Can in-service training influence pre-service education in healthcare?

January 2017

The success of any training programme depends on a good curriculum. Curriculum, a plan of the learning experience, needs to be focused and tailored to trainee needs, the training environment and the end user key demands. Following completion of a pre-service (formal) training, usually healthcare workers need in-service training, commonly referred to as Continuous Professional Development (CPD), to keep their knowledge and skills fit for purpose. In-service training in healthcare often aims to complement gains from pre-service training and its success will be dependent on how it is aligned with the pre-service training among other things. However, can in-service training also be useful in providing feedback that will improve pre-service training?

Key considerations for curriculum development in healthcare programmes include clearly define competencies based on current evidence-based practice, resources and support structures available for teaching. Upon graduation, a candidate is expected to have attained competency, at least at the acceptable minimum level, in all aspects of a particular cadre.

It is mundane that rapid scientific discovery and innovation can easily overtakes a carefully made package of competencies that was considered up-to-date at the start of a 3 to 5-year course. The dynamic nature of the evidence for healthcare may result into frequent change in guidelines and other patient management processes hence the need for in-service training.

In high income countries with well-developed systems for professional registration, licencing and CPDs, the additional competencies may be defined in terms of credit points and a healthcare provider is required to accrue certain level of credit points before their licence is renewed in a set time interval. Same may not always be possible in low resource settings where organising a effective CPD programs may prove challenging. Often times in-service training happen as an opportunity arising from a vertical time bound program.

Through the “Making it Happen” programme, the Centre for Maternal and Newborn Health at Liverpool School of Tropical Medicine has supported short time competency based in-service training programmes for emergency obstetric & newborn care (EmOC) in 8 countries in sub-Saharan Africa and 2 countries in south-east Asia. Some participants exclaimed that the training was their first opportunity to attend a ‘skills and drills’ type of training since their graduation.

On several occasions, trainees who received the short term EmOC training demonstrated competency in skills that were not part of their in-service training, but which were badly needed at their workplace. This points towards a potential mismatch between pre-service training and skills need to provide care to the end user. What could explain the mismatch? At least two thoughts come to mind. Either pre-service curriculum is inappropriate, not based on current research or the actual teaching fall short of the required standard. 

A sound basic pre-service training is invaluable in inculcating basic professional concepts, knowledge and skills, that without which it would be difficult to implement CPDs. Thus efforts to continually improve pre-service training should be considered by stakeholders involved in both pre- and in-service training programs.

Pre-service training is usually quite even in coverage and the training environment is controlled, on the other hand, in-service training is usually patchy and liable to apt modifications based on prevailing conditions at work place. Compelling job responsibilities, restrictive policies and human resource shortage and the available training equipment etc can lead to inevitable modifications of in-service training. Also, whereas a national registration board or body sets minimal competencies to be achieved for pre-service training, in-service training is not always as regulated especially when training is part of a vertical programme.

It may therefore be important then to ask a question: How can experiences in implementing in-service training programmes help inform pre-service education programmes? If it happening already, how can the process be made more efficient and timely? Should in-service programs embrace strategies to improve pre-service training from the start?

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.