observe the trainers:

If using transparencies, the trainer:

– Lists one main idea and maximum seven lines on one transparency.

– Numbers transparencies.

– Has an overhead projector (OHP) in working condition.

– Has an extra projector bulb on hand.

– Does not read from transparencies.

– Uses a pointer or pencil on transparency rather than pointing fingers on the screen.

Total Score

37. The trainer uses media materials appropriately.

Observe the trainers:

If using VCD/DVD player, the trainer:

Training Guide 68



– Introduces the video topic.

– States the objective of viewing the video.

– Focuses participant attention on key points.

– Stops in between and ask questions or lead discussion as appropriate.

– Leads follow up discussion at the end.

– Summarizes the session.

Total Score

38. The trainer prepares for the illustrated lecture

Observe trainer presentation or review an illustrated lecture plan to verify that it:

Includes an effective introduction.

Has prepared trainers notes and activities.

Has identified questions to use for developing clinical decision making skills and assessing understanding.

Has a plan for effective summary.

Total Score

39. The trainer facilitates small group activities effectively.

Observe during the training session that the trainer:

Plans small group activities that are consistent with the objective of the session.

Provides clear instructions for the group work:

– Directions for the small group activity (whether role play, clinical simulation or case study)

– The trainer allocate people among small group as time keeper, writer and presenter

Training Guide 69



– Time limit

– How to document and report when required

Summarizes the session.

Total Score

40. The trainer facilitates large group activities effectively.

Observe a session during which the trainer facilitates a large group session and verify that the trainer

States the objectives of the session and announces the topic or problem (whether brainstorming, games or group discussions).

Establish the ground rules.

Moderates the discussion appropriately.

Maintains a written record during brainstorming.

Reviews ideas and suggestions periodically during brainstorming and discussions.

Summarizes effectively.

Total Score

41. The trainer uses assessment to competency.

Observe that the trainer:

Uses questions during activities to assess understanding and/or reinforce key points

Uses the summary to highlight important information or assess understanding of important information

Uses end of the day sessions to evaluate training and learner progress and makes changes in training when needed

Training Guide 70



Provides periodic formative assessment (are they competent in simulation, etc.) when needed to determine if participants are ready for clinical practice or to move to the next topic

Uses the provided assessment tools to determine if the participant has mastered the required content

Creates a plan for achieving competency for participants who do not meet the requirements for completion or passing of the course

Total Score

TOTAL Verification Criteria for Classroom Training Standards Critical Important Remarks



C. Percentage of achievement (A/B x 100)



SECTION 5: CLINICAL DEMONSTRATION, PRACTICE AND COACHING STANDARDS

42. The trainer effectively demonstrates types of skills.

Observe a session during which the trainer is demonstrating a skill and verify that the trainer:

Has setup the demonstration in advance with adequate supplied and equipment

Introduces the skill being demonstrated.

Clearly states objectives as a part of instruction.

Ensures all the participants are able to see clearly.

Training Guide 71



Asks questions and encourages participants to ask questions as appropriate.

Maintains eye contact with the participants as much as possible.

Speaks loud enough so that participants can hear.

Psychomotor Skills:

Communicates with the anatomical model or client during the demonstration of skill or activity.

Demonstrates or simulates proper infection prevention practices.

Positions anatomical model as actual client.

Communication Skills:

Provides a concise (under 15 minutes) demonstration of related communication skill.

Uses questions to assess participants understanding and progress

Clinical Decision Making Skills

Explains rationale in decisions made in clinic

Uses questions to ask participants “what if…” in simulation and in clinic to assess their understanding and clinical decision‐making abilities

Asks questions during psychomotor skill demonstrations to assess participants’ related clinical decision‐making skills.

Training Guide 72



Uses pre or post clinical meetings to review pertinent cases and ask additional questions to develop clinical decision making skills in related clinical area

Total Score

43. The trainer is an effective coach.

Observe while the trainer is working with participants:

Before:

Greets the participant

Reviews previous performance as applicable.

Works with the participant to set specific goals for the practice session.

During:

Observe the learner, providing positive reinforcement or constructive feedback (when necessary for client comfort or safety) as s/he practices the procedure.

Refer to the checklist or performance standards during observation.

Record notes about learner performance during the observation.

Is sensitive to the client when providing feedback to the learner during a clinical session with clients.

Provides appropriate practice activities in clinic based on each participants’ abilities and progress

After:

Review notes taken during the practice session

The trainer is an effective

Ask the learner to identify those steps performed well.

Training Guide 73



Ask the learner to identify those steps where performance could be improved.

Provide positive reinforcement and corrective feedback

Work with the learner to establish goals for the next practice session

Total Score

44. Clinical practice is arranged to ensure participants have safe and adequate practice with clients.

Observe the clinical practice session for participants and verify that:

Client’s rights are respected during the clinical practice including his/her right to:

– Bodily privacy

– Confidentiality

– Know the role of each person involved in the procedure.

