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Educational
Handbook for
Health Personnel
Sixth Edition
J.-J. Guilbert
o
o
-t-
lffi;
'$/orld
Health Organization, Geneva
l.987
W H O O f f s e t P u b l i c a t i o n N o . 3 5
R e p r i n t e d 1 9 8 9
W H O o f f s e t p u b l i c a t i o n s a r e i n t e n d e d t o m a k e g e n e r a l l y a v a i l a b l e m a t e r i a l t h a t f o r e c o n o m i c ,
t e c h n i c a l , o r o t h e r r e a s o n s c a n n o t b e i n c l u d e d i n W H O ' s r e g u l a r p u b l i c a t i o n s p r o g r a m m e a n d
w o u l d o t h e r w i s e r e c e i v e o n l y l i m i t e d d i s t r i b u t i o n . T h e y a r e u s u a l l y r e p r o d u c e d b y p h o t o - o f f s e t
f rom typescript, rather than by letterpress, and do not necessarily receive editorial revision.
t Ce livre est publi6 en frangais par l'OMS sous le titre: Guide p6dagogique pour les personnels de sant6.
I
|
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t Ce livre est publi6 en frangais par l'OMS sous le titre: Guide p6dagogique pour les personnels de sant6.
I
I n f o r m a t i o n c o n c e r n i n g A r a b i c , B u l g a r i a n . C z e c h , F a r s i , G e r m a n , H u n g a r i a n , l n d o n e s i a n , l t a l i a n , P o l i s h ,
Portuguese, Russian, Serbo-Croat, and Spanish editions is available from WHO, Geneva (attention EPM/HMD).
r s B N 9 2 4 1 7 0 6 3 5 X
rssN 0303-7878
@ World Health Organization 1 987
Reproduction and translation authorized, for nonprofit educational activities provided that WHO origin is mentioned
and that copies containing reproduced material are sent to: Chief, Office of Publications, World Health Organization,
1 2 1 1 G e n e v a 2 7 . S w i t z e r l a n d .
|
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The designations employed and the presentation of the material in this publication do not imply the expression of
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Educational
Handbook for
Health Personnel
How to help educators to increase their skills so
as to make learning easier for the students
o
o
1987
objectives of the handbook
When you have studied this handbook you should be able to:
|
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How to help educators to increase their skills so
as to make learning easier for the students
o
o
1987
objectives of the handbook
When you have studied this handbook you should be able to:
define the professional taslts which will provide ttre basis for determining educational
objectives
plan a curriculum
construct tests and other measurement devices.
These skills will be based upon a measurable gain of knowledge concerning:
I
I
r
.
r
relationship between profeNsional training programmes and subsequent practice;
principles of learning and rble of the teacher;
role of objectives in educational planning;
principles and methods of curriculum planning;
principles and practice of educational evaluation.
you will also have strcngthened your desire to go on learning and acquiring skills in
education and will hare mastered an effective way of setting about it.
Contents
Identification ofyour needs as an educator
|
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Identification ofyour needs as an educator
o Objectives of the Handbook
o For whom is this Educational Handbook intended?
o How to use the Handbook
o
o Pre-test
o List of educational objectives
o Theoretical background that will help you reach the educational objectives
o Table of exercises proposed in the Handbook
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Educational obiectives
o
The educational spiral
o
Importance of defining professional tasks
a
Selection of uaining goals
a
Example of services provided by rural health units
o
Types of educational objectives
o General objectives: professional functions
o
o
a
r
o Construction and critique ofspecific educational objectives
Professional activities and intermediate objectives
Built-in relevance approach to educational planning
Professional tasks and specific educadonal objectives
Identifying the components of a task
Formative and cenifying evaluation
|
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] |
Formative and cenifying evaluation
Evaluation planning
o What is evaluation?
o
o Aims of student evaluation
o
.
o Qualities of a measuring instrument (validity, objectivity and practicabiliry)
o How to organise an evaluation system
Selection of an evaluation method
Advantages and disadvantages of different types of test
Programme construction
o Distinctive attributes of education for the profesions
o Curriculum planning principles
a
o
o
a
o
o
o
o
The purpose of teaching is to facilitate learning
Teaching: a complex but challenging task
Teaching methods and educational media
Self{earningpackages
The concept of integrated teaching
The concept of integrated learning
Planning of programme reform
The use of specification tables
Test and measurement techniques
. Why evaluate?
o Guidelines for evaluating a training programme
a
o Guidelines for evaluating educational objectives
a
o
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Test and measurement techniques
. Why evaluate?
o Guidelines for evaluating a training programme
a
o Guidelines for evaluating educational objectives
a
o
Programme evaluation by the students
Evaluation of students' level of performance
Poins to consider in evaluating programme changes
Assessment of practical skills
Assessing attitudes
Written tests
The programmed examination
Stages of assessment
Test construction specification table
o
o
o Relative and absolute criteria tests
o
Item analysis
Chapter 5
How to organise an educational workshop
Chapter 6
Index and glossary
Chapter 7
Bibliography
page
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6
7
8
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] |
4 . O l
4.O4
4.O5
+.o7
4 . t o
4 . 1 5
+ . 2 L
4 . 2 2
4 . 2 3
4.28
4 . 4 t
4.49
4 . 5 4
+.6t
4 . 6 5
5 . 0 1
6.Ol
7 . O l
preface to the sixth edition
result of national initiatives. It too was used
'educational workshops", during
at many
which interesting and constructive criticism
the same effect as the
was expressed to
comments received from the readers partici-
included rnany
pating in the survey, who
experienced educators: need for greater
clarity (less jargon), more concrete examples
and more practical exercises.
Another attempt has been made in this edition
to take this advice into account.
Like the previous ones, this new edition will
be revised in its turn, in the light of the
suggestions we hope to receive from users. To
ordir copies please see the list of addresses at
the back of the book. For editions in other
if you s)ould
languages, or
farther
informati.on or expknations, do not hesitate
to write to:
|
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like
Chief, Educational Planning,
Methodology and Evaluation
Division of Health Manpower Development
\World Health Organization
l2I1- Geneva 27
Switzerland
Your suggestions will always be welcome.
There is a special sheet you can use for
them at the end of this handbook.
I Dr. S. Abrahamson and Dr. H. Peterson (USC, Dept' Med.
Educ., Los Angeles).
This sixth edition (1987) brings up to date,
and improves on, the previous edition. It is
taking into account the
a collective work
suggestions of
critical
numerous users of the earlier editions and
the results of a survey carried out among
2OO selected readers, whom we take this
opportunity of thanking.
comments and
|
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comments and
The first edition was prepared on the basis of
documents distributed during a workshop
organized by the Regional Office for Africa,
the
Brazzaville,
in medical
assistance of
education.l It has been widely used in the
Region and served as a basic document for
many educational planning workshops.
in December 1969 with
consultants
|
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in December 1969 with
consultants
It then became evident that it would be useful
to give the reader better guidance during his
progression through the whole educational
planning cycle. Although this objective would
most likely be achieved by a completely
programmed presentation it seemed that the
complexity of the problems involved was not
great enough to justify a method which would
be so intricate and long to Prepare. Only
practice could say whether this was correct.
