design and deliver effective in-service training: evidence from an integrative review of the...

7/30/2019 Design and Deliver Effective In-Service Training: Evidence from an Integrative Review of the Literature

1/33

Effective In-Service TrainingTechniques, Timing, Setting and Media:

Synthesis of an IntegrativeReview of the Literature


2/33

What evidence is there to supporteducational techniques, timing (single vs.repetitive), setting, and media used todeliver instruction?

What evidence exists about the outcomes(knowledge, skills, attitudes, providerbehaviors, patient outcomes) of continuedhealth professional education?

In the context of continuing healthprofessional education


3/33

3

In the context of continuing healthprofessional education

Julia Bluestone, MSPeter Johnson, PhDJudith Fullerton, PhDCatherine Carr, DrPHJessica Alderman, MPH

James BonTempo, MS


4/33

First Quality Review:81 excluded

37Systematic

Reviews

32Randomized

Control Trials

JournalDatabase

244

133Grade One

30Grade Two

61First Tier

69First Tier

Titles andAbstract Review

Second QualityReview:

100 excluded

Additional Time andSetting Hand Search:

8 added

Inclusion/Exclusion Process


5/33


6/33

Techniques for 10 Points

In a systematic review, didactic instruction wasfound to result in which level of learningoutcomes?

a) no-to-lowb) low-to-moderate or

c) moderate

6


7/33

7

Didactic techniques and providing printedmaterials alone clustered in the range of

no-to-low effects, whereas all interactiveprograms exhibited mostly moderate-to-high beneficial effects. The most commonlyused techniques, thus, generally werefound to have the least benefit (Bloom)



8/33


Of the following, which has the strongest evidenceto support it as an effective educational technique?

a) Self-directed learning

b) Clinical simulations

c) Team-based learning

Strong evidence base

8


9/33


Which of the following has the strongestevidence for skill development outcomes?

a) Demonstration

b) Using a checklist

c) Practice and feedback

9

Dose-response, or providing sufficient

practice and feedback was identified asimportant for skill-related outcomes

(McGaghie, Moores, ONeil)


10/33


The use of SMS messages, without additionaltraining, has been shown to improve clinicalpractice behaviors by which percent?

a) 3-10%

b) 9-18%

c) 24-26%

10


11/33

11



12/33

Timing for 10 points

Which of the following has stronger evidence tosupport it?

a) A 5-day training on training skills

b) A series of 30 minute practice sessions spreadover a week

c) Weekly practice sessions of 15 minutes,

over two months, each session repeatedseveral times

12


13/33

13

Timing for 10 points

And the winner is. Repetitive

RCTs: Better knowledge acquisition, betterretention and some evidence of improved

practice behaviors (Kerfoot articles)

Systematic reviews: better learningoutcomes (Marinopoulos, et al)


14/33

Timing for 20 Points

Repetitive, short learning interventions have

been shown to increase retention by howmuch?

a) 2-fold

b) 4-fold

c) 8-fold

14


15/33

15

Timing for 20 Points


16/33

Setting for 10 Points

In one randomized clinical controlled trialfocused on emergency obstetrical skills, aclassroom setting, simulation center and

workplace all resulted in similar knowledgeoutcomes, true or false?

TRUE

16


17/33

17

SimulationCenter

WorkplaceLearning

However, setting

matters for skills



18/33


Clinically integrated teaching has someevidence to suggest it can improve:

a) Knowledge

b) Skills

c) Attitudes

d) All of the above

18


19/33

19

Several RCTs focused on clinical decisionmaking skills comparing interactive lecture vs.clinical integrated teaching found clinically

integrated teaching more effective. Clinical integration may be an effective method

for clinical practice behaviors, attitudes andcritical thinking and communication skills.



20/33

Setting 30 Points

20

Faculty for 10 Pts

Educationalpsychology literaturereinforces that

situated learningresults in easiertransfer intopractice, true or

false?TRUE


21/33


22/33

22

Computer-based equally or slightly better

One RCT found:

Greater efficiency

Three months post-test results found nodifference in retention (Harrington andWalker).

Two RCTs found: computer-simulated patientsequal and less expensive than live,standardized patients

Media for 10 Points


23/33

Media for 20 Points

Multiple systematic reviews caution against:

a) Use of print only media

b) Self-directed learning via mobile

c) Computer-delivered without face-to-face

23


24/33

24

Media for 20 Points

Multiple systematic reviews caution againstthe use of print-only media (Berkhof, Bloom,Moores), concluding that that live instruction

is preferable to print-only (Marinopoulos,Rampatige). Targeted use of multimediaimproves learning outcomes


25/33

Media for 30 Points

We do NOT have enough evidence to support theuse of mobile as a medium to deliver continuedprofessional education, true or false?

FALSE

25


26/33

26

e-IMCI: 84.7% performance compared to 61%(DeRenzi)

Promising for point-of-care decision support(Leung)

CHWs: Rich media job aids: 33% reduction in

errors; 30% increase in compliance (Arango) Extremely promising for reminders/reinforcement

(Zurovac)

Media for 30 Points


27/33

Media for 40 Points

27

Which of the following is the best answer? Mediato deliver instruction should be selected based onits ability to:

a) Be innovativeb) Deliver effective techniques

c) Undergo rigorous evaluation

Technique, Technique, Technique, andTechnique


28/33

Research Agenda

Evaluate promising practices in

LMICs

Test with lower-level cadres Ethiopia: Post-BeMONC SMS

MCHIP MNH Champions

28


29/33

29


30/33

Recommendations: Techniques

Select techniques that help the learner processand integrate information

More case-based, problem-based and

simulation, less didactic instruction Prioritize simulation for emergency skills

Increased feedback and interaction = positive

learning outcomesAvoid passive techniques, choose case-basedapproaches & simulations


31/33

Recommendations: Timing

Leverage technology to provide short, repeatedexposures

Aggressively explore the use of spacing and

testing Shorter, repeated workplace based trainings for

skills practice


32/33

Recommendations: Setting

Select setting based on if it will support effectivetechniques, and

Reduce absenteeism

Address workplace quality assurance Reduce costs and increase productivity

Increase use of mentored, facility-basedapproach for skills-practice and feedback portion

of training


33/33

Recommendations: Media

Select media based on if it will support effectivetechniques, and more effective learning

Use appropriate technology to deliver instruction

efficiently

design and deliver effective in-service training: evidence from an integrative review of the...

Documents