– Give permission before having clinician‐in‐training observe, assist with or perform any procedure.

– Have clinical trainer present when participants are practicing.

Clients are carefully selected by the trainers for participants to practice. There is a daily plan for clinical practice containing:

– The date

– Name of the clinical trainer

– The clinic staff responsible for the day

– Learning objectives

– Activities to be accomplished by the participants.

Training Guide 74



Clients have been recruited ahead of time when needed to ensure sufficient client load for practice

Clinic practice is structured to ensure maximum exposure to clients

Trainer to participant ratio is sufficient to ensure clients are not harmed through adverse events

The plan for clinical activities allows participants to move from supervised to independent practice

The trainer has identified which practice activities may be completed by which participants independently

Total Score

45. The trainer uses preclinical practice meetings to clearly outline expectations for the clinical day.

Observe the trainer during preclinical practice meeting to verify:

Learning objectives for the day.

Any change in the schedule.

Participant roles and responsibilities for the day.

Special assignments if any.

Cases/topics for post clinical practice meeting.

Answer participant questions.

Total Score

46. The trainer supervises clinical practice to ensure safety and adequate practice with clients.

Observe the trainer during clinical practice to verify:

Trainer is always there when participants are performing psychomotor skills with clients.

The trainer provides coaching during clinical practice as appropriate.

Training Guide 75



The trainer is sensitive to client’s presence while providing feedback.

The trainer intervenes if the client’s safety is in question

47. The trainer uses post‐clinical practice meetings effectively to help learners develop competency

Observe the trainer during a post‐clinical practice meeting to verify:

Trainers hold post clinical practice meeting each day to:

– Assess progress in learning.

– Present cases seen during the day.

– Plan for the next day’s activities.

– Use questions to reinforce key points and develop clinical decision making skills

Total Score

48. The training body has adequately prepared the clinical practice site.

Verify by interview with clinic management that:

The training body has shared key resources with the facility management and related ward staff, including:

– Assessment tools used for clinic

– Related skill performance standards

– Training materials or reference materials

The trainer(s) communicate pertinent information with facility staff, including:

– Topic, times and dates of planned clinical practice

– Types of clients needed

– Any particular learning needs or capability of particular participants

Training Guide 76



Total Score

49. The training body or trainer has ensured clinic staff involved in supervision or supports of clinical practice are adequately prepared

Verify by interviewing appropriate clinic staff or training body records that:

Facility staff expected to supervise have been standardized and updated in required skills

Facility staff expected to supervise have been provided with relevant training and assessment tools.

Expectations of facility staff in supervision have been documented and shared.

Any incentives for supervision have been documented and are implemented consistently.

Total Score

50. The trainer uses assessment effectively to help learners develop competence and determine if training goals have been met.

Verify by observation or interviewing participants from previous courses that the trainer:

Uses questions during clinical practice to help learners develop clinical decision making skills

Uses client record review during clinical practice to provide feedback on clinical decision making skills

Assesses participants ability to move from closely supervised to more independent practice in the clinical setting

Uses the provided assessment tools to determine if the participant has mastered the required content

Communicates regularly about participant progress with any clinic staff assigned with any participant mentoring or supervisory responsibilities

Training Guide 77



Creates a plan for achieving competency for participants who do not meet the requirements for completion or passing of the course

Total Score

TOTAL Verification Criteria for Clinical Demonstration, Practice and Coaching Standards:

Critical

Important

Remarks






SECTION 6: TRANSFER OF LEARNING (TOL) STANDARDS

51. The training body has developed processes that incorporate transfer of learning (TOL) activities in training implementation.

Verify by interviewing the training coordinator or associated staff that:

Plans and budget is in place for follow up support of participants after training.

Trainers have access to copies of the action plans prepared by participants during the course.

Copies of the participant’s action plans are sent to their supervisors.

Total Score

52. Training body or trainers perform the TOL activities before, during and after each training course.

Conduct interview with trainers to verify/or observe during the training course:

Before training, trainers:

– Review the performance needs assessment findings if available.

– Make changes in course to adjust to participants needs.

Training Guide 78



– Send course syllabus, course objectives and course schedule to participants along with invitation letter.

During training, trainers:

– Review any individual learning plans

– Provide work‐related (realistic) exercises and job aids.

– Give immediate and positive feedback to participants.

– Revise training and activities based on participants’ progress

– Encourage participants to develop realistic action plans to encourage TOL.

– Remind participants to meet with supervisor to review action plan.

– Identifies who to contact for support or questions, or links to any existing networks or other providers for support

After training, trainers:

– Communicate with participants as appropriate.