In 7975 a fully revised text was field tested
and led to the 1976 revision distributed in over
1O,OOO copies in four languages. The 1981
edition was translated into 14 languages as a
4
W O R L D H E A L T H O R G A N I Z A T I O N
ORGANISATION MONDIALE DE LA SANTE
o
Dear Colleagues,
In our common struggle to achieve the objective of "Health for all by the year 20OO", the place
of basic training and continuous education of health personnel is a crucial one.
|
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Dear Colleagues,
In our common struggle to achieve the objective of "Health for all by the year 20OO", the place
of basic training and continuous education of health personnel is a crucial one.
The Conference of Alma-Ata recommended, among other things, that governments "[define]
the technical role, supportive skills, and attitudes required for every caregory of health worker
according to the functions that need to be carried out to ensure effective primary health care...".
It also recommended that "health workers, especially physicians and nurses, should be socially
and technically trained and motivated to serve the community; that all training should include
field activities", and that due attention should be paid to the preparation of teachers of health
workers.
|
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All these reasons lead me to regard the publication of this revised edition of the Educational
Handbook for Healtb Personnel as particularly useful, in that it will facilitate the application
of those recommendations.
It is also a practical example of the technical support that an international organization such as
ours must offer to back up national efforts in favour of primary health care.
Of course it is only one element among many; a small stone that helps pave the difficult way to
health for all.
I hope this Handbook will continue to meet with the succes it has enjoyed for over 15 years
among its many users.
/MDr. H. Mahler
Director{eneral
l2ll GENEVA2T-SWITZERLAND Telegr.: UNISANTE-GENEVA Telex: 2782lOMS
l2llGENEVE2T-SUISSE Tdtdgt.: UNISANTE-GENEVE
for whom
is this educational handbook intended?
t969,
|
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Director{eneral
l2ll GENEVA2T-SWITZERLAND Telegr.: UNISANTE-GENEVA Telex: 2782lOMS
l2llGENEVE2T-SUISSE Tdtdgt.: UNISANTE-GENEVE
for whom
is this educational handbook intended?
t969,
the first edition was
in
Originally,
teachers of the health sciences.
written for
Subsequently, however, the Handbook was
used above all by hundreds of participants in
meetings organized by WHO or held withWHO
assistance (educational planning workshops,
teaching methodology seminars, etc.......).
A survey of 2OO users carried out in 197 5
revealed the following opinions.
|
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A survey of 2OO users carried out in 197 5
revealed the following opinions.
A very small minority (10%) felt that the
Handbook should be supplied only to partici-
in controlled educational activities
pants
(workshops, seminars, courses, etc.) or
reserved for "teachers of teachers". Tbe
maiority, bouteuer, felt
that dissemination
should be as uside as possible, and be directed
to all teachers of health sciences at all levels,
to health administrators with staff supervision
responsibilities, and to students, so as to help
them to draw maximum benefit from their
learning activities and participate in their
|
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organization. The latest poll, conducted in
1978, produced very apposite comments
from about 100 users in all parts of the world
and the consensus is still in favour of the
widest possible distribution. Many teachers of
the various health professions (dentists, nurses,
sanitary engineers, physicians, pharmacists,
etc.) have stated that the Handbook answers
their needs, but some think that the author's
training as a physician has still too often
biased the choice of examples. A further
effort has been made with this 1981 edition
to produce a text better suited to eagryone
working in the health professions. lt is, how-
ever, very difficult to strike a perfect balance,
for many reasons. While it is still true that
most of the examples relate to the medical
and nursing professions, it is the author's
hope that each user of the Handbook will
make a personal effort at adaptatioz, replacing
|
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] |
most of the examples relate to the medical
and nursing professions, it is the author's
hope that each user of the Handbook will
make a personal effort at adaptatioz, replacing
the examples given by other more suitable
ones whenever necessary.
|
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] |
jargon and meaning of words
the previous editions have
Many users of
asked for special care to be taken to simplify
the language used. We hope they will be
satisfied. It has not, however, been possible
to avoid using certain technical terms (for
example, discrimination index). Neither has
it been possible to avoid assigning precise and
resfficted meanings to words which are often
used interchangeably in everyday parlance
(for example' task, activity and function). In
all such cases the words are defined in the
Glossary (p.6.01 et. seq.).
It is very important that we should understand
one another, and for that we must give
identical meanings to the words we use. But
it is just as important not to get bogged down
in endless discussions. Your aim is not to
draft definitions of words for a dictionary.
please accept the definitions proposed in
Handbook, at least while you are using
|
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] |
please accept the definitions proposed in
Handbook, at least while you are using
So
this
i t .
how to use the handbook
The presentation and layout of this Handbook
are unusual.
It should be stressed at this point that the
approaches suggested in this book are the
result of a deliberate choice by the author
and reflect his ideas in the field of education.
Various theories sometimes regarded as con-
tradictory are explained to the reader so as
to give him food for reflection, rather than
to subject him to any philosophical con-
is for the reader to make his
straint. It
choice, to draw initial conclusions and, in
particular,
to seek solutions for his own
teaching problems by taking what is worth
theoretical
using among
approaches suggested. To reject them whole-
sale would hardly be constructive; it would
be preferable to propose better ones.
various
the
|
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] |
various
the
For each chapter a list of objectives is
included (yellow pages) to give you an
idea of what you will get out of the chapter.
theoretical input
(white pages) is
The
presented in the form of original docu-
ments or short quotations from
texts
listed in the bibliography.
through
the Handbook
there are
All
exercises (blue pages) to help you
to
determine whether you have increased
your skills (see check list, page 15).
Certain documents are printed
large
type so that they can be easily made into
transparencies for use with an overhead
projector (see technique on page 3.45).
in
The page numbering is also unorthodox:
every chapter begins with a number ending
in 01 (for example page 3.01 is the first
page of the third chapter), however many
pages there may be in the previous chapter.
This meakes it easier to find a specific
passage in the Handbook.
|
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] |
Rather than try to explain the whys and
wherefores of this unusual lavout. which
irritating and complicated at
some find
first, and others as intriguing as a detective
story, it seems simpler to invite you to use
this book just as it is. You will then draw
your own conclusions as to the "reasons"
for its layout. There must be some... even
if the author is not aware of them all!
In any case you are warned not to read this
Handbook like a conventional book, starting
with the first page and hoping to get to the
last. It is meant to be used as determined
by the questions you put to yourself, your
needs, and the teaching problems that
bother you - by your own objectives, in
short, whether or not they are already
articulated.
This is why we are going to try and help you
in this essential but unusual and therefore
difficult undertaking.
|
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This is why we are going to try and help you
in this essential but unusual and therefore
difficult undertaking.
First situation: you are alone (on a desert
island) or else you are accustomed and prefer
to work alone. You are going to need grit,
perseverance and 35 to 50 hours of free
time.
