Presentation on theme: "“A European network on cervical cancer surveillance and control in the new Member States - AURORA” 3rd Module: Organization, management and evaluation."— Presentation transcript:
1“A European network on cervical cancer surveillance and control in the new Member States - AURORA” 3rd Module: Organization, management and evaluation of the “Train – the – Trainers courses”
2Partner www.aurora-project.eu This publication arises from the project «AURORA» which has received funding from the European Union in the Framework of the Health Programme.
3Index 1. Identifying training needs 2. Training organisation 3. Practical issues4. Methodology: theory concerning education and adult learning principles5. Adult learning principles: Andragogy6. Learning circle: how to explore and absorb new knowledge7. Role of the trainer: facilitate learning8. Pitfalls in small-group work9. Getting it right: participants find small-group discussion rewarding when …10. 9 steps: a practical guide to group work11. Gaining audience interaction: participatory techniques12. Training materials13. Feedback and evaluation14. Resources
4Identifying training needs - 1 In the health sector training has become part of professional lifeWhat is training?Training is generally thought in terms of courses and training sessions that are trainer-led.It is also the case that too often ‘trainer-led’ is interpreted as meaning delivering a lecture or presentation. But this ‘traditional’ course based learning should not be seen as the only way for participants to acquire and maintain knowledge, skills and behavioural attributes necessary to do their job effectively.AURORA course will be a mix of a computer-based training and a self-managed learningTraining Vs. EducationEducation is most often described as focusing on knowledge to be transferred to the learner. Education is what takes place at for example universities.Training focuses on teaching someone how to do something; it focuses on developing skills. Training is therefore more concrete and specific, the objectives and expected outcomes are easier to define.
5Identifying training needs - 2 The health sector needs not only to ensure that healthcare professionals are properly trained when they are newly appointed but also needs to ensure that quality standards in medical performances continue to be metWhy train?Training is also part of the personal - professional development.Training allows the trainee to develop his/her professional capacities and to have better performances.Well trained healthcare professionals deal with cases more effective and will feel better and happier with their job. Training can work as an incentive. It will not only increase professional capacities and skills but also motivation and even team spirit, as contacts with other participants in training activities enrich the working environment.
6Identifying training needs - 3 Why train?The training process has to start with a clear definition of needs of the trainees.The only way to ensure that needs are properly identified is finding a way to get information directly from the target group.This can be done by organising explorative meetings with representatives of the health sector or personal interviews with doctor and nurses. Also the results of AURORA’s “Analysis of Local Context” can be used to identify whether the activity met the needs of the participants.
7Identifying training needs - 4 To write intended learning outcomes, we need to use appropriate languageExamples of alternativelearning routes:• Distance learning: Computer-based training and e-learning• Workplace learning: Mentoring, coaching and appraisal• Self-managed learning: Observations and sitting-in, reading, research, project work• Wider opportunities: Study visits, secondements and work shadowing, conferences and workshopsClarifying intended learning outcomes!to help trainers and trainees to focus on the essential content of the training.to help to identify further training needs.The learning outcomes must be:Specific;Manageable;Attainable;Relevant;Time-specific.
8Identifying training needs - 5 Why must trainers spend time identifying and writing down the intended learning outcomes?The training should be pragmatic (i.e. applicable to trainees’ needs), attainable within the time available, able to be assessed to enable both trainers and trainees to appreciate what has been achieved.The course ensures that trainers and trainees know the specific objectives of the training.Choice of training technique.Specificities of the contexts in which the training will be carried out and specific hard to reach population groups should be consideredThis training course is developed in the framework of AURORA Project and addressing professionals involved in Cervical Cancer Screening.The target group of training activities are healthcare professionals and in particular: gynecologists, family planner, nurses, general practitioners, etc.So, firstly, trainers have to define trainees needs in order to make a training affordable by each participant in the course.