– Facilitate the review of action plans with supervisors and participants

– Maintain communication with supervisors and participants.

Total Score

53. The trainers or training body involve

Verify by interviewing the trainers or participants (if available)

that:

Training Guide 79



participants in transfer of learning activities.

Before training, the participants:

– Are involved in needs assessment if conducted.

– Receive the course syllabus, course objectives and course schedule along with the invitation letter.

– Complete pre course activities if required.

During training, the participants:

– Develop an individual learning plan when used in training.

– Develop a realistic action plan.

Total Score

54. The Training coordinator reminds the participants to complete the following after training.

Review of records and interviewing with training coordinator to verify:

Apply new skills and implemented action plan.

Use job aids as appropriate.

Network with other participants and trainers.

Monitors their own performance.

Total Score

TOTAL Verification Criteria Transfer of Learning: Critical

Important

Remarks




Training Guide 80

TOTAL Verification Criteria for all Sections: Critical

Important

Remarks




Training Guide 81

Annex 4. Term of References for Quality Improvement Teams

Islamic Republic of Afghanistan Ministry of Public Health

General Directorate of Curative Medicine Improving Quality in Health Care Unit (IQHC)

Provincial Quality Improvement (PQI) Committee Terms of Reference

Background: The Ministry of Public Health (MoPH) of the Government of Afghanistan has established a clear mission “to improve the health of the people through quality health care services provision and the promotion of healthy life styles in an equitable and sustainable manner”. In order to achieve this goal, the MoPH and donors have introduced and implemented a number of different strategies, tools and methodologies aimed at improving the quality of health care services. A national strategy for improving quality in health care was developed and formally introduced across the country in 2011. To ensure smooth implementation of the IQHC strategy, it require strong coordination at and between the national and sub‐national levels, there is a need to establish quality improvement committees as a comprehensive mechanism to address the implementation of quality approaches, at provincial and health facility/IST providers’ levels. Purpose: The purpose of the Provincial QI Committee is to establish and enhance coordination mechanisms for implementation of improving Quality in Health Care Strategy at provincial level and ensure links/liaison with the IQHC Unit at central level through an assigned Provincial QI Focal Point (Job Description under development). Membership and Representation: The Provincial Quality Improvement Committee will have representation from a wide range of MoPH stakeholders including provincial health director, PPHO staff, national in‐service trainers, representatives from donors and UN agencies at provincial level, implementing NGOs, hospital managers and Community Health Shura members. Provincial‐level Quality Improvement Focal Points will serve as a liaison between the IQHC Unit in Kabul and the provincial Quality Improvement Teams. Through the monitoring of quality improvement efforts, they will support the Public Health Department office, NGOs and other stakeholders. The committee will be chaired by PHD or his/her nominee from provincial public health office. This committee will meet a monthly basis or as integrated part of PHCC meeting. In the latter case, the IQHC strategy implementation and quality‐related issues will form a permanent/ regular agenda of the PHCC meeting. Roles and Responsibilities: The PQI Committee has the following role and responsibilities:

Ensure the implementation of the IQHC strategy at BPHS and EPHS facilities and focus on the quality aspect of healthcare delivery at provincial level.

Ensure the implementation of the IQHC strategy at in‐service training centers/providers and focus on the quality aspect of in‐service training programs delivery at provincial level.

Ensure proper implementation of harmonized quality program at provincial level.

Provide oversight to planning, organizing and conducting capacity building activities on Improving Quality in healthcare at provincial level. As an example, this oversight includes assessing training needs for health facility QI teams and facilitating the identification of potential QI trainers from within provincial hospitals.

Review the progress of QI interventions at BPHS and EPHS facilities and in‐service training centers.

Act as advocating body for QI at provincial level.

This committee will assign a provincial focal point and provincial quality expert’s team from health facilities to meet on a more regular basis and report its progress on monthly basis to the Provincial QI Committee and the IQHC Unit in central MoPH.

The minutes of all meetings will be recorded and maintained by the provincial QI focal point and the team for reporting purposes.

Revision of performance reports of health facilities provided by provincial QI focal point and his/her team for the selection of potential health facilities and their nomination to the central MoPH for National recognition & award system.

