Servicios territoriales de banca y seguros

The majority of reproductive health inservice and preservice courses have a skill component. The skill area or psychomotor learning domain looks at the skills and practices necessary to perform a job or task. Below are several examples of clinical skills:

! Load an IUD in a sterile package ! Insert an IUD

! Remove an IUD

! Use effective infection prevention practices when performing a minilaparotomy

! Counsel a family planning client

Skills required by service providers should be identified during the needs assessment process. Typically it is only the skill that is identified in the problem statement or needs assessment recommendations (e.g., physicians need to be trained to perform a minilaparotomy under local anesthesia, nurses need to improve their infection prevention skills). The responsibility of the instructional designer is to work with subject matter experts to identify the steps individuals will need to learn in order to be able to competently perform each skill. Supporting the development of the clinical skills is the acquisition of the essential information or

knowledge as described previously in this chapter.

Task Analysis The primary approach used to analyze psychomotor tasks or skills is the

task analysis. A task analysis is used when the skill or procedure has a

fixed or standard sequence and is almost always performed in that sequence (e.g., inserting an IUD). Once the steps within the procedure are identified, they are used in the development of learning guides and

checklists (see Chapter 6).

An instructional designer is told there is a need to prepare family planning service providers to perform a specific procedure or task. After talking with proficient service providers, the designer determines that this procedure consists of a number of steps which are usually performed in the same sequence. In order to identify the steps within the procedure and their sequence, the designer has the following alternatives:

! locate an existing learning guide and checklist for this skill, review the steps and sequence within these instruments and adapt them to fit the situation; or

! identify the steps and sequence by observing proficient clinicians perform the procedure.

In both of these approaches, it is critical that the designer ensure that there is consensus among a group of proficient clinicians that this is the

standard way of performing the procedure. This task analysis and

consensus building process is also referred to as a clinical skill

standardization.

The skill standardization process involves identifying the essential steps of a clinical procedure and analyzing the steps to determine the safest,

most efficient way to perform it and to train others. A standardized procedure provides the basis for developing competency-based learning guides and checklists.

The advantages of developing a standard method for performing a procedure are:

! Trainers have a model to use in performing and teaching the procedure. This promotes standard training throughout a country, regardless of who does the training, or where it is done.

! Learning the necessary steps or tasks is easier and evaluating the participant’s performance is more objective.

! The standard method is used in practice because local clinicians participated in its development.

! Followup assessment of clinical skills is easier and more objective because those being evaluated are aware of the criteria.

! Followup also can be done by a variety of individuals, not just the trainer, because everyone learned and uses the same standard procedure.

! Development of training materials is easier and more cost-effective, particularly for supporting audiovisuals which show the steps of the procedure (e.g., a videotape showing the steps of the standardized procedure).

Standardization of a clinical procedure involves the following steps: ! Identify a group of clinicians who are proficient in performing

the procedure.

! Observe several of the clinicians performing the procedure. Record each step that each of the clinicians performs. Take photographs or videotape the procedure if possible.

! Develop an initial list of steps. This could be developed during group discussions or while viewing the videotape.

! Discuss the procedure with the same group of clinicians. Review the steps, discuss common techniques, study any differences and reach a consensus on the best approach to performing the procedure.

! Test the initial procedure. Test the steps by performing the procedure using an anatomic model, if possible. Make any revisions to the list based on feedback from the clinicians.

! Test the final standard procedure. Testing of the standard procedure should occur first using an anatomic model and then with clients, in both training and service delivery settings. This testing ensures that all of the steps, in the correct sequence, have been included.

Table 4-2 presents a portion of the standardized procedure for inserting

Norplant implants. These skills, coupled with several others, will be used to develop a learning guide for a clinical skill. Note that the first word in each step of the procedure begins with an action verb reinforcing the fact that this is a psychomotor skill. Refer to Chapter 6 for more information on how to use the steps in a standardized skill to develop a learning guide and a checklist.

Table 4-2. Stand ard Pro cedure for Inserting N orplant Implants Pre-insertion Tasks

1. Wash hand s thoro ughly with so ap an d wa ter and dry with c lean, d ry cloth o r air dry.

2. Put sterile or high-leve l disinfecte d surg ical glov es on both hand s. (If glove s are p owd ered , wipe p owd er off glove fingers with sterile gau ze so aked in sterile or boiled water.)

3. Arrange instrum ents and supp lies on ste rile or hig h-level d isinfected tray. 4. Count to make sure that there are six capsules.

5. Apply antisep tic solutio n to the in cision a rea two times usin g a circ ular m otion for 8 to 13 c m; allow to air dry.

Step s continue thro ugh co mple tion of the proced ure. . . .