Good Luck!
Second situation: a colleague also has the
Handbook and agrees to work with you.
It will not be such an uphill task. If you
can get together a small working group of
five persons, still better.
Third situation: you are taking part in an
educational workshop. The working
methods for such a meeting are described
in this Handbook (pp. 5.10 - 5.L2) and
group dynamics will do the rest.
In any case, the first thing to do is to iden-
tify yoar needs.
You are invited to proceed in three stages.
identification of your needs as an
educator
First Stage
|
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] |
In any case, the first thing to do is to iden-
tify yoar needs.
You are invited to proceed in three stages.
identification of your needs as an
educator
First Stage
What are the educational "questions" that
you would like to have answered? (For
example: "what is an educational object-
ive?", "what does the word 'validity'mean
with reference to an examination?").
What are the educational "tasks" that you
take on? (For example:
would
"organizing a nutrition course for student
like to
nurses" or "teaching how to interview a
patient").
r What are the educational "problems" you
would like to solve? (For example: "I am
in charge of 600 students in different
university years: how am I to organize field
work in preventive medicine?"
Now ............ Try to draw up a preliminary list of your "questions", "educational tasks" or
"problems" for the coming 12-month period.
|
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] |
Now ............ Try to draw up a preliminary list of your "questions", "educational tasks" or
"problems" for the coming 12-month period.
E X E R C I S E
identification of your needs as an
educator
Second stage
Would you like to find out how much you
know before studying the rest of the Hand-
book? One way of doing this is to try to
answer the questions in ^ pre-test* .
To do so, read straigbt away the questions on
p a g e s 1 . 5 7 - 7 . 6 0 , 2 . 4 5 - 2 . 4 7 , 3 . 7 9 - 3 . 8 3
and 4.75 - 4.80 and enter your answers on
the answer sheet, page 10.
If your score is low in this pre-test, this should
be a source of satisfaction, for it may show
that you were right to start perusing this Hand-
book and that it will be worth your while
continuing so that you can improve your
weak spots.
The test will help you make a personal diag-
nosis of the teaching areas you need to bring
|
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|
e5d3a289-c6ed-47d6-bab0-a1b99934c915
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] |
The test will help you make a personal diag-
nosis of the teaching areas you need to bring
up to date. Your aim in doing this test is not
to find the right answer but simply to take
note of tbe fact that you do not find it!
You may also rest assured that your score in
the post-tesr (page 5.34) will be another occa-
sion for satisfaction for it will show an appre-
ciable gain after you have used the Handbook.
If your score in the pre-test is high, you should
choose areas which are still "uncertain" (those
for which you did not find the correcr answer)
and go into the matter more thoroughly.
*This pre+est deals only with theoretical knowledge relating
to group 2, page 2. You will have an opportunity ofgauging
how far you have achieved the group I objectives by doing
other exercises which appear throughout
the Handbook
(blue pages).
9
answer sheet for pre-test *
Chapter I
|
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|
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9
answer sheet for pre-test *
Chapter I
8tr8trtr
EEgtrE
trtrtrtrtr
trEEEE
trE8trtr
trEgEtr
trtr EEtr
trtrEEE
trtrtr8tr
tr89trtr
trtrEEE
8trtrtrtr
ts88trtr
BEEEE
tsts9trtrtrG
trtr9 trE trE
trEEEEtrtr
trtr gE trtrtr
trEgtrtrtrG
EEtrEEtrtr
Chapter II
1 0
1 1
1 2
1 3
1 4
1.5
r 6
1 7
1 8
I 9
trEEtrE
trtr98tr
tr8trtr
trtrgE
trEE tr
EEEtr
trEEE
*see page 9
r@
r@
r@
tqE
r@
E
tq@
E@
t-cEl
9
1 0
1 1
t 2
r 3
7 4
1 5
t 6
1 7
1.3tr8tr8
14trtrtrtr
1sEEtrE
T6EEEE
77tr8tr8
188trtrtr
LgtrEEE
zotrtrEE
18trtr8tr8
gtr8trtrtr
20trtrtrtrtr
21'EEtrE
22trtr8Dtr
23tr8trtrtr
24trtrtr8tr
zstrEEEtr
Chapter III
trtr88tr
trtr8tr8
trtr8trtr
trEE
trtr9
trEE
trEE
EtrEtrE
trtrBEE
trEtsE
EEEE
trts8tr
1 0
1 1
7 2
Chapter IV
rEEEtrtr
z@tr88tr
r@trtrtrtr
+trtrEEE
s@8tr8tr
O@8trtrtr
z@BEE
a@trtr8
gEtrEE
10tr8trtrtr
11 8trtrtr
72trtrtrtr
13trtr8tr
14trtrtr8
lstrtrtr8
16trtr8tr
17trtrEEtr
18tr88trtr
rstrEtrEtr
zotrtrtrD
|
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rEEEtrtr
z@tr88tr
r@trtrtrtr
+trtrEEE
s@8tr8tr
O@8trtrtr
z@BEE
a@trtr8
gEtrEE
10tr8trtrtr
11 8trtrtr
72trtrtrtr
13trtr8tr
14trtrtr8
lstrtrtr8
16trtr8tr
17trtrEEtr
18tr88trtr
rstrEtrEtr
zotrtrtrD
To check your raw score compare your answers with those given on page 5.34.
identification of your needs as an
educator
Third stage
To use this Handbook effectivelyfor your own
needs, it is proposed that yoz choose from
among the following educational tasks or
objectives (broken down into four main
themes) the ones which interest you a;nd, n
which you would like to achieve a degree of
competence.
The time required for personal work (study
of the text, practical exercises) on some of
these tasks will be more or less long. Some
call for a few minutes' work, others several
hours to allow for study of the documents
suggested (p.14).
|
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To guide you in this first choice, do not
forget to take into account the "questions
and problems" you listed on p.8 and your
weak and strong points (results of pre-test,
p. s.3a).
Limit this initial choice to about f0 tasks,
circling the numbers of those that seem
most important fo,r you on the list (numbered
1 - 40) appearing on pages 12 - L3.
It is natural that you should have some diffi-
culty in making your choice at this stage, for
you are not yet familiar with "educators'
jargon". Do nor forget the Glossary (pp.6.01
et seq.) Don't worry
in any case there
is no risk involved!
Moreover, you can always adjust your choice
as your work progresses.
Once your initial choice has been made, turn
to p. L4 and follow the instructions given
there, study the suggested pages and do the
corresponding exercises (blue pages.)
1 1
educational a
obiectives t
evaluation 6
planning Z
|
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1 1
educational a
obiectives t
evaluation 6
planning Z
1. Define the following terms: professional
task, activities, functions, role, institut-
objective; specific objective;
ional
domains of practical skills; communic-
ation skills and intellectual skills.
,)
3 .
+.
5 .
6 .
7.
8 .
9 .
the qualities of an educational
List
objective aird the sources necessary to
ensure lts relevance.