9Identifying training needs - 6 When we know how to identify the training needs and the target group the next step is to set objectives for the training activitySetting the objectives of the trainingThe identified needs should be translated into concrete topics that can be part of a training activity.At the same time, attention should be paid to the particular target group: which level of knowledge or skills is required and which method is appropriate (see also the chapters on methodology and training techniques).It is fundamental to take into account all sources that contribute to the identification of training needsIt is advisable to follow a systematic and structured approach to translate identified needs into objectives for a training activity or programme.A strategy might be as follows:Gather identified needs together.Identification, as specific as possible, of the skills, knowledge and behavioral attributes needed to achieve competence in relation to each need.
10Identifying training needs - 7 Decide on a priority order of which needs are most important to the performance.After discussion, evaluate the size of the training gap and produce a needs index.Consider any other evidence that is relevant to the problem.Reach a final conclusion based on:Priority of the need to the performance of the role.Results of the needs index and size of the training gap.Evidence from other sources.The likely duration of the need- some problems disappear with time.The proportion of the target population to which the identified need applies.The cost, both in social and financial terms, of ignoring the need.With this systematic approach it is less likely to omit important aspects of the problem.
11Training organisation - 1 Identifying training resourcesIn planning the training, think about training resources. Try to identify them using a checklist as follows:People: trainers who have participated in AURORA “Train the trainers” programme, experts, general practitioners, health professionals, the participants themselves, patients, etc…Places: visits to relevant medical centres, hospitals, universities, etc.Written or on-line materials: AURORA e-learning material, books, newspapers, hand-outs, manuals, videos, on-line materials, etc.
12Training organisation - 2 Establish the best possible learning environmentWhatever methods are adopted, there is one general issue which needs to be addressed: how ensure that trainees feel comfortable and receptive. In other words, how to establish the best learning environment?Location: providing an environment geographically distinct from the working place of trainees is helpful. In this way, there will be less chances of interruption on work-related issues (mobile phones should be definitely turned off!) making easier to achieve training aims and outcomes.Accommodation issues: physical comfort is important. Consider:• room temperature;• room ventilation;• seating capacity;• seating arrangements – can everyone see the speaker? Can the speaker see every member of the audience? Are there enough rooms (or areas for ‘breakout’ small-group activities)?
13Training organisation - 3 Deciding on materials and methodsThe (team of) trainers should decide at an early stage how they want to conduct the training.This means they should identify:- What materials the trainees will be provided, either in advance or during the training (programme, handbooks, readers, hand-outs, manuals).- Which tools would they like to use? (PowerPoint, overhead projector, video/DVD, flipchart)Deciding on the activityTiming: duration of the event (one day, several days)Level of training: for experienced participants or beginners?Aim of the course: transfer of knowledge or skills, change of values or attitude? Formulate the intended learning outcomes in advance; they are the basis for all further decisions and preparations.
14Training organisation - 4 Practical organisation1. Send the invitations or the confirmations of participation to the trainees. (min. 2 months in advance)2. Send the materials well in advance to trainees, so that they will have enough time to prepare themselves. (min. 2 weeks)Inform the trainers and trainees about the ‘house rules’.Prepare the evaluation tools (pre and post training questionnaires, etc.)5. Prepare the badges for participants and trainers.6. Coffee breaks/ lunch: ensure that coffee, tea and lunch are available at the right time.7. Prepare the documents to be distributed at the venue.8. Prepare PowerPoint, overhead projector, flipcharts and pens etc.9. After the event: compile the evaluation results and plan a follow-up. Discuss the evaluation outcome with the trainers and within the training institute.
15Practical issues - 1 Establishing the best learning environment How to establish the best learning environmentTimingHow to make the trainees feel at easeGround rulesEstablishing the best learning environmentToo much running around to make last minute arrangements for equipment and materials is not professional and does not invite the trainee to have confidence in the trainer.Therefore, you should be sure before the training course, that trainers have identified any equipment needed (e.g. in relation to overhead projectors, PowerPoint, flipcharts, etc.) so that you can start on time and in an organised manner.Distribute the definitive programme (including intended learning outcomes) 7-14 days before the course to trainees (in written format, or electronically).At the beginning of the course, highlight (e.g. by PowerPoint or overhead projector slide or by referring to written support material) the intended learning outcomes and explain why these have been considered relevant.