Training Guide 82

Islamic Republic of Afghanistan Ministry of Public Health

General Directorate of Curative Medicine Improving Quality in Health Care Unit (IQHC)

Health Facility/In‐Service Training Centers Quality Improvement (HFISTCQI) Committee Terms of Reference

Background: The Ministry of Public Health (MoPH) of the Government of Afghanistan has established a clear mission “to improve the health of the people through quality health care services provision and the promotion of healthy life styles in an equitable and sustainable manner”. In order to achieve this goal, the MoPH and donors have introduced and implemented a number of different strategies, tools and methodologies aimed at improving the quality of health care services. A national strategy for improving quality in health care was developed and formally introduced across the country in 2011. To ensure smooth implementation of the IQHC strategy, there is a need to establish quality improvement committees at provincial and health facility/in‐service training center levels. Quality Improvement Committees (Teams) currently exist in several hospitals in Kabul and 13 other provinces. The IQHC Unit is seeking to revitalize the current committees with slightly modified roles and responsibilities both at health facilities and existing IST centers. Purpose: The purpose of the Health Facility/IST center QI Committee is to oversee the quality of healthcare and in‐service training programs within hospitals/IST centers and ensure links/liaison with other HFISTCQI teams, the Provincial QI Committee at provincial level and the IQHC Unit at central level. Membership and Representation: The Heath Facility QI Committee will have representation from different departments of health facility, hospital/facility managers and community health shura members. The IST centers QI committee will have representation from training centers staff, in‐service trainers, and supporting NGO/entity The health facility committee will be chaired by the manager of the health facility (e.g. Hospital Director and his/her deputy/appointee) or the QI focal point of the health facility. The IST centers QI committee will be chaired by training center’s head or QI focal point of the center. It is worth mentioning that the job description of the QI focal points will be revised in close coordination between the IQHC unit and HRD, to reflect quality‐related responsibilities. This committee will meet on a weekly basis or even more frequently as needed. Roles and Responsibilities: The Health Facility/IST Centers’ QI Committees will be responsible for overseeing the quality of healthcare within hospitals and quality of provided IST programs within IST centers. Sub‐Committees will then be created and mandated with overseeing quality improvement activities. Examples of these sub‐committees include Medical Records Sub‐Committee, Maternal Death Review Sub Committee, Adverse Events and Near‐Miss reporting system that includes analysis, distilling of lesson learned dissemination of findings and action to reduce further risk. Organized into periodic meetings, these sub‐committees will provide quality improvement recommendations with hospital/IST centers’ leadership and aid in the implementation of these activities. The Health Facility/IST Center’s QI Committee has the following role and responsibilities:

Oversee the quality of healthcare within hospitals.

Oversee the quality of IST programs within IST centers

Ensure the implementation of the harmonized quality program and prioritize quality‐related interventions at health facility and IST center level.

Ensure that a responsive complaint management system is in place at health facility and IST center.

Ensure a proper quality‐related data recording and reporting system.

Implementation of patient safety mechanism such as safe surgery checklist.

Ensure client‐centered services by promotion of patient charter of right at health facility.

The minutes of all meetings will be collected, recorded and maintained by the facility focal point for improvement and local decision making purposes.

Establish links with existing structures mentioned above such as Maternal Death Review Sub‐committee.

Training Guide 83

Annex 5: List of IST M&E Indicators

No. Indicator Definition Indicator metrics Reporting frequency

Source and means of verification

1. Proportion of health personnel whose annual training needs assessment is completed

TNA will be conducted on annual basis and this indicator will monitor the progress towards completion of TNA of MoPH and other stakeholders’ personal

Numerator: Number of health personal (MoPH and other stakeholders’’ personnel) whose annual TNA is completed) Denominator: Number of health personal working for MoPH and other stakeholders Calculation: Numerator/ Denominator x 100

Annual Training System Database

2. Proportion of in‐service training programs planned based on TNA results

The indicator will measure improvement of in‐service training planning and use of TNA for in‐service training planning at national level

Numerator: Number of national level training programs planned based on annual TNA result Denominator: Number annual in‐service training programs conducted at national level. Calculation: Numerator/ Denominator x 100

Annual IST Unit’s annual reports

3. Percent of in‐service training programs conducted based on approved MoPH in‐service training thematic annual plan.

This indicator will monitor the coordination of in‐service training programs at national level

Numerator: Number of national level annual training programs conducted based MoPH approved integrated in‐service training plan Denominator: Number annual in‐service training programs conducted at national level. Calculation: Numerator/ Denominator x 100

Annual In‐service training reports/monitoring checklists

4. Percent of in‐service training programs with updated MoPH approved learning resource package

The indicator will monitor standardization process learning resources packages for BPHS and EPHS priority in‐service training areas

Numerator: Number BPHS and EPHS in‐service training areas with updated MoPH approved learning resource package Denominator: Number existing in‐service training areas within MoPH BPHS/EPHS priority in‐service training areas list Calculation: Numerator/

Annual IST mapping reports

Training Guide 84



Denominator x 100

5. Number of certified national in‐service trainers for BPHS/EPHS priority training areas

MoPH will certify qualified in‐service trainer for BPHS/EPHS training areas and the indicator will measure the progress on certification of national in‐service trainers at national level.