Define the professional functions of a
member of the health team whom your
is responsible for
teachins institution
training (general educational objectives)
so as t6 dial with the health problems of
society.*
Analyse a major professional function by
defining the various intermediate com-
ponents (activities) making it up.*
Define a professional task and identify
its components (domains of practical
and
skills.
intellectual skills).
communication
skills
'be
|
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] |
Define a professional task and identify
its components (domains of practical
and
skills.
intellectual skills).
communication
skills
'be
Draw up a list of the specific educational
objectives relating to a professional task,
rtatitts explicidv' whaf you
feel the
able to "do" after a
studeit shbuld
instruction (that he
given course of
was not able to do previously) and
corresponding to
the
communication skills or practical skills
involved in this task.x
the domains
'of
^domain
Taking a specific objective in a non-
(i... practical or
intelleitual
communication skills), define in
the
form of specific educational objectives
feel
theoretical knoailedge you
what
the student should possess if he is to
attain that objective.'r'
|
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|
28bdb398-2cc0-4509-a252-282b6743395e
|
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] |
Make a critical analysis of specific
educational obiectives (listed by a
partiiular
colleaque).
whethtr they include- all the-requisite
(act, content, condition,
elements
criteria). *
indicatine
in
havTng
Draw up a list of the possible reactions
of colleigues in your ficulty to the idea
educational
of
from professional
objectives
tasks and propose strategies for over-
coming those reactions. *
-derived
define
t6
'
I 2
10. Draw a diagram showing the .relation-
the other
ship betweei evaluation
parts of the educational Process.
-and
11. Define the principal role of evaluation,
its purpose and its aims.
12. Describe the difference between forma'
tive and certifying evaluation.
13. List the good and bad features of a test.
1 4 . Compare the. advantages and disadvan-
tages ot tests m current use.
1 5 .
following
|
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|
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tive and certifying evaluation.
13. List the good and bad features of a test.
1 4 . Compare the. advantages and disadvan-
tages ot tests m current use.
1 5 .
following
t€rlnS: validity,
Define the
reliabilitv. obiectivitv, and describe the
relationship tliat exists between them.
L 6 .
Choose an apProPriate evaluation
method (questionnaire, written examrn-
ation, "objective". test (MCQ or short,
open-answer question) or essay questron'
oial examinalion, direct observation,
etc.) for measuring the students' attain-
ment of a specifictducational objecti-Ye'
Compare the alternatives in a specific-
ation table.*
17. Define (in the form of an otganizational
diagram) the organization oT an evalu-
atron svstem suiiable for your establish-
ment, and list the stages involved.
Indicate:
(a)
(b)
(c)
important educational
|
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] |
Indicate:
(a)
(b)
(c)
important educational
the most
decisions You have to take;
the data to be collected to provide
a basis for those decisions;
the aims of the lys.teln. and sub-
systems in terms of decisions to be
the object of each
tiken and
decision (teachers, students, Pro-
grammes). *
18. ldentify obstacles to and strategies for
improv-ement of a system of evaluating
students, teachers and programmes'
t S e e f o o t n o t e , p . 5 . 1 9 .
programme o
construction r)
implementation
of evaluatio n4
1 9 .
the
Explain
differences between
"education", "teaching" and "learning",
and describe the new trends in the
teaching/learning system and the various
learnmg sltuatlons.
20.
Define the concept of relevance of a
programme.
2 t .
) )
List 10 conditions which
facilitate
learning on the basis of the list and evaluate
a specific learning activity.
Indicate the aims and general methods of
teaching.
2 3 .
|
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] |
2 t .
) )
List 10 conditions which
facilitate
learning on the basis of the list and evaluate
a specific learning activity.
Indicate the aims and general methods of
teaching.
2 3 .
Specify at least two advantages and two
disadvintaees for each tecTrnique and
medium uied in teaching.
30.
3 7 .
3 2 .
33.
3 4 .
24.
Select a teaching method that will make
an educational obiective easier to
achieve.
3 5 .
Compare the alternatives in a specific-
ation table.*
the different elements that
Indicate
should be considered in the evaluation of
a teaching programme.
the different elements that
Indicate
should be considered in the evaluation of
the educational objectives of a teaching
programme.
Define the advantaqes and limitations of
a system of .evaluition of teaching by
the students. *
|
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] |
Define the advantaqes and limitations of
a system of .evaluition of teaching by
the students. *
Construct an observational rating scale
and/or a practical test to evaluite the
behaviour of a student in the domain of
communication and/or practical skills.{-
Propose a question for a written (open-
book) examination of the "essay" type
or a series of six short, open-answer
questions and indicate the norms of
objective
ferformance
marking (marking table). *
permitting
Draw up three multiple choice questions
(MCO
in the domain of int'ellectual
skills - at least two of the objectives
must measure an intellectual process
superior to level 1 "simple recall"-(either
leiel 2 "interpretation'of data" or level
3 "problem-solving").*
2 5 .
Indicate
structlng a programme.
the steps involved in con-
2 6 .
Construct a programme or decide
whether a .programme or course needs
revision, using a specification table. *
|
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|
01b1e48d-5f40-4641-bc0f-5659579727ad
|
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] |
2 5 .
Indicate
structlng a programme.
the steps involved in con-
2 6 .
Construct a programme or decide
whether a .programme or course needs
revision, using a specification table. *
27. Construct a selfJearning package.*
2 8 .
Define the role which, as a teacher, you
would like to assume in order to motivate
and facilitate the learninq of students
for whom you are responsible.*
2 9 .
Identifv
to be
the obstacles liable
encountered in setting up a competency
based curriculum qeared to the health
needs of the com-munity and describe
strategies for overcoming them. "
3 6 .
Indicate the advantages and limitations
of a programmed exairination. *
3 7 .
the following.terms:. prerequisite
P.fl".
level test, pre-test, lnterval test, com-
prehensive pre-final; indicate their pur-
pose and the stages at which they are set.
3 8 .
Explain the difference between a rehthte
and an absolute criteria test.
3 9 .
|
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] |
3 8 .
Explain the difference between a rehthte
and an absolute criteria test.
3 9 .
Calculate the acceptable pass level for a
MCQ examination and establish the
scoring criteria and norms which permit
determination of the passing grade of a
mini-test (made up of
the questions
mentioned in objectives 34 and 35).*
40.
Do an item analysis of a question (cal-
culate the difficultv index'and the dis-
crimination index) ind draw the relevant
conclusions.