16Practical issues - 2 Timing Making the trainees feel at ease How to make the trainees feel at easeGround rulesHow to make the trainees feel at easeGround rulesTimingTime is a resource, but timing is a potential hazard.Consider starting and finishing times: can the audience realistically get to the venue from their homes in time for the start of the session? Will too late a finishing-time prompt some to leave early to get home at a reasonable time?Periodic breaks are necessary for revitalising the audience – but be aware that the time taken to serve coffee is usually much longer than trainers estimate.Making the trainees feel at easeThe needs of adult learners differ from other groups such as undergraduate students. The training environment can be an uncomfortable one.So, consider the arrival at training location: is the process of welcoming each trainee appropriate? (Does a member of the training team welcome each trainee as they arrive? Is there coffee? Are name badges issued? Does the training team try to mix with participants during breaks or at meal time?)
17Practical issues - 3How to make the trainees feel at easeGround rulesPay attention to your opening session: are the intended learning outcomes clearly specified?Maintain a supportive climate: be sensitive to possible signs of anxiety and be ready to provide encouragement and reassurance where necessary.Keep the sessions short and provide break times. But also make sure there is enough time for discussion and time to respond to questions to help ensure that training is proceeding at the pace needed by trainees not that desired by the trainers.In formal sessions, present information in a highly structured and organised way, and make use of overviews/summaries/headings, etc. (for example, by means of ‘PowerPoint’).Keep the content relevant to the audience and use a variety of modes of presentation to maintain interest.It is important to provide opportunity for practice or application: case studies, group discussion and reporting-back, role play simulations, etc.
18Practical issues - 4 Establish appropriate ground rules It may be considered appropriate to ensure trainees understand their responsibilities. In other words, do not assume that each trainee is a willing learner! You, the trainer are responsible for ensuring that trainees co-operate by following basic ‘ground rules’, most of which are matters of mere basic courtesy to others. It is always better to lay down the law at the start of training to prevent misunderstandings later.Consider :Attendance throughout the course is expected – any tendency to disappear early can be addressed by circulating claim forms at the very end of training;Timing: you will lose time if you do not show that the timetable is not for mere guidance: try to start at the allotted times and finish promptly.Participation is essential– it could be necessary to explain that especially small-group training methods (see chapter 6) require active participation.
19Methodology: theory concerning education and adult learning principles Designed to help trainers (trainers of health care professionals) to:understand the importance of ensuring participation in training and variety in the methods selectedidentify the knowledge, skills, attitudes and values which are part of health trainingdevelop specific strategies and training methods for cervical cancer screeningdraw up guidelines of good practice in cervical cancer screening training which will assist trainees and trainers in recognising when the training is effective
20Adult learning principles: Andragogy Health care professionals involved in cervical screening: (gynecologists, nurses, GPs etc.) already have:Proven professional experience and knowledge;Demand on identifying learning needs;Interest in practical results and knowledge;Need to be handled as peersThe perfect learning process will cover all four elements
21Learning circle: how to explore and absorb new knowledge Concrete experience: role play, demonstrations‘do it the right/wrong way’: e.g. communication strategies with HTR in cervical cancer screeningForming abstract concepts: structured discussion about the experiences of the trainees and their conclusionsMultiple choiceMind-mappingObservation and reflection: Lecture/presentationResearch: the trainees are provided with some literature and should find themselves the most suitable theory to solve a case study/answer a question.Testing in new situations:The trainee makes a checklist, based on the theory. The trainees assess if in a case study the theory was applied correct or wrong.
