In this blog, THET's Evaluation & Learning Officer, Emily Burn, shows how the introduction of a self-assessment tool is key in demonstrating the impact of health worker training.
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| Trainee nurses at Kambia District Hospital, Sierra Leone. Photo by Timur Bekir |
Imagine this
situation: A team of
doctors were trained in palliative care by their UK partners in a one-week
course. There were 30 trainees in the group and the partnership plans to train
another cohort of the same size. The
trainee doctors received a certificate of competence at the end of the course
if they performed well enough in the final written assessment. Once they completed the course, the doctors
returned to their places of work in the hospitals and clinics both in peri-urban
and urban areas. For many of the doctors, they will be the most senior or only
clinician at their place of work and they will also be the only ones
responsible for delivering palliative care.
What can the
partnership do to gather data on the doctors’ practice in palliative care once
they have returned to their places of work? In this scenario, the trainees are
spread widely geographically making it difficult for those responsible for
M&E to visit each of them. The
doctors do not have an appraisal system or a senior colleague who can provide
objective feedback on their practice. The doctors do keep practice logbooks but
it may not be feasible to retrieve data from all of those logbooks. The partnership does not have enough funds or
supervisors available to visit each doctor in their place of work to assess
their skills, and in any case, how thorough an assessment can be made in just
one visit? So the partnership faces various
issues in data collection but they do need to come up with ways to gather data
on practice that are reasonable given the context they work in.
The case for self-assessment
This
scenario is typical of many health partnerships’ experience of monitoring
change in a rigorous way: they have limited staff, time and funds available to
monitor and evaluate each health worker’s performance yet they still need to
gather evidence that could demonstrate the impact of the training on the health
worker’s practice. Given the context
that health partnerships work in, there is a strong case for using a
self-assessment tool, such as an online or paper questionnaire. The obvious issue is the lack of objectivity
or external verification of the claims made in a questionnaire and indeed the
aim should be to combine it with other sources of information (e.g. clinical
records) yet the questionnaire can overcome some of the difficulties health
partnerships face in data-gathering to provide interesting insights to
trainees’ experiences in their own places of work.
How can you
design a questionnaire for use in your own work? I asked THET’s community of
practice for examples of self-assessment tools that they use in their projects.
Interestingly, I received several examples of workshop evaluations, which
looked at things like knowledge gained, course relevance, and overall
satisfaction with the training, all gathered at the end of the course. I had
far fewer examples of questionnaires that trainees complete further down the
line on if, or how, they applied their training.
Although any
questionnaire must be tailored to the specific techniques taught, the following
generic topic areas are a useful starting point for designing your self-reporting
tool:
Evaluation
of the training
· This is to understand if the training targeted
the right cadre of candidates so the questions should ask how relevant the trainee
has found the training to be once they returned to their institution.
Knowledge
retention
· A set of multiple choice questions (MCQs) can directly
test how much knowledge the trainee has retained since the training. You could compare results from a final
assessment at the training with this later MCQ assessment.
Confidence
to practice
· How confident does the trainee feel to carry out
procedures or new techniques, learnt on the training course? A Likert scale (e.g. Very confident – Fairly
confident – Not really confident – Not at all confident) is the commonest
format for this type of question.
Include a comment box to give rationale for their answer. It could be interesting to compare confidence
answers across three points in time: pre training, immediately post training,
and 6 – 12 months after training. The comments box could help to explore
reasons for notable dips or peaks in confidence.
Change in
practice
· With what frequency does the trainee now
practice a set of techniques, bearing in mind what is reasonable for a given
context? Always provide comment boxes
for these questions as it is important to understand any barriers to practice,
such as lack of equipment or adequate supervision.
·
Include text boxes to gather narrative examples
of practice such as cases where they have used the skills gained in training; if
appropriate, request that the answer includes any information on the outcomes
for the patient.
Lastly, what
response rate would you be satisfied with?
It is unlikely that you will get 100% of trainees to complete and return the questionnaires so make it as
user-friendly as possible (test it out on some colleagues before you distribute
it), consider creating it online if local bandwidth allows – THET uses the online tool Survey Monkey because it is easy to
use and has useful reporting functions – and review your M&E plans to determine
other data-gathering tools so that you are not reliant on just the
questionnaire for data on change in practice.
If you have
an example questionnaire that you would be happy to share with us, please send
it to emilyburn@thet.org or post it on
the community
of practice. I am also interested to
hear about people’s experience of using self-reporting to gather evidence.
Useful
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