Numerator: Number of MoPH certified national trainers for BPHS/EPHS priority training areas. Denominator: Number of existing trainers for BPHS/EPHS priority training areas. Calculation: Numerator/ Denominator x 100

Annual TrainingDatabase

6. Percent of in‐service training providers registered in MoPH training database

The indicator will monitor registration process of in‐service training providers/entities in MoPH training database

Numerator: Number of IST providers registered in MoPH training database Denominator: Total number of existing IST providers at national level. Calculation: Numerator/ Denominator x 100

Annual TrainingDatabase

7. Percent of IST providers/centers using MoPH training database for in‐service training data management

The indicator will monitor the process of national in‐service training programs data management and reporting.

Numerator: Number of IST providers using MoPH in‐service training database for in‐service training programs’ reporting and data management Denominator: Total number of existing IST providers at national level. Calculation: Numerator/ Denominator x 100

Bi‐quarterly IST mapping reports/TMIS database

8. Percent of QI participating IST centers with a functioning QI system

The indicator will measure progress on implementation of IST QI by IST providers/entities

Numerator: Number of IST providers/center/entities using IST QI tool for improvement of their IST programs Denominator: Number of existing IST providers/center/entities providing IST programs at national level Calculation: Numerator/ Denominator x 100

Annual QI database

9. Proportion of IST providers/centers with IST quality improvement score of higher than 80%

The indicator will measure progress on implementation of IST QI by IST

Numerator: of IST providers /center/entities obtaining score of higher than 80% in QI assessment

Annual QI database

Training Guide 85



providers/entities of their programs. Denominator: Number Number of IST providers/center/entities using IST QI tool for improvement of their IST programs Calculation: Numerator/ Denominator x 100

10. Percent of QI participating IST centers recognized in the QI process

The indicator will measure progress on implementation of IST QI by IST providers/entities

Numerator: Number of IST providers/center/entities recognized as best providers based on QI assessment of their IST programs. Denominator: Total number of IST providers /center/entities implementing QI for their in‐service training programs. Calculation: Numerator/ Denominator x 100

Annual QI database

11. Proportion of the IST providers/centers submitted their in‐service training reports to MoPH.

The indicator will monitor the process of national in‐service training programs reporting to MoPH.

Numerator:Number of IST providers /center/entities submitted their IST programs report to MoPH. Denominator: Number of existing IST providers /center/entities providing IST programs at national level Calculation: Numerator/ Denominator x 100

Quarterly TrainingDatabase

12. Availability of hard and soft copies of MoPH documents, LRPs, publications, records though established provincial resource centers.

The indicator will evaluate availability and accessibility to existing MoPH informative and learning materials in all provinces.

Qualitative Annual TrainingDatabase/Resource centers annual reports

Training Guide 86

GLOSSARY

In‐service Training In‐service training is a training that is provided to an organization’s employee based on organization priorities and introduction of new workingapproaches and technologies.

Training Needs Assessment

A training/learning needs assessment (TNA) is a review of learning anddevelopment needs for staff and volunteers within your organization. Itconsiders the skills, knowledge, and behaviors that your people need, and how to develop them effectively.

Training Cycle A training cycle is a model that can be used to represent a systematicapproach to training and development. It helps businesses identify theseries of sequential steps they need to undertake when training anddeveloping staff. The key steps are:

Identify training needs

Analyze the needs

Plan the training

Set training objectives

Design the training

Evaluate and adopt the content

Run the training

Evaluate the training (did it meet the objectives?) The cycle demonstrates that the steps should be viewed in their entiretyand not be seen as a series of isolated activities. This means that the outcome of one stage provides the inputs for the next stage and theabsence of any stage would undermine the validity of the whole process.

Active listening A communication technique that helps stimulate open and frank exploration of ideas and feelings and establishes trust and rapport with trainees.

Assessment A process to determine whether trainees have achieved the learning objectives.

Attitude A state of mind or feeling. For example, when counseling a patient, the counselor’s attitude toward the patient is important.

Training Guide 87

Brainstorming A teaching method in which a list of ideas, thoughts, or alternative solutionsthat focus on a specific topic or problem is generated. Brainstormingstimulates thought and creativity and is often used along with group discussions.

Case study A learning method that uses realistic scenarios focusing on a specific issue,topic, or problem. Trainees typically read, study, and react to the case study individually or in small groups. (See also Clinical scenario and Patient management problem.)

Checklist A list of the steps, given in the correct sequence, that are needed toperform a skill correctly.

Clinical practice A learning method, essential for developing healthcare delivery skills, that allows trainees to practice skills in the clinic. Clinical practice helps preparetrainees for the roles and responsibilities they will hold in their profession. Itprovides opportunities to integrate knowledge, skills, and attitudes. (Seealso Clinical practice site.)

Clinical practice site The site(s) where trainees practice clinical skills. (See also Clinical practice.)