L3
Theoretical background that will help you
reach the educational objectives of the workshop
For objective
Study the following
pages of the
Educational Handbook
For objective
Study the following
pages of the
Educational Handbook
1
2
3
4
)
6
.1
8
9
1 0
1 1
L 2
r 3
I+
7 5
L 6
L 7
1 8
T 9
20
Glossary and pp. 1.05-1.07,
L . \ 7 , L . 2 3 , r . 2 9 , 1 . 3 3 -
r . 3 6
p p . 1 . 2 0 , 1 . 3 3 , 1 . 4 3 - I . 4 5
,
1 . 4 8 - 1 . 5 0
Obj. 1 and pp. 7.O9-1.27
|
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L 6
L 7
1 8
T 9
20
Glossary and pp. 1.05-1.07,
L . \ 7 , L . 2 3 , r . 2 9 , 1 . 3 3 -
r . 3 6
p p . 1 . 2 0 , 1 . 3 3 , 1 . 4 3 - I . 4 5
,
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Obj. 1 and pp. 7.O9-1.27
O b j . 3 a n d p p . r . 2 9 - r . 3 2
p p . 1 . 1 7 - 1 . 7 9 , I . 3 3 - 7 . 4 1
Obj. 2, Obj . 5 and pp. 1 .4 3
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o b j . 6 a n d p p . r . 5 4 - I . 5 6
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3 . 7 5
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3 4
3 5
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p p . 3 . 2 8 , 3 . 2 9
|
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p p . 1 . 0 4 , 3 . 1 8 - 3 . 2 9
p p . 1 . 3 3 , 3 . O + - 3 . 1 2
2 L
2 2
2 3
24
2 5
2 6
27
2 8
2 9
3 0
3 1
3 2
3 3
3 4
3 5
3 6
3 7
3 8
3 9
40
p p . 3 . 2 8 , 3 . 2 9
p p . 3 . 2 1 , 3 . 2 2
p p . 3 . 4 1 - 3 . 4 7
Obi. 16, Obi.23 andPP.3.22,
3.23,3.55-3.58
p p . 3 . 0 3 - 3 . 1 5
O b j . 2 5 a n d p p . 3 . 5 9 - 3 . 7 5 o r
p p . 1 . 2 7 , 3 . 7 3 , 4 . 0 4
Obj.24 and pp. 3.494.54
Ob|2a;obj.27
and pp. 3.33-3.40
Obi. 23 znd/or Obi. 26 and
p p . 3 . 2 t , 3 . 7 5 - i . 7 8
p p . 4 . 0 3 - 4 . 0 9
p p . 4 . 1 0 - 4 . 1 4
p p . 4 . L 5 - 4 . L 9
Obj. 16 and pp. 4.22-4.27
Obj. 16 and pp. 4.284.30
obj. 16 and pp. 4.3t-4.+o
pp
+.41-4.48
pp
+.49-4.53
p . 4 . 6 r
O b j . 3 5 , O b j . 3 8 a n d p p . 4 . 6 2 ,
4 . 6 3
p p . 4 . 6 5 - 4 . 7 3
and do the corresponding exercises (blue pages): see list on next page.
L 4
Recapitulative table of exercises proposed
Ilandbook
Objective
3
3
Exercise
|
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4 . 6 3
p p . 4 . 6 5 - 4 . 7 3
and do the corresponding exercises (blue pages): see list on next page.
L 4
Recapitulative table of exercises proposed
Ilandbook
Objective
3
3
Exercise
Identifying professional activities
Defining the main functions of health personnel
20/26 Analysis of the relevance of a programme
5
6
8
8
6
7
8
Identifying components of a professional task
Selecting active verbs relating to a task
Identifying the elements of an educational objective
Evaluating an educational objective
Drawing up specific educational objectives
Drawing up enabling educational objectives
Critical analysis of an educational objective
I / T 1
Evaluation of knowledge about educational objectives
Page
1 . 1 5
l . 2 t / 1 . 2 2
r . 2 7
t . 4 7
r .47
T . 5 L
r . 5 2
r . 5 +
l . ) )
1 . 5 6
1 . . 5 7 / r . 6 0
2 . 0 9
Statement of educational decisions
L 7
L2
Distinguishing between formative evaluation and certifying evaluation
|
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T . 5 L
r . 5 2
r . 5 +
l . ) )
1 . 5 6
1 . . 5 7 / r . 6 0
2 . 0 9
Statement of educational decisions
L 7
L2
Distinguishing between formative evaluation and certifying evaluation
2 . 1 6 t 2 . t 9
13,r4,76Selecting a method of evaluation
1 5 , 7 6 Comparing several methods of evaluation
T7
1 8
Graphic representation of an evaluation system
Identifying obstacles to and strategies for applying an evaluation system
2 . 2 3
2 . 3 8
2.+3
2.4+
1 0 / 1 8 Evaluation of knowledge about evaluation planning
2 . 4 5 t 2 . 4 7
t 9
2 8
2+
24
2 9
2 9
Describing learning situations
Describing the teacher's functions
Selecting a teaching method
Comparing several teaching methods
Constructing an organizatronal chart for programme implementation
Identifying obstacles to and strategies for introducing a new programme
1 9 / 2 9 Evaluation of knowledge about programme construction
3 2
33
3 3
3 4
3 4
3 5
3 6
36
3 9
40
|
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Identifying obstacles to and strategies for introducing a new programme
1 9 / 2 9 Evaluation of knowledge about programme construction
3 2
33
3 3
3 4
3 4
3 5
3 6
36
3 9
40
Listing advantages and limitations of evaluation by students
Drawing up a practical test or project test
Constructing an attitude table
Preparing an essay question
Preparing short open-answer questions
Preparing multiple-choice questions (A,lCQ)
Preparing a programmed test
Completing a specification table for a test
Calculating the acceptable pass level (APL) for an MCQ test
Calculating the difficulty index and discrimination index for a
questlon
3 . 2 9
3 . 3 9
3 . 5 7
3 . 5 8
3 . 7 7
3 . 7 8
3 . 7 9 / 3 . 8 3
+ . 1 9
+ .22
+ . 2 5
+ .29
4 . 3 0
+.39t+.+O
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+ . 5 5 t + . 5 7
4 . 7 r
+ .7 5
30/40 Evaluation of knowledge about test and measurement techniques
4.7 5 t4.80
acknowledgments
|
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+ .29
4 . 3 0
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+ . 5 5 t + . 5 7
4 . 7 r
+ .7 5
30/40 Evaluation of knowledge about test and measurement techniques
4.7 5 t4.80
acknowledgments
This revised edition of the Handbook has
involved a lot of meticulous and time-con-
suming work over the last three years. Many
people have offered advice and help and have
supplied documents used in the text.
From the start, the encouragement, support,
advice and patience of T. Fiiliip, Director of
the Division of Health Manpower Develop-
ment, have been invaluable.
B. Pissaro (Paris) has followed our work with
unfailing interest and has carefully read and re -
read the intermediate drafts.
We wish to express special thanks to:
S. Abrahamson (Los Angeles), C. McGuire and
G. E. Milter (Chicago) for their appreciative
comments and even more for their useful and
judicious advice.
