CHAPTER 2: An overview of the problem

· The purpose of a training programme is to teach students to do a job.

· Teachers should concentrate on the essential facts, skills and attitudes. It is neither possible nor desirable to teach everything.

· Teachers should base their teaching on the health problems of the community and on the work their students will be expected to do.

· Teachers should plan courses and lessons using situation analysis and task analysis.

A story

A community nurse completed her training and passed all the exams at the end of the course. She was given two weeks leave before starting work, so she went back to her village to spend some time with her family. It was a long journey because the family lived in a remote village, but everybody was pleased to see her again. Her mother was specially pleased and very proud that her daughter had done so well.

After the first greetings, the mother said "It is good that you are back because your baby cousin is ill. The baby has diarrhoea and doesn't look well to me. Do you think that you could help?" The nurse went to see the baby and realized that it was very dehydrated. She thought the baby should go to a health centre, but the journey was too far. So she thought about what she had been taught. She could remember details about the anatomy of the gastrointestinal tract and the balance of electrolytes. She also remembered that a mixture of salt and sugar in water would help to rehydrate the baby, but she couldn't remember what amounts to use.

She was very worried that the amounts would be wrong. She didn't know whether to send for help or to guess the amounts. By this time, the baby was very ill. She made up the solution and gave it to the baby. The solution contained the wrong proportions of salt and sugar. The baby died.

Moral

Some courses for health workers may be ineffective or even harmful because they spend a lot of time teaching facts that are not important. The courses may fait to spend enough time teaching the skills that are really needed.

2.1 Some basic principles

The story shows what can happen when a course for training health care staff is unsuccessful. But what makes a course successful? The following are basic principles.

Basic principles

1. The main aim of a course should be to train students to do a job.

2. The job determines what the students should learn.

3. Only those facts, skills and attitudes that are relevant to the job should be taught and learned. Those that are not essential should not be taught.

These may seem very obvious points, but they do have important consequences, which are briefly explained in the next few paragraphs.

2.2 The main aim of a course should be to train students to do a job

This is the basic principle on which this book is based. It means that if students can do their job competently at the end of a course then it has been successful. If they cannot do the work they have been trained for, then the course has failed.

This means that the teachers must know a lot about the work which the students will be doing. The teachers should watch experienced health staff doing their work. They should ask them about the problems of providing health care. The whole course should be closely linked to the way in which health care is provided. Chapter 3 explains how this may be done.

If this principle is followed, students will be able to do a job at the end of the course rather than just know about it.

Some people feel that this aim of "training to do a job" is too limited. They feel that there should be much more to education than this. While there is some truth in this point of view, the wider goals should be secondary. The first and most important goal is that the students should be able to do their work in an intelligent, understanding and competent way. This is the whole emphasis of this book.

For example, a broadly educated health worker who infects patients because he or she does not follow aseptic techniques is a danger to the community. So it is important that students get the basic competence first. When this has been achieved, other aspects may be added to the training if time permits.

2 3 The job determines what the students should learn

In all courses, choices have to be made about what facts, skills and attitudes students should learn. Choices also have to be made about what details should be left out of the course. It is simply not possible to learn everything that is known about medical sciences and health care. So some selection is essential.

Figure

“Must learn” is the target. Theses are facts and skills that all students need to learn in order to be competent in their work. Teachers should stress the importance of these facts and skills when they are helping students to learn. These facts and skills should be tested in examinations.

There are very many other facts and skills that are "useful to learn", but they do not need the same emphasis. Nor should they be tested as thoroughly in examinations.

There are also very many other facts and skills that are "interesting to learn". Of course, teachers should not prevent students learning anything. In fact they should show students how to learn from books, conversations and their own and other people's experience of the world. However, the teacher's main responsibility is to decide what students must learn and to make sure that they learn it.

Facts and skills that must be taught are those that are needed to do the job competently and thoughtfully. These are discussed in Chapters 3 and 4.

2.4 Learning objectives

An important idea which should be introduced now is the concept of "learning objectives".

A learning objective is a statement that describes what the student should know, feel or be able to do at the end of the course.

This definition includes some important points. First of all, the learning objectives concern the student and not the teacher. Second, the learning objectives describe the state of the student at the end of the course. The learning objectives therefore do not describe what the teacher will teach or the experiences the student will have during the course. The learning objectives are therefore a statement of the targets which the course is trying to achieve.

Some writers also use the phrases "learning goals" or "aims". Some writers make distinctions between "specific" and "general" objectives. The distinctions between these terms are not very clear and are probably not important.

2.5 Making use of learning objectives

The crucial importance of learning objectives is that they define what the students must learn.

They can do this at a very general level, e.g. "the learning objective of this course is that the students should be able to do the work of a maternal and child health (MCH) assistant".

Or at a very specific level, e.g. "the students should know the quantities of each ingredient in home-made oral rehydration solution".

So the learning objectives can refer to a whole course or to just a few minutes of a lesson - or anything in between.

In all these situations, the learning objectives are vital because they control (or should control) the whole process of teaching and learning. The learning objectives determine:

· what is included in a lesson or course,
· how the teaching is done, and
· how the students are tested.

For example, if the learning objective is that "the students will be able to diagnose anaemia from clinical signs", then:

· the students must be taught about the clinical signs of anaemia, how to observe them, and how to distinguish between people who are anaemic and those who are not. For this objective there would be no point in teaching students about the structure of haemoglobin or how to test for anaemia using laboratory methods.

· the students must be able to practice their skills of clinical diagnosis on some patients with anaemia and some who are not anaemic. There will be little need for lecturing.

· each student should examine some patients and decide whether they are anaemic or not. The teacher will then be able to assess whether the students have achieved the learning objective. The students should not be asked to write essays on anaemia, because this is not related to the learning objective.

Figure

2.6 How can you decide what are the learning objectives?

The most important thing about learning objectives is that they should be relevant to the job that students are being trained to do. Because learning objectives determine what is included in a course, they can damage all aspects of it if they are not relevant. The way in which teachers and course designers decide what the learning objectives should be goes back to the basic principle stated in Section 2.1.

The main purpose of a course should be to train students to do a job.

Therefore the learning objectives should be based on the job description.

In summary, this is done by making a list of all the tasks that the health worker will be expected to do. This process is called situation analysis in this book, and is described in Chapter 3. Then each task is analysed to find out what skills are involved and what knowledge and attitudes are needed in order to do it competently. This process is called task analysis and is described in Chapter 4.

These two processes together give a list of all the learning objectives for a course - i.e., the skills, knowledge and attitudes that should be learned. If all the learning objectives are achieved, the health worker will be fully competent to do his or her work and the overall purpose of the course will have been achieved.