Delivering education and training including an education plan

In this activity, we will look at STEP 5 of setting up an AMS programme – education and training. This step involves:

• Understanding the core AMS healthcare professional education and training competencies.
• Understanding the modes and methods of delivering education.
• Developing a training delivery plan.
• Understanding the increasing use of e-learning.

Outline of Competencies

Within the WHO toolkit (chapter 7) is a list of core competencies that should form the basis of any education plan. AMS competencies are the guiding set of knowledge, skills and attitudes that result in durable, trainable and measurable behaviours facilitating better prescribing of antibiotics.

These competencies are:

1. Introduction to AMR: global situation, drivers of AMR, call for action
2. Antibiotics: classes, formulations, PK/PD, prescribing principles, communication, adverse reactions, essential medicines lists
3. Microbiology: causative agents, resistance mechanisms, data collection/analysis, selective sensitivity reporting of antibiograms etc.
4. Clinical syndromes: guidance and best practice prescribing, common infections, IPC
5. AMS programme: plan AMS programme, perform AMS programme
6. Assess AMS: assess, measure and evaluate

This image below describes the levels of competency, which are dependent on the function of the healthcare professional. For example, those undertaking AMS team duties would be expected to reach an advanced level of competency. Others, for example, ward doctors, pharmacists and nurses, who play a supporting role in delivering stewardship through their own clinical practice, would be expected to have an intermediate level of competency.

Click here to see a larger version of this image.

Delivering Education and Training

Depending on the needs of the healthcare professional and the resources available to their organisation, training can be accessed and delivered in different ways. While some professionals may be trained within their hospital, this is not always possible in LMICs. In these countries, sources can include pre-registration (university) and in-service training, on-the-job training, e-learning, and activities accessed via membership of professional organisations. Training can also arise from other sources as diverse as audit meetings and journal clubs.

The WHO toolkit describes the core steps in implementing education programmes. These include:

• Identifying programme leaders with advanced competencies to lead and deliver training.
• Arranging access to e-learning resources to train programme leaders.
• Training programme leaders, possibly requiring 2-3 days of national / international resources.
• Identifying a multidisciplinary team (MDT) of trainers for advanced AMS training, ideally including a prescribing non-specialist.
• Identifying the broad training requirements of prescribers and related HCPs and developing a training programme cycle for course content and its evaluation.

Note the need to emphasise the importance of an educational programme leader with leadership skills and advanced AMS competency. Often if the lead person is not identified, a successful, sustainable education programme is less likely.

There is often thought to be a cycle of six steps to developing, implementing and evaluating a training programme as illustrated below. This is a simple way of remembering the six steps in developing, implementing and evaluating an educational training programme.

Click here to see a larger version of this image.

Developing a successful education or training programme can include a range of ideas. Here are some top tips for developing a successful training programme!

• Create material for a range of learning styles e.g. verbal, visual, hands-on, etc.
• Ensure training reflects changing skills.
• Make programmes more interactive and less lecture based e.g. group work or quizzes can make learning more effective and enjoyable.
• Embrace computer-based training methods.
• Consider employee needs beyond training.
• Evaluate the effectiveness of training programmes.
• Personalise information so it is specific to your health system.

Effectiveness of different methods of training

It has been shown that active training methods such as interactive workshops, e-learning, blended learning (a mix of technology and face-to-face instruction) and hands-on training improve knowledge retention and impact prescribing practice in AMS more than passive methods such as lectures. This is demonstrated in this 2007 meta-analysis by Maliheh Mansouri and Jocelyn Lockyer.

The WHO toolkit highlights the variety of methods available and draws attention to some options for active education (below).

There is increasing use and value of e-learning as a means of augmenting and complimenting face-to-face learning.

e-Learning

While face-to-face training methods have historically been the norm , e-learning is increasingly being used to compliment and augment face-to-face learning by being more learner centric, flexible, and cost-effective. Through necessity, the COVID-19 pandemic has advanced virtual learning platforms and experience in using them.

There are many different kinds of e-learning, from courses like the one you are doing now to e-books such as the BSAC AMS e-book. Other approaches are listed below:

This infographic is also available as a screen-reader compatible PDF.

The WHO has published an excellent review, highlighting the range of benefits of e-learning in the context of undergraduate health care professional education. Some of the benefits of using e-learning for the education of health care professionals include the following:

• Lower cost of delivery (once computer and internet access is established).
• Encourages the development of educational interventions.
• Removes geographical and other barriers to education.
• Increased access to experts and new curricula.
• Personalisation of e-learning to the learner.
• Augmented reality and 3D learning are possible.
• Mobile and cloud-based learning are possible.

Now it’s your turn! What is your previous experience of using e-learning resources? Share your views in the comments below.