We should also like to thank all those who have
sent us helpful comments and suggestions,
|
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We should also like to thank all those who have
sent us helpful comments and suggestions,
H. Jason (Miami),
|
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Z. S. Al-Alway (Dacca), P. Alexander (Minneapolis), L. Allal
B. Adjou-Moumouni (tomi),
(Geneva), J. L. Argellies (Tunis), W. Barton (Geneva), G. R. Beaton (Johannesburg), A. Benadouda
(Algiers), D. Benbouzid, (Algiers), J. Beneke (Copenhagen), D. Benor (Beer Sheva), V. Bergk
(Heidelberg), P.J.B\izard (New Delhi), C. Boelen (Tunis), J. Brines (Valencia), S. Bukkavesa
(Bangkok)l L. Burke (Mogadiscio), F. Canonne (Paris), P. Carteret (Lome), P. Chaulet (Algiers),
D. Clark (London), A. Coelho (Lisbon), A. L. Courtieu (Nantes), K. R- Cox (Sydney),T. O. Crisp
(Dacca), L. Daufi (Barcelona), R. Debr6 (Paris), H. Dieuzdde (UNESCO), J. F. D'Ivernois (Paris),
C. Di Pasquale (Dakar), S. R.Dodu (Accra), M. A. C. Dowling (Geneva), C. Engel (Newcastle),
V. Ermakov (Moscow), W. Felton-Ross (Bloomfield), J. -J. Ferland (Quebec), D. Flahault
(Geneva), H. H. Freihofer (Bern), A.T. Garcia (Aden), S. Goriup (Geneva), J. P. Grangaud
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V. Ermakov (Moscow), W. Felton-Ross (Bloomfield), J. -J. Ferland (Quebec), D. Flahault
(Geneva), H. H. Freihofer (Bern), A.T. Garcia (Aden), S. Goriup (Geneva), J. P. Grangaud
(Algiers), J . P. Grillat (Nancy), V. F. Gruber (Basel), R. M. Harden (Dundee), E. Harper
(nllahabad), H.D.Houran (Kuwait), C. Iandolo (Rome), T. Jaoude (Mogadiscio), C. Jaramillo
T. Javor (Pecs), O. Jeanneret (Geneva), M. Jegathesan
Trujillo),
(Kuala Lumpur), S. Jones (Visakhapatnam), J. Kadish (Washington), I. Kapoor (Bombay),
F. Katz (Geneva), J. Kemp (San Josi), H. Kolb (Vienna), X. Kondakis (Patra), S. R. Kottegoda
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E. Mabry (Bangalore),
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V. G. MacDonald (Wellington), N. Mclntyre (London), J. M. Mclachlan (Kuwait), S. Maes
(Antwerp), A. Maglacas (Geneva), M. Manciaux (Paris), W. F.Maramis (Surabaya), A' Mazer
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V. G. MacDonald (Wellington), N. Mclntyre (London), J. M. Mclachlan (Kuwait), S. Maes
(Antwerp), A. Maglacas (Geneva), M. Manciaux (Paris), W. F.Maramis (Surabaya), A' Mazer
(Marseillis), D. Melliere (Paris), A. Mejia (Geneva), P. I. Mintchev (Sofia), S. Mokabel
(Alexandria), R. Mol (Veldhoven), K. Mowla (Islamabad), E. Muret (Paris, M. Nichol
(Katmandu), G. Nicolas (Nantes), C. Nihoul (Ghent), N. M. O'Brien (Amman), G. H. Pauli
(Bern), M. Pechevis (Paris), P. Pine (Marseilles), S. L.Purwanto (Djakarta), C. A. Quenum
(Jitra), A. Rodriguez-Torres (Valladotid), J. E. Rohde (New York),
(Btazzaille), A.A.Rahman
L. Roy (Geneva), A. M. Sadek (Alexandria), J. C. Salomon (Paris), G. Scharf (Woipy), C.Searle
J. D. Shepperd (Bangkok), S. Slimane-Taleb (Algiers), A. Stewart (Dundee),
(Pretoria),
V. Subhadra (Calcuaaj, A. E. Suliman (Dacca), G. Szabo (Debrecen), A. Thein (Rangoon),
|
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] |
J. D. Shepperd (Bangkok), S. Slimane-Taleb (Algiers), A. Stewart (Dundee),
(Pretoria),
V. Subhadra (Calcuaaj, A. E. Suliman (Dacca), G. Szabo (Debrecen), A. Thein (Rangoon),
A. Tigyi (Pecs), A. Torrado da Silva (Coimbra), E.Yarga (Debrecen), F. Vilardell (Barcelona),
K. Viylsteek (Ghent), J. Vysohlid (Prague) J. S. Wasyluk (Warsaw), W. Warkentin (New Delhi),
M. Yamamoto (Tokyo), J. Yip (Djakarta).
|
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] |
I. M. Lovedee (Rangoon)'
We trust that anyone who has been overlooked
will forgive us. Indeed, among the 1250 collea-
grr., *fro have taken part iriworkshops with
h"rry whose questions
ihe author, there
"r.
to
and opinions have helped in our .ifort,
ensurJthat the Handbook is tailored to meet
the needs of its users. These contributors are
too numerous to be mentioned by name.
Finally, our thanks go to:
P. Duchesne, P. Etienne,M. Magnin,E. Riccard,
the
M. Schaltegger and M. Wolff and to
English editors R. Binz, K. Grinling and
C. Stevenson without whose untiring work
this document would never have been com-
pleted.
t 6
educational
obiectives
the concept of educational obiectives
|
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t 6
educational
obiectives
the concept of educational obiectives
The aims of this first chapter are to show the advantages of defining educational objectives; to
show that if precision and ctarity of educational objectives are important, relevance to health
problems is even more so; and to show that an approach based on objectives will ensure that
health personnel are better prepared to perform professional tasks corresponding to the health
problems of society.
Those interested in this approach should read the following works by R.F. Mager.
r
Freparing instnrctional objectives (1962).
I Goal analysis (1972).
r Measuring instructional intent (L973, (Chapter III, pages 15 to 46) Fearon Publishers,
California, U.S.A.
And the following publication by the World Heahh Organization.
r
Criteria for the evaluation of objectives in the education of health personnel,
WHO, Technical Report Series, 1977, No. 608.
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] |
And the following publication by the World Heahh Organization.
r
Criteria for the evaluation of objectives in the education of health personnel,
WHO, Technical Report Series, 1977, No. 608.
After having studied this chapter and the reference documents mentioned you should be able to:
1. Define the following terms: professional
task, activities, functions, role, institutional
objectives; specific objective; domains of
practical skills, communication skills and
intellectual skills.
should be able to "do" after a given course
of instruction (that he was not able to do
prwiously) and corresponding to the domains
of the communication skills or practical skills
involved in this activity.
2. List the qualities of an educational
objective and the sources necessary to ensure
its relevance.
|
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] |
2. List the qualities of an educational
objective and the sources necessary to ensure
its relevance.
3. Define the professional functions of a
member of the health team whom your
teaching institution is responsible for training
(generol educational objectives) so as to deal
with the health problems of society.
4. Analyse a major professional function by
defining the various intennediate components
(activities) making it up.
5. Define a professional task and identify
its components (domains of practical skills,
communication skills and intellectual skills).
