Completing the feedback loop from in-service training to pre-service education in healthcare

The author had earlier on explained the potential mutual benefit that can be harnessed when feedback from in-service training programmes informs pre-service (formal) training. However, such accordance cannot be automatic. The responsible parties need to actively engage. Who are these responsible parties? How can they engage? 

The partnership for maternal, newborn and child health highlights importance and position of professional organisations/associations in healthcare training. Obstetrics/Gynaecology and Paediatrics associations in each country need to take a pivotal and leading role in overseeing quality of maternal and newborn training programmes specific for a country. The association’s influence needs to permeate the entire spectrum of training programs from curriculum review to the actual training. The ministries of health (MOH), regulatory bodies (eg doctor’s or nurse’s) pre-service institutions and other stakeholders involved in teaching need to be on board and all work collaboratively.

Do professional associations and regulatory bodies exist in all low resource countries? Do all MOH have a section to oversee training?

There is lack of global information on existence and duties performed by professional associations however the WHO reported in 2006 that poor health care worker performance could be linked to weak professional associations. Most MOHs would have a specific section to deal with training. However, the extent to which stakeholders involved in training collaborate with such a unit is clearly beyond the scope of this short piece. Professional associations, regulatory bodies and the government (MOH) would be key in making sure lessons learnt from in-service training programs shape pre-service training and vice-versa. 

How can such feedback be collected and used?

It would be helpful to see MOHs taking an active coordinating role to all pre-and in-service training. This would also be strategic since MOH is a portal to all programs (including vertical) and the assumption is that MOH will have a direct link to pre-service institutions. MOH also has to ensure that regulatory bodies spearhead and enforce Continuous Professional Development (CPD) programs.

Existing CPD programmes may need strengthening. “Development” in this sense suggests a broader, holistic focus not just to lack of skills and knowledge. The aim should be to improve efficiency and professionalism at the workplace. Work environment and healthcare worker attitude need to be revised and addressed.

When new guidelines are issued by organisations such as the WHO, responsible authorities (often MOH) would decide when to endorse them. The gap between when new evidence is published to when it filters to regular practice will vary in each country. Existence and effectiveness of profession associations and regulatory bodies might be the main determining factor. In the UK, organisations such as The National Institute for Health and Care Excellence (NICE) cover up such a gap. 

New guidelines are commonly disseminated through in-service training in form of workshops and seminars, should pre-service be targeted at the same time? can in-service course schedules (often quite tight) accommodate additional training?

It will be helpful if stakeholders implementing health programs with a ‘training’ component (including CMNH) find answers to the following questions from the outset:

  • How is the training aligned to the pre-service curriculum?
  • How will professional associations, MOH and regulatory bodies be involved?
  • How will feedback be managed to make sure the loop is complete?

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Mselenge Mdegela is a Clinical Research Associate at the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine. He is involved in designing, implementing and evaluating sexual and reproductive health teaching programs at LSTM and overseas. He is part of the EMOC team which provide technical assistance for implementing EMOC programs in low resource settings and a PhD student in the area of Human Resource for Health.

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