Clinical scenario A scenario that typically begins with a variable amount of clinicalinformation and data, followed by a series of questions to which the traineeshould respond. (See also Case study and Patient management problem.)

Clinical simulation A simulation that presents the learner with a carefully planned, real orhypothetical patient management situation. Clinical simulations are an excellent method for developing cognitive or clinical decision‐making skills. The learner interacts with persons and things in the environment, appliesprevious knowledge and skills to respond to a problem, and receivesfeedback about those responses without having to be concerned about real‐life consequences.

Closed question Questions that have a small range of answers (often yes or no) and are used to assess trainees’ knowledge and develop their problem‐solving skills.

Communication skills The abilities to listen, ask questions, educate, inform, advise, counsel, andcheck understanding.

Competency The ability to perform a skill correctly and according to a specific standard(often presented in the form of a performance checklist).

Computer presentation Use of computer software to create presentations that may include text,graphics, audio, video, and other features. The presentation is then shownto individuals or small groups of trainees on a computer screen or may be projected on to a large screen using a projection unit.

Constructive feedback Feedback that is used to tell trainees how to improve their performance. Constructive feedback must make clear how trainees can correct inappropriate or incorrect behaviors.

Core competencies Aspects of a subject or discipline that are common to all trainees, essential to practice, and essential to master in order to graduate from an academicprogram and enter into practice. Each core competency for an academicprogram will encompass cognitive (knowledge), psychomotor (skills) and affective (values and behaviors) domains that are observable and can beappraised.

Training Guide 88

Core curriculum Courses and other learning experiences in an academic program orcurriculum that are required of all trainees. There may also be elective courses or courses in specialty areas, but these are not required of alltrainees so are not considered part of the core curriculum.

Course The basic unit or component of a curriculum within an academic program. Itconsists of a series of learning sessions on a particular topic. In someinstitutions, it may be known a subject area, block, or unit. A course mayinclude both classroom and clinical learning experiences.

Course objective An objective—also known as a main objective, primary objective, or course aim—that describes in clear, measurable terms what trainees should know and be able to do after completing the entire course. A course may haveone or several course objectives. Course objectives often encompassknowledge, skill, and attitude areas or domains, and should relate to one ormore of the core competencies for the overall academic program.

Course schedule A session‐by‐session summary of learning activities and topics for a course.The course schedule is typically given to trainees on the first day of a course.

Criterion A standard on which a judgment or decision is based.

Criterion‐referenced test

An assessment that is based on clear criteria that are found in the learningobjectives of a course.

Critical thinking skills The abilities to draw on past experience and seek out new information inorder to analyze, reason, reflect, create ideas, and clarify information.Critical thinking is essential for solving problems and making sounddecisions.

Curriculum All of the courses of study offered by an educational institution (e.g., all ofthe courses offered by a school of nursing).

Direct observation Watching trainees as they perform skills. This may take place in a simulated situation or with patients. It is the most valid way to assess trainees’ skills and can be used for both formative and summative assessments.

Discussion An interactive process in which trainees share their ideas, thoughts, questions, and answers in a group setting with a facilitator. A discussion that relates to the topic and stays focused on the learning objectives can be avery effective teaching method.

Distractor An incorrect response in a multiple‐choice question. (See also Multiple‐choice question, Response and Stem.)

Drill A verbal question‐and‐answer period during a classroom or practical session that helps the teacher obtains a general impression of trainees’ understanding of the subject.

Education See Preservice education.

Educational institution School or university (e.g., medical, nursing, midwifery school) that grants certificates or degrees.

Essay examination A common type of written examination in which trainees are asked to write down what they know about a subject or question. Essay questions are easyto develop and can test trainees’ ability to organize and express ideas. However, the scoring of essay questions is subjective and very time‐consuming.

Training Guide 89

Evaluation The periodic assessment of the overall process and final results of anacademic program. Evaluations of academic programs are designed to answer questions such as; “Did trainees achieve the competencies expected from the academic program?” and “Are trainees able to effectively apply their knowledge, skills and attitudes to their work after graduation?”

Feasibility Capability of being accomplished. An assessment method is considered tobe feasible when it can be easily implemented to measure trainee learning.

Feedback Information given to trainees about the quality of their performance. It is essential throughout learning, particularly during and after practice sessionsand after trainees’ skills are assessed.

Field notebook A record of external learning experiences completed by the trainee in the field (e.g., community or home visit) that can be reviewed by the teacher or clinical instructor.

Flipchart A large tablet or pad of paper on a tripod or stand, used for presentinginformation (e.g., agenda, announcements, drawings) to trainees.

Formative assessment An informal assessment of trainees’ progress throughout a course. Formative assessment not only helps trainees improve their performance, it may be used to reinforce important content areas and supplementsummative assessments.