6. Draw up a list of the specific educational
objectives relating to a professional task,
stating explicitly what you feel the student
|
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6. Draw up a list of the specific educational
objectives relating to a professional task,
stating explicitly what you feel the student
7. Taking a specific objective in a non-
(i.e., practical or
cognitive domain
communicative skills), define in terms of
educational objectives what
specific
theoretical knowledge you feel the student
should possess if he is to attain that objective.
8. Make a critical analysis of specific
educational objectives (listed by a colleague),
indicating in particular whether they include
all the requisite elements (act, content,
condition, criteria).
9. Draw up a list of the possible reactions
of colleagues with whom you work in your
the idea of having to define
faculty to
educational objectives derived from pro-
fessional tasks and propose strategies for
overcoming those reactions.
t.o2
If you are
not
certain
of where
you
are
going
you may verY
well
end up
|
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] |
t.o2
If you are
not
certain
of where
you
are
going
you may verY
well
end up
somewhere else
(and not even know it )
Mager
o
Every individual should have access to a type of education that permits
maximum development of his potential and capabilities.
Education is a process, the chief goal of which is to bring about change
in human behaviour
The result of education is
an expected change in the behaviour of the student in the course of
a given period.
The Educational Spiral
This "behaviour" will be defined explicitly in the form of educational
obiectives derived from professional tasks.
An evaluation system will be planned so that better educational decisions
can be taken.
A programme will be prepared and implemented to facilitate attainment
of educational objectives by the students.
|
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|
5e6c78d5-e670-4f45-ab9d-130a39f763c5
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A programme will be prepared and implemented to facilitate attainment
of educational objectives by the students.
The evaluation process will be used to measure the extent to which the
objectives have been achieved . . . it will measure the student's final abilities
. . . and the effectiveness of programme and teachers.
t.o4
the educational spiral
the strength of
Programme reform has been a source of
concern for many years to those training
health personnel and the alarm has often been
the
sounded. However,
traditions impeding necessary reforms has been
such that it has not been possible to avoid
serious disturbance
in many universities
the world, always caused by a
throughout
face of
reaction
the apparent diehard
in
conservatism of the system.
It would, however, be negative and dangerous
merely to accuse of incompetence those at
present in positions of teaching responsibiliry.
They should be offered help.
|
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It would, however, be negative and dangerous
merely to accuse of incompetence those at
present in positions of teaching responsibiliry.
They should be offered help.
Societies change and have always been
changing, but until the present century their
evolution was relatively slow and adaptation
to change was possible without unduly
violent disorders.
The form of teaching has remained unchanged
for centuries. The university has wrapped
itself in its privileges and remained deaf to
the cry from without. The needs of society,
the practical side of the matter, have been
left to chance, whereas specific features of
the situation in each country are changingever
more rapidly. Hitherto, unfortunately,
little
or no account has been taken ofthosefeatures
and the training of health personnel has
followed traditional systems. What is required
now is to make sure that educational pro-
grammes are relevant.
|
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] |
There can be no question of continuing to
copy the models of the past or, in the case of
developing countries, foreign models.
Tbe educotional system leadingto tbe deaelop-
ment of health personnel, at all leaels, must
be re-examined witbin
tbe context of tbe
needs of tbe coantrJl concerned.r
No educational system can be effective unless
its purposes are clearly defined. The members
of the health teum rnust be tained specifically
for tbe tasks tbey will baae to perform, taking
into account the circumstances under which
they will work.
These tasks can only be defined in occordonce
witb a plan in which the nature of the seryices
to be provided
is specified, priorities are
the staff needed to provide these
allotted,
services determined, etc. . . . .
Professional training programmes must then
be tailored to meet these needs.
|
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] |
Professional training programmes must then
be tailored to meet these needs.
There is room for some degree of optimism
in this sphere, for no financial assistance is
needed for a move in the right direction.
that is needed is a resource distributed
All
more or less equally around the world: mental
ability. The management of that resource is
the art of organizing talent and of coping
intelligently with change.
the professional
tosks of health
Defining
personnel to be trained, the very basis of the
training centres,
educational objectives of
is of crucial importance.
Thus an educational programma, instead of
being the result of a non-selective accumul-
ation of knowledge built up over the centuries,
must be shaped selectively in terms of tbe
goal to be acbieaed. If that goal is modified
in the course of time, the programme must
also be modified accordingly.
|
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] |
Definition of professional tasks must Proceed
from a study of needs, take account of
available resources and indicate clearly and
precisely what various categories of personnel
will be called upon to do during their pro-
in a given type of health
fessional sreers
service.
t The study of needs, organization of health services, and definition o{ tasks and functions are, however, not dealtwith in this Handbook.
Consequently, specialized texts should be consulted concerning those aspects (see Bibliography, p. 7.O1).
ft
t
!
tr
!
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t]
!
!
!
!
t
n
!
!
!
!
n
tL
The obiect of education is not to shape citizens to the
uses of societyr but to produce citizens able to shape
a better society.
f 1 !
t r !
!
! D !
t r !
t L
! .
n
!
!
!
!
t
n
1 . 0 5
the educational spiral
Defining
Tasks and
Educational Objectives
lmplementing
Evaluation
Planning
an Evaluation
System
|
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] |
t r !
t L
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n
!
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t
n
1 . 0 5
the educational spiral
Defining
Tasks and
Educational Objectives
lmplementing
Evaluation
Planning
an Evaluation
System
Preparing and
lmplementing an
Educational Programme
importance of defining
professional tasks
of being confined
limited personal
experience they will accept the use of more
formal educational research methods.
to
stimulus
can be a powerful
|
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] |
of being confined
limited personal
experience they will accept the use of more
formal educational research methods.
to
stimulus
can be a powerful
for
This
institutional change, particularly when used
by faculry members whose experience in the
educational process has already alerted them
to the ways in which educational innovation
the greatest
can be accomplished with
possible enthusiasm and the least possible
hostiliry on the part of their colleagues. Such
innovation, based upon carefully gathered
to
information
sound educational principles, could enable
to
some medical education
explore, in particular, non-traditional means
of preparing the members of the health team
for the professional tasks they will have to
undertake. Without the incrusted educational
that long adherence to a single
tradition
system creates, the opportunity for innovative
experimentation is far greater.
and dweloped according
|
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and dweloped according
institutions
This is a very difficult
task which may well
have daunted the most conscientious. We
teachers should be offered
consider that
assistance in this field.
That is the main reason why this Handbook
has been prepared and used during work-
shops on educational planning.
importance of the prior
If we stress the
definition of professional tasks, it is because
this is a precondition for ensuring that training
programmes are really designed to meet the
population's health needs. Over the
last
10 years or so teachers, under the cloak of an
educational revival, have used the title of
educational objectives to disguise what they
had been in the habit of teaching in the past.
Such educational objectives have favoured the
creation or continuation of
training pro-
grammes which only too often seem hardly
relevant to the needs of the population.
|
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] |
Indeed, if educational objectives are based
on faulty principles, then the "best" system
of training may well give "bad" results. There
is even a danger that a "bad" message will be
"better" communicated, and this is certainly
not the goal sought.