22Role of the trainer: facilitate learning - 1 Identifying training needsImproving communication strategies according to HTR needsDetermining desirable training outcomesAppropriate communinaction of trainees in order to promote cervical cancer screening participation,To improve follow-up andCommunication of smear resultsDesign courses and programmesAccording to local settings of cervical cancer screeningConsidering and selecting resources and methodsAccording to trainees (health care professionals involved in cervical cancer screening) and local resourcesConducting a trainingTrainees-tailoredEvaluating and analysing the results of the training‘Sparring partner’ for the training institute to discuss training requirements
23Role of the trainer: facilitate learning - 2 BarriersTraining techniquesOrganisational (related to training course settings) and individual (in connection with trainees)Solution:Training tailored to the needs of the audienceHealth care professionals involved in cervical screening: (gynecologists, nurses, GPs etc.)Involving a range of participatory training techniquesChoosing the appropriate methodology promotes:Changing the inappropriate attitudes of traineesReinforcing existing positive attitudesSensitising trainees to accepting the need to promote and perform cervical cancer screeningThe correct method keeps learners interested
24Role of the trainer: facilitate learning - 3 Working with small groups Group workInvolves co-operative or collaborative learning techniques:Such as tasks and responsibilities, discussion, explanation, exchange of opinions and asking for helpHomogeneous groups: participants feel safer, interact more easily with each otherGroup composition based on former professional experience and knowledge on cervical cancer screeningHeterogeneous groups: might hamper collaborative learning (reluctant to participate in discussions)Working with groups requires specific skills of the trainerSource of information/role modelOpportunity for group discussionCareful preparation to obtain:a satisfying discussionconclusions of direct use to professional practice (guidelines)3 types of discussions:Directed-teaching discussion group – there is one correct answer, the aim is to arrive at the correct answer.Non-directed discussion group – there is no one correct answer, the aim is to explore the topic through getting participants to interact in the group in a positive and constructive way.Seminar-type discussion – there is no hitherto accepted correct answer, discussion will attempt to get some constructive conclusions which may lead to some collective decision from the competing alternatives available.
25Pitfalls in small-group work Already existing relationships among trainees (collegues)Readily dismissing certain ideas and accepting others as obvious without recognising their limitations (entrenched habits in former experince)Too many references to examples from personal experienceNot clarifying expectations and purpose of the discussionUninteresting or not stimulating tasksNo qualitative discussion materialsPersonality-centred rather than task-centred groupsToo large groups do not to ensure proper participationGroup members may not know each otherThe choice of group members may make open discussion difficultToo many tasks for the groupInsufficiently prepared group leaderDominating group leaderNot appropriate accommodation for discussion
26Getting it right: participants find small-group discussion rewarding when … They have the chance to contribute:Share and acquire knowledge and experienceThe purpose of the discussion is clearThe atmosphere is warm and friendlyThere is a good leadershipThey feel they are learning something relevant
279 steps: a practical guide to group work 1: Understand the group: special composition according to local settingsMotivation, Previous experience, Barriers (entrenched habits in former experince)2: Plan the group exercise (topics on cervical cancer screening)3: Ensure the group understands the tasks and intended learning outcomesIdentifying rules, tasks, resources4: Ensure the group understands the role of the group leaderFacilitating discussion5: If conducting a discussion, use an appropriate range of well-timed and well-focused questionsOpening discussion, promoting discussion and continuity6: If allocating tasks to smaller groupsIdentifying pairs, monitoring progress, stepping in7 [if necessary]: Deal with the awkward member appropriatelyMaintaning the group’s purposes and central concerns.8: SummariseThe relevance of the activity to professional practice in cervical cancer screening9: Review – self-check list after group discussion
28Gaining audience interaction: participatory techniques - 1 Snowballing or pyramidingBrainstormingFollowing a presentationAudience is asked to respond with ideasTo list and to reject attempts at premature discussionSubsequent discussion / analysis / categorisingIn pairs or threes or foursDiscuss a topic for a brief period of timeThen with another pair/threeFollowed by a general discussionInteraction in a relatively ‘secure’ environmentAudiences of 4 – 40Requires a plenary ‘feedback’ sessionBuzz groups2-3 people asked to discuss a particular topic and then report backWhen there is no oppurtunitiy to undertake a full-scale, small-group exerciseGiven a clear, straightforward topicParticularly effective in the early stages of a training course
29Gaining audience interaction: participatory techniques - 2 Seeking audience responsesPre course tasks for the participantsProvides opportunity to gain insight into:ViewsKnowledgeAttitudes orValuesof the audience on the topic of how to promote cervical cancer screening among HTRUseful: providing trainees some materials in advance (background information)Provides basic knowledgeTo identify relevant issues in daily work of trainees (real cases)IcebreakersRunning a role- playShort exercises at the beginning of a trainingTo feel more at ease and to get to know each other quicklyTo enable the trainer to identify members of the groupTimingPractical application of theoriesHelps the trainees to put in practice what they learnedCo-operative group work: everybody should be involvedRealistic situationsFeedback is essential
