|Teaching for Better Learning (WHO, 1992, 197 p.)|
|Part 1: What should your students learn?|
This chapter explains how teachers can find out more about the job that their students will be doing.
A maternal and child health (MCH) worker completed her training at college and went to work at a family welfare centre as the leader of the MCH team.
One of her responsibilities was to "work with the community", but she found this very difficult to do, so she spent her time in the family welfare centre waiting for clients to come. A few clients came, but for a lot of the time she sat and waited. When I talked to her and asked her why, she told me that her boss expected her to be at the centre during all working hours. If she was not there she would get into trouble. Further, she didn't really have any idea about the work she could do in the community. She had listened to lectures on community analysis and development, and the principles of communication. However, she had not been told what work she was expected to do.
People will only work effectively if they are told precisely what their work involves and are given opportunities to practice during their training.
3.1 The purpose of this chapter
The main purpose of the previous chapter was to emphasize that courses should train students to do the job of a health worker. So it is obvious that the people who design or teach the courses should know exactly what the job involves. Unfortunately they often do not have this knowledge. This may seem very surprising. Why not test yourself to see if you are clear about the job that will be done by the students you are involved with?
Many health workers in primary health care have responsibility for some of the following:
- managing a health centre,
- intersectoral cooperation,
- community involvement,
- treating common diseases, and
- preventing and controlling disease.
For all of the responsibilities above that are part of your students' work, ask yourself:
What should be the first daily task of health workers who manage a health centre?
What should they do in order to cooperate with other sectors? What should they do in order to involve the community?
Exactly which diseases are common and which are not? Which diseases can be controlled or prevented? What should health workers do to control or prevent disease?
First of all check that you have answered what the students should do (e.g. act as a chairperson at weekly staff meetings) rather than what they should achieve (e.g. the health centre team should be well motivated).
Maybe you would like to have a second attempt at the questions.
If you are able to give clear and precise answers to all these questions then you are in a strong position to plan effective courses and to teach your students relevant facts and skills. If not, you are like the vast majority of teachers! This chapter will help you to think through the problems so that you will be able to answer the questions better.
More importantly, if you cannot answer the questions, you will not be able to make good decisions about what students should learn. So, the important purpose of this chapter is to help you think through exactly what the job of the health worker involves.
3.2 Starting from a job description
In many countries the ministry of health will probably be responsible for deciding what the job of the health worker should involve. Even in these countries, it may be necessary for teachers or course committees to make clear what the employer intends.
The employer usually provides a description of the work that each category of health worker is expected to do. This is called the job description or job specification.
So the teacher or course committee must start by looking at the job description. This usually defines various administrative matters such as the grade of the job and conditions of service. But the key information for the teacher is the list of responsibilities (which may be given other names such as duties or functions). Some job descriptions are precise and detailed, and can be very useful in guiding teachers. Others tend to be rather vague and may be very brief.
The aim is to start from the job description and end up with a list of tasks that the health worker must be trained to do. It is usually convenient to have between 50 and 100 tasks on the list. This is not a matter of right or wrong - it is simply a matter of convenience. The exact number of tasks depends on the scope of the work and the level of detail which you choose.
3.3 An example of a list of tasks
The job description gives a general idea of what health workers should do. For example, the job description of an MCH nurse in one country included "monitor the growth of children" as one of the responsibilities.
The teachers observed MCH nurses doing this work and drew up the following list of tasks for this responsibility.
List of tasks
· Keep a list of all children in the community who are under 5 years of age.
· Train community health workers to weigh children, record their weights on growth charts and decide when children are at risk.
· Organize MCH clinics in the community for children to be weighed as part of the MCH care programme.
· Maintain a register of children who are "at risk" because they have not been brought to the weighing sessions or because they are showing signs of malnutrition.
· Arrange follow-up visits to all at-risk children.
The list of tasks is simply a more detailed and more precise version of the job specification.
This example shows that "monitoring the growth of children" involves training, organizing, managing and record-keeping. The list of tasks therefore gives a much clearer and more precise picture of the real nature of the work - and of what the students need to learn.
3.4 How to prepare the list of tasks
Unfortunately it is not possible to give a fixed list of steps for teachers to follow.
In preparing the list of tasks, teachers should start with the official job description. From there it is a matter of thinking, asking, discussing and observing until the meaning of each part of the job description is clear and precise. First of all, the employers (often the Ministry of Health) should be asked what they think is involved in each part of the work. Useful questions to ask are:
· " When health workers start work at 9 o'clock on Monday morning (or whenever work starts) what should they do in order to...?"
· "How should that be done?"
· "Should they actually do...?"
· "What exactly do you mean by...?"
· "Which are the common diseases/conditions/problems?"
The point of this exercise is not to get into the fine details of how to give an injection or conduct a vaginal examination. On the other hand, teachers do need to find out certain facts, such as which examinations should take place during an antenatal visit.
There is a risk that this type of approach may be too aggressive
and make the employer act in a defensive manner. It is quite likely that these
questions will not have been considered in detail by the Ministry of Health, so
staff may not know the answers. The mood of the discussions should, therefore,
be of shared problem-solving and not that of an interrogation.
Visiting health workers
After visiting the employers you should visit the health workers in the community and watch them at work. You should ask them questions such as:
· "How do you involve the community in health education?"
· " What do you do when you...?"
· "Which diseases can you treat?"
Again, you are not looking for fine details, but you do need to be clear. It is no good being told, "I inform the community". You need to know what this involves.
Asking for advice from "experts"
There may be some experts whom you could ask. They may work in academic institutions such as medical schools or nursing colleges. You should ask them how they think that the job should be done. The aim here is not to get an "official" answer but to find out their ideas for better ways of doing the work.
3.5 Bringing the information together
When you have collected the information from the different groups, you need to compare the answers they have given. There are likely to be quite large differences in opinion.
The next step is to produce your own list of tasks based on these different sources of data. Be realistic. Take account of how much time the health worker has available. (In one study, the health worker would have spent more than 100 hours per week on just one part of the job if he or she had done the work according to the official job description!). Take account of the resources available (such as what equipment is available for health workers to sterilize instruments). When you have completed the list you should then discuss it with the employers, health workers and experts to check that it is realistic, that it does help to solve the most important health problems of the community, and that it is consistent with what could reasonably be expected of the health worker.
This review is likely to lead to quite a lot of changes.
Above all, check that the final list of tasks is precise and clear and that you know exactly what is involved in each task.
3.6 What is the value of the list of tasks?
The list of tasks for a job is the list of learning objectives for the course that trains people to do that job.
This is an absolutely crucial point.
If this principle is accepted and applied many courses for health workers will need to be changed. Students are often taught about facts and skills that are not relevant to their work. For example, in a recent review of one curriculum for health workers, it was shown that more than 30% of the teaching in the curriculum was of no relevance to the actual tasks that the health workers were expected to do. The curriculum was therefore changed to include more relevant teaching concerning tasks that the health workers had not previously learned about.
The list of tasks is used to plan the overall curriculum, including the assessment methods (this is discussed in Chapter 5). However, when teachers plan individual teaching sessions or units of a course they will need more detailed learning objectives. They can obtain these by analysing each of the tasks. This process is called task analysis and is described in Chapter 4.
Teachers help their students learn how to do a job. Therefore, the teachers must know exactly what this job is.
Situation analysis helps teachers to find out more about the job. Teachers can do a situation analysis by talking to health workers, employers of health workers, and experts.
The list of tasks produced at the end of the situation analysis is a list of the learning objectives for the course.