What Is the Purpose of Healthcare Training?

The purpose of training is to cause learning to happen. Think about this statement for a moment.

We often hear phrases such as ‘delivering training’, ‘ensuring compliance’ and even ‘telling them what they have to know’.

But the role of training is actually to ensure lasting changes take place in the knowledge and skills of our learners.

In Healthcare, training almost always has four aims:

• ‘Knows that’ – learners possess the necessary knowledge.
• ‘Knows how’ – learners can perform the required skills.
• ‘Shows how’ – learners demonstrate a defined level of competence.
• ‘Does’ – learners apply new knowledge and skills in their role.

Training is designed to achieve these elements in the most effective way. The ‘Does’ part, which ensures learners apply newly acquired knowledge and skills in their role, is often shared between trainers, mentors and managers.

Can healthcare staff train themselves?

Books and videos are available for most topics, so is training always necessary? Can our colleagues really teach themselves?

For simple tasks, such as learning how to use a new type of sharps bin, self-teaching may be adequate. But although reading is a helpful and often necessary part of learning, it is rarely sufficient to acquire a new skill on its own. Self-help books and videos compensate for the absence of a trainer by offerring exercises and recommendations for further practice. But they cannot provide individual feedback. In a worst-case scenario, a self-taught learner may form unsafe habits which go unnoticed until the occurence of a clinical error.

Can we learn just by watching someone else?

For most of the 18th and 19th centuries, workplace trainees watched an experienced person until they could carry out the job themselves. The practice was known as ‘Watching Joe’ or ‘Sitting by Nellie’, and on a superficial level it was effective. But by the 20th century the requirements of work became increasingly complex. A more scientific approach to learning at work was needed to maintain quality and safety.

For simple tasks, watching someone else and copying their actions is a helpful part of learning. Demonstrations are regularly provided as part of training. However, as the cartoon below suggests, giving a demonstration does not guarantee learning has taken place.

Here, learning clearly did not happen because dogs can’t whistle; yet in one sense ‘training’ did take place. Demonstrations almost always need to be followed by learners ‘having a go’ and receiving feedback on their performance. In Week 1 we saw that if all learners do is passively watch a presentation, much of the content may be forgotten. A similar risk applies to passively watching a demonstration if there is no opportunity to practice.

Training is tailored to produce the best results for the topic

Training seeks to ensure learning is as efficient as possible by using methods which suit the topic. For example, in IT systems training, learners explore a process map and discover the reasons certain protocols are followed when adding patient data (Knows that). They practice entering patient information into an online training environment (Knows how). Their accuracy is assessed by a tutor who observes the unaided entry of new data (Shows how). Data quality is checked after the training by regular audits (Does). If errors are found, further training may be offered to staff.

A regular requirement in healthcare training is Infection Prevention and Control (IPC). This training may include group discussions, quizzes and local compliance data (Knows that). A practical section provides an opportunity to practice correct hand washing techniques (Knows how). In this experience, participants have their hands dusted with a powder which is only visible under ultraviolet (UV) light. They wash their hands and place them under the light to check whether or not any powder remains (Shows how). The Does element is measured by regular handwashing audits undertaken in the healthcare facility.

IPC training employs well-established teaching methods. Yet according to the World Health Organisation (WHO), staff in the most careful healthcare organisations only wash their hands on 90% of the occasions they should. In less compliant healthcare facilities the figure drops below 50%. This disturbing finding suggests that training alone is not always sufficient to ensure a permanent change in behaviour.

Limitations of training

The transfer of knowledge and skills from trainng to everyday practice (Does) is the part most vulnerable to failure. A common example may be seen among car drivers. Every novice driver learns why they should keep a safe distance from the vehicle in front (Knows that). They are taught to do this by allowing 2 seconds (3 in the US) to elapse between when the vehicle in front passes a roadside object and they do (Knows how). New drivers demonstrate their ability to maintain this gap during their driving test (Shows how). The desired outcome is that drivers continue to maintain a safe distance once they have passed their test (Does).

However, a trip along any highway shows that a relatively small proportion of drivers actually do so. As with handwashing for healthcare staff, training alone does not ensure drivers keep a safe distance from the vehicle in front.

Failure to transfer learning to practice is not always attributable to a lack of knows that, knows how or shows how. Sometimes, for the desired behaviour to be maintained, training needs to be supported by additional means. For example, a mentor may allocated meet regularly with a new member of staff and discuss how they are putting their learning into practice. A manager may work occasional shifts alongside new staff to observe their practice. A ‘‘handwashing champion’* role may be created to observe handwashing compliance. In this way the Does element of training is achieved through a partnership between trainers and managers.