Illustrated lecture See Interactive presentation.

Imperfect matching exercise

A type of matching exercise in which the responses given for a question maybe used repeatedly or not at all. (See also Matching question and Perfect matching exercise.)

Inpatient ward

Settings where patients are generally seriously ill, and have already started a care plan and specific treatments. Inpatient wards are a good setting toteach patient management, practice healthcare delivery skills, anddemonstrate rarely seen conditions.

Interactive presentation

Verbal presentation of information by the teacher in which presentation of content is supplemented with a variety of questions, interactions, visualaids, and instructional materials. Also known as an illustrated lecture.

Knowledge What is known about a topic or subject. For example, as a trainee learns the information presented in a course and begins to study and apply thisinformation, the trainee begins to develop knowledge about the topic or subject.

Knowledge assessment Formative and summative measures of the information acquired during a course (e.g., quizzes, objective written examination, drills, practice tests,written exercises, case studies, clinical scenarios, patient managementproblems, project reports, essay examinations).

Learning Life‐long process of acquiring new knowledge, skills, and attitudes. It may occur formally during a learning event or informally during personal readingor study.

Training Guide 90

Learning journal A record of a trainee’s learning experiences, which usually includes a brief description of the problem encountered, management of the problem, and education received. It is especially useful for situations in which the traineehas minimal or no supervision, such as home visits, community‐based experiences, or rotations to distant clinical sites.

Learning materials Materials (e.g., books, articles, reference manuals, performance checklists)used to conduct a course.

Learning objective A statement indicating what the learner or trainee will know or be able to do after completing a learning experience or course.

License A permission granted by a competent authority to engage in a business oroccupation, or in an activity otherwise unlawful. For example, to practicemedicine, a doctor must have a license, usually granted by a nationallicensing body.

Logbook A list of skills or tasks that trainees should be able to perform. Also called a casebook.

Management Skills

The abilities to organize, regulate, or be in charge of things such as assigningtasks to staff, maintaining patient records, ensuring the availability of essential supplies and equipment, or designing a system of patient referral.

Mastery learning Approach to learning that is based on the premise that all learners canmaster (learn) the required knowledge, skills, and attitudes, provided sufficient time is allowed and appropriate training methods are used. Thegoal of mastery learning is that 100 percent of learners will master (learn)the knowledge, skills, and attitudes on which the training is based.

Matching question A test item that in its simplest form consists of two lists of words andphrases that is to be matched. The first list is known as a list of premises;the second is called the list of responses. (See also Perfect matching exercise and Imperfect matching exercise.)

Monitoring The process of continually checking the status of a program by observingwhether activities have been conducted and completed as planned andwhether they are generating anticipated results. In education, monitoring isthe ongoing process of collecting information about teaching in order to improve the quality of trainee learning. Monitoring asks the questions: “How well are we doing?” and “How can we do better?”

Multiple‐choice question

A knowledge assessment question in which one or more correct answers can be selected among a variety (commonly four or five) of suggestedanswers. Multiple‐choice questions are the most widely used type of objective test item. (See also Distractor, Response and Stem.)

Norm‐referenced test A test in which trainees are compared with one another in order to develop a ranking of trainees.

Objective assessment method

A test in which equally competent scorers will obtain the same score for agiven test. It is a method that is free of teacher bias. Objective assessments include multiple‐choice, true‐false, and short‐answer questions. A multiple‐choice test is an objective assessment method because two different course instructors can score the same test and the results will be the same.

Training Guide 91

Open question A question that allows a wide range of responses, and permits trainees to describe in their own words the answer to the problem or question. It isused to assess trainees’ knowledge and develop trainees’ problem‐solving skills.

Performance The way in which someone functions. Good performance is the ability to do something according to the standard in the real world (on the job).

Positive feedback Feedback that gives trainees a clear idea of which correct behaviors they are demonstrating, so that they can repeat those behaviors.

Practice test A short version of a written examination designed to help prepare traineesfor a summative assessment. Also called a quiz.

Pre‐service education Learning that takes place in preparation for taking on a future role, forexample as a doctor or nurse. This education provides a broad array ofknowledge, skills, and attitudes needed to fulfill that future role and fromwhich the trainee can later select what is needed according to a given situation. Pre‐service education most frequently takes place in schools and universities (e.g., medical, nursing, and midwifery schools) that grantcertificates or degrees.

Procedure All of the individual steps or tasks required to perform an intervention.

Question bank Lists of questions available to create a variety of tests. Question banks can be recorded on paper or stored on a computer.

Quiz A short version of a written examination designed to help prepare traineesfor a summative assessment. Also called a practice test.

Rating scale Scale that describes a quality or frequency of judgment. It is usuallyassociated with a number and descriptive text, and can be incorporated intochecklists or feedback reports or used independently.