30Gaining audience interaction: participatory techniques - 3 Running a case studyConducting a “report back” sessionPresentation of a specific „story” (among HTRP)case management of a given screening situationmanaging behaviour of a HTRP person because of cultural/language etc. BarriersInterpreting results and/or folow-up instructionsRelevant background informationContents should be designed to achieve clearly defined aims and learning outcomesMore effective in small groupsProvides an opportunity for groups to report-back to othersAllows review of the activityIdentification of different viewpointsOpportunity for others to share ideasDifficulties:responses and attitudes contrary to those which the trainer intendedensuring that the reporting-back reflects the group’s views, rather than the views of the spokesperson for the group
31Gaining audience interaction: participatory techniques - 4 PresentationsOral PresentationsEnsuring time for questions/discussions afterwardsCan be used in a variety of situations and for a variety of taskslecture from an expert (trained by AURORA)lecture followed by open discussion (or lecture with the opportunity to intervene during presentation)short presentations from panel members followed by panel discussion (and with the opportunity to respond to questions from the audience)short presentations from groups on allocated tasksDifficultiesImpression of the speakerHold the audience’s attention throughout the speechPreparation and contentNo irrelevant contents, clear and logical structureDeliveryConsidering setting, aids, speech speed
32Training materials Introduction Visual aids: Effective training - appropriate tools and materialsEffective materials - intended learning outcomesVisual aids help to:understand structure of presentationretaining attentionForms of visual aid:overhead projectors, slide projectors, PowerPoint presentations, computer graphics, black/white boards, flipcharts, videos, objects or hand-outsVisual aids:use where appropriate to what you say (not a gimmick!)ensure that they can be seen by everyonekeep them as simple as possibleChoice of materials:size of the group to be trainedplace of venue and available technical equipmentcapacities of the trainer (to use for example PowerPoint)physical condition of participantssight or hearing disabilities require adapted materials
33Training materials Audio-visual aids To put across a point with more effect.To help trainees take more in – up to 75% of knowledge or information is gained through sight.To maintain interest.To focus attention in one spot/place.To break up a lecture (particularly every 20 minutes).To help the preparation of a talk.To help keep the speaker (and the audience) on track.To aid memory by providing a summary.To help standardise presentations involving a number of trainers at different locations.To add variety.
34Training materials: Power Point and overhead projector normal routine in many presentationsvisualise the structure and key points of presentationpreparation stagetrainers can use slides to build the structure of their presentation (headlines and key remarks)actual presentationslides as the basis of the oral presentation, explanation of theory and giving detailsSlidesalso to give new information (e.g. when video-presentations are integrated)ensure active role of participantsintegrate slides with questions for participantsshort demonstrations or visual modelsintegrate links to internet sitescan be printed in a hand-out formatsupport for participants during presentations (no need to concentrate on making notes)support the oral presentationcolours, fonts, formats and animations help to bring varietybut too many animations will distract the participants
35Make sure that the slides can be seen at the back of the hall: Training materialsAudio-visual aidsMake sure that the slides can be seen at the back of the hall:use minimum font size 24text in a dark colourUse these tools economically – avoid overkill.Ensure that the content is relevant.Use the slides to emphasise the key issues.Practise using them in advance – make sure you know how to use the audio-visual resourceNot too many information at one time: do not overload the audienceNo more than seven lines of five words each line on a slideGive the audience enough time to read the content of any slideThink about hand-out for distributionYou can consider revealing or unmasking the text graduallyYou can use a pointer for issues you wish to highlightStand beside the projectorOnly turn the projector on when you are going to use it; and turn it off immediately after you have used itNEVER turn your back on the class when talkingCheck compatibility of your version of the Power Point with the version available at the locationEnsure you know how to link up the data projector and laptop/computer
36Training materials Flipcharts Flipcharts are easy to use Check in advance all practical issues:Are the flipchart pens working?Are they thick enough?Is there enough paper?Can the chart be seen by all participants?Flipcharts areeasy to useuseful at times of reporting-back by groupspractise writing legibly and in capitals with big letterstry not to write and speak at the same timesize of lettering is:10 people; board 2m away: letters 2cm high and 3mm thick25 people; board 10m away: letters 4cm high and 3mm thick50 people; board 20m away: letters 8cm high and 5mm thickup to 100 people; board 30m away: letters 12 cm high and 1cm
37Training materials Training materials HandoutsTraining materialsVideos and DVDsto make life easier for traineesto ensure that they will have a clear and logical text, guiding them through a presentationadd detailed information or references that you cannot include in spoken presentationPowerPoint - possibility to print slides in a ‘hand-out format’you can decide how many slides to copy on one page, leaving space for trainee to make notesalways explain in advance why this is being usedfreeze the video to discuss particular issue that should be considereduse the resources with considerationsomeone does have sight or hearing problems?consider time of day: will it send people to sleep?