Reliability The ability of an assessment method to consistently measure what it is designed to measure.

Response One of the four or five alternative answers in a multiple‐choice question. (See also Multiple‐choice question and Distractor.)

Role play A learning activity in which trainees play out roles in a simulated situation that relates to one or more learning objectives. Role‐plays promote learning through imitation, observation, feedback, analysis, and conceptualization.

Short‐answer question Question requiring the trainee to provide one or several short responses (one or two sentences) to a question or situation. No predefined possibleanswers are given to trainees.

Skill A group of steps or tasks, often using motor functions, which are completedto accomplish an end. A skill can be either a physical activity or an intellectual activity.

Skill acquisition The initial phase in learning a new skill or activity, in which trainees are aware of the skill and know how it should be performed, but do not alwaysperform it correctly.

Skill assessment Determining the ability of trainees to perform essential skills.

Training Guide 92

Skill competency An intermediate phase in learning a new skill or activity, in which traineesperform the skill correctly, but may not always progress from step to stepefficiently. This is the level typically reached in the preservice education of healthcare providers, because the final level requires practice over time.

Skill proficiency The last stage of skill development, which usually occurs after traineesgraduate from an academic program and have practiced the skill over time at their workplace. Proficient healthcare providers consistently performskills correctly and efficiently.

Skills development lab A classroom, a room dedicated to simulated practice (sometimes called aClinical Skills Center), or a room in a clinical practice site set up for clinical orskills practice sessions.

Slide Information (e.g., text, tables, charts, diagrams, photographs) projectedonto a screen. Slides include traditional 35 mm slides shown using a slide projector and computer slides shown using a computer and a projectionunit.

Standard A measure of comparison established by authority, custom, or generalconsent as a model.

Stem The part of the multiple‐choice item that poses a question or a problem situation and is followed by alternative answers. (See also Distractor and Multiple‐choice question.)

Step Specific action needed to accomplish a skill or activity. (Task often used synonymously.)

Structured practical examination

An examination that can assess knowledge, skills, and attitudes by having trainees rotate through a series of stations where they answer questions(orally or written), or perform tasks under observation.

Subjective assessment method

An assessment method in which the score can be affected by the opinion or judgment of the person doing the scoring.

Summative assessment A formal assessment of the trainee’s achievement at scheduled times throughout the course. Summative assessments assign a grade or mark tothe trainees’ level of competence for key learning objectives.

Supporting objective An objective (also known as a secondary, specific, instructional, or enablingobjective) that supports the main objective by describing the specificknowledge, skills, and attitudes that trainees must master to achieve the main objective.

Syllabus The design document for a course, providing a summary of all the basicinformation about a course (e.g., course objectives, trainee assessment methods).

Task Skill or activity broken down into specific actions, assignments, or duties. (Step often used synonymously.)

Task analysis A description of the essential steps of a task or skill, including exactly howthe steps are performed, and in what order.

Teacher Person who has knowledge and skills in a specified subject area and the ability and training to transfer them to others. Course instructors are usually found in preservice education programs.

Training Guide 93

Teaching Transferring or conveying knowledge, skills, and attitudes. Teaching usuallyrefers to instruction provided through classroom activities and is oftenassociated with preservice education programs.

Teaching method Methods or approaches used by a teacher for presenting information (e.g.,classroom presentation, brainstorming, discussions) and helping traineesdevelop skills (e.g., demonstrating a skill, giving feedback as traineespractice a skill).

Transparency Plastic sheet with information to be presented to trainees. The transparency is placed on an overhead projector and shown on a screen in the front of the classroom.

True‐false question A question that asks the trainee to respond with either the answer “True,” meaning the statement is true, or the answer “False,” meaning thestatement is false.

Validity The ability of an assessment method to measure what it is intended to measure. A test is considered valid when it adequately measures whetherthe knowledge, skill, and attitude objectives of the course have been met.

Video Visual images and audio shown on a monitor or computer screen, or projected from a computer and a projection unit onto a screen.

Visual aid Writing board

A type of learning aid or teaching tool that supplements learning activitiesby highlighting important points or key steps or tasks. Common visual aidssuch as writing boards, flipcharts, overhead transparencies, slides,videotapes, and computer presentations help to communicate informationclearly and maintain trainee interest. Board on the wall of a classroom used for writing and displayinginformation. This board may be a chalkboard or a white writing board.

Written exercises Exercises that ask trainees to read (or view, watch, listen) something and then answer questions in writing to check their understanding of theinformation. Exercises, which are typically completed as “homework,” are useful for formative assessment.

Training Guide 94

Documents

Training Guide Final16Sep14old.moph.gov.af/Content/files/Training Guide Final16Sep14(1)(1).pdfGeneral Directorate of Human Resources ... HMIS Health Management Information System HRMIS