38Feedback and evaluation IntroductionWhy seek feedback?Trainers need:To know if intended learning outcomes have been metTo identify future training needs of traineesTo know what trainees thought of their performance in plenary and group sessionsTrainees need to know:Whether they have met the intended learning outcomesWhat can they do to make good the shortfallSatisfaction of these outcomes is regarded as necessary for the proper discharge of job, etc.To assess the effectiveness of the courseTo identify future training needsCollect information from all stakeholders:TrainersTraineesInstitute
39Feedback and evaluation Learning cycleTaking stock:What do I know?(individual)Planning:How can I take my learning further?(developmental)Reflection:What do I need to know?(contextual)Feedback and Evaluation:How much and how welldo I now understand?(relational)
40Feedback and evaluation: Giving feedback to trainees Important task of the trainerKnowledge: how much did the trainees understand and they were able to apply their knowledgeSkills: feedback on the impact of training on performanceTrainee should first evaluate his own performanceFeedback should be specific, not generalRelate to the performance, not the trainee’s personalityAmount of feedback should be manageable – three or four points as maximumThere should be a balance between positive comment and constructive criticismGiving feedback should be a continuous processComment from trainers to be given at various stages of training:At the end of a role playAs part of audience interaction in plenary sessionWherever possible, try to relate the feedback to specific intended learning outcomes
41Feedback and evaluation Giving feedback to trainers and training institutesTrainees should be told why the feedback is being sought:to improve the quality of future trainingfeedback should be anonymousadequate time should be set at the end of the coursequestions need to be designed to elicit useful responsesquestions should relate both to performance of trainers and to perceived relevance or success of the training
42Feedback and evaluation Identifying future training needsIdentify the extent to which the current intended learning outcomes have been metSeek to elicit ideas or suggestions for future trainingImportant message is that training is tailor-made for specific audiencesModes: course evaluation forms, end-of-course conclusion, small-group discussion, or even informal talk during breaksWhat went well (and why)What improvements could have been made (and how)
43Feedback and evaluation Disseminating lessons from trainingcollate resources and make available after the traininginvite trainees to make available to their colleagues the materials presentedtape talks from trainers/experts (or even videoed) and make them available on websiteestablish some form of resource centre by asking participants to supply materials which could be used in future training activities
44ResourcesKnowles, Malcolm S. (1980) The Modern Practice of Adult Education; From Andragogy to Pedagogy. Englewood Cliffs, NJ: Cambridge Adult Education Merriam, Sharan B. and Rosemary S. Caffarella. (1999) Learning in Adulthood: A Comprehensive Guide. San Francisco: Jossey Bass.Coetzee, M. (2002) Short course in Skills Development Facilitation. Pretoria: University of South Africa.Gough, Jacqui (1996), developing learning materials, Institute of Personnel and DevelopmentSloman, Martyn (1994) A Handbook for Training Strategy - England: Grower publishing LimitedTiberius, R.G. (1990) Small Group Teaching: A Trouble‐Shooting Guide, Toronto, OISE Press and the Ontario Institute for Studies in Education.Gibbs, Graham (1992), Teaching More Students: Discussion with More Students, Oxford Brookes University, Oxford Centre for Staff.