We therefore propose to demonstrate that
the professional
tasks of a member of the
health team and the educational objectiues
providing a basis for construction of his
training programme must be almost identical.
the
|
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the
Another important point to bear in mind is
that it can be useless to try to change a pro-
gramme or teaching methods without also
changing the system of evaluation (parti-
cularly examinations). Experience has shown
that if, on the other hand, the evaluation
system is modified, this has a much greater
impact on the nature of learning than has
modification
programme
of
unaccompanied by any change in
the
evaluation system. Evaluation provides a
sound basis for programme planning. There-
fore, an evaluation mechanism should be set
up before proceeding to any reform of the
programme. This makes it possible to measure
the level at the outset (prerequisite level)
finish and thus to
and the
determine whether
the change has been
positive or not. This process can be
represented by what is called the educational
spiral.
level at the
|
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level at the
If the teaching staff are given an opportunity
to gain the new knowledge they need and to
acquire the appropriate modern teaching
skills, they will feel more secure and instead
t.o7
Organizational diagram showing the relationship between the subsystem "Education" (inside the
dotted linel and the subsystem "Health Seryice".
Community Health
Needs and Resources
of Country's
Analysis of Professional
Functions and Activities
Characteristics of
Student Population
and Teachers
Definition of
Educational Objectives
Planning of
Evaluation System
Programme Preparation,
Choice of Teaching
Media and Methods
lmplementation of
Educational Programme
Formative and
Certifying Evaluation
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1 . 0 8
selection of training goals'
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this selection has been made
Traditionally,
by relying on the judgment of experts to
determine what a neophyte in the profession
ought to know and ought to be able to do.
In the past we have relied almost exclusively
on this method. As a result curricula are
crammed with an ever-burgeoning amount of
new and highly specialized knowledge which
the student perceives as irrelevant to his own
goals and which, in fact, may be of little value
to other than the super sub*pecialist. Certainly
expert opinion is an important source of
information about the knowledge and skills
which trainees should be able to demonstrate,
but it is also possible to make this decision
on the basis of scientific evidence about what
competent health personnel need to know
and need to be able to do in order to fulfil
their responsibilities. A number of procedures
have now been developed for collecting such
|
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|
ddfc0fd6-b90f-4c04-895e-a72a32995f94
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competent health personnel need to know
and need to be able to do in order to fulfil
their responsibilities. A number of procedures
have now been developed for collecting such
data which provide an empirical basis for
working out a behavioural description of the
essential components of professional com-
petence. This is of great assistance to faculties
in setting goals and designing curricula. Three
of these procedures are of special interest:
the critical incident technique, the method of
task analysis and the method of analysis of
epidemiological data.
|
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The critical incident technique
II.
|
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II.
This method consists in collecting data about
specific types of behaviour that charactetize
professional effectiveness and ineffectiveness
and using these data to make an objective,
the essential per-
empirical assessment of
the profession.
formance requirements of
This technique is an outgrowth of studies
in aviation psychology made in the United
that
States during World War
that in reporting
programme it was found
the reasons for eliminating a trainee, pilot
frequently
instructors and check pilots
offered such cliches and stereotypes as "lack
of inherent flying ability", "poor judgment"
or "unsuitable temperament". In an effort
to determine the specific characteristics of
to success or
personnel that contributed
failure, combat veterans were asked to report
that involved
incidents observed by
bebaoiour whicb was especially helpful or
especially inadequate in accomplishing the
them
In
|
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them
In
assigned mission. This request concluded with
the statement: "Describe the officer's action.
What did he do?" The several thousand
this
incidents submitted
inquiry were analysed and categorized to
provide a relatively objective and concrete
the "critical requirements"
description of
of combat leadership.
response to
in
to
this method
several hundred
|
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the health
To apply
professions, several thousand incidents des-
cribing observations of especially effective
or ineffective colleague behaviour are collected
health workers
from
representing various age groups, geographical
areas, professional categories and specialty
interests. For example, in a critical incident
intern and resident performance
study of
(i.e. of the general practitioner) commissioned
the U.S. National Board of Medical
by
Examiners, the American Institute of Research
which conducted the study collected over
3000 incidents from physicians across the
country. The incidents submitted involved
all areas of behaviour: practical, communic-
ation and intellectual skills. They identified,
for example, such general requisites of com-
in gathering clinical
petence as "Skill
i.e., in taking a competent
information,"
in performing an adequate
history and
physical examination, or "Skill in relating to
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] |
in gathering clinical
petence as "Skill
i.e., in taking a competent
information,"
in performing an adequate
history and
physical examination, or "Skill in relating to
the patient and in gaining his cooperation
in a treatment plan". In a similar study con-
ducted by the University of lllinois Center for
the critical
Educational Development of
performance requirements in orthopaedic
surgery, over 1700 incidents were collected
from more than 1000 orthopaedic surgeons
representing various practice settings and
sub-specialty interests. An empirical classific-
ation defining 94 critical performance require-
ments, grouped into nine major categories of
competence, was derived from the incidents.
This operational and prospective definition
of the essential components of competence
could then be used to determine the goals of
specialty training, the design of programmes
their achievement and the criteria and
for
If
|
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] |
of the essential components of competence
could then be used to determine the goals of
specialty training, the design of programmes
their achievement and the criteria and
for
If
their
methodology
|
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evaluation.
for
I
F.o-
"An overview of applied research in medical education
problems, principles and priorities". Christine H. McGuire,
WHO Report on the Workshop on the Needs for Research
in Medical Education, Alexandria, March 1974.
1 . 0 9
educational planning were regularly based
on such operationally defined, empirically
derived goals, educational programmes would
look quite different.
|
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] |
Task analysis
A second method of determining the essential
components of professional competence which
should define educational objectives consists
in detailed task analysis of what various
categories of health personnel actually do,
and in deriving from that list of tasks a
the knowledge and skills
statement of
(what should be done, not merely what
is done) which they must have to perform
competently. Such a task analysis should
be based on careful, systematic observations
of the activities of a representative sample
of various categories of staff or on the daily
logs of a representative sample who report
in minute detail the way in which they spend
their working days over a specified period
of time, or on some combination of these
two approaches.
in a
limited pilot
|
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] |
Wherever this method has been employed,
the results have been most enlightening. For
studY of
example,
paediatricians in a typical small U.S. city,
researchers found that all the physicians had
different but consistent patterns for taking
a history and performing a physical examin-
the 481 patient visits observed,
ation. Of
222 were well childr€n; afl zverage of lO.2
minutes was spent with these children (range,
7.5 minutes to 13.6 minutes) in contrast
with an average of 8.L minutes spent with
ill children (range: 7.4 minutes to 10 minutes).
Of the 259 rll children, 104 (i.e. 40%) were
diagnosed as having an infection of the upper
respiratory tract, 15 had chronic illnesses
and five had potentially dangerous diseases.
For the total group of 481, optic fundi were
examined only nine times and rectals were
performed in only six cases; two physicians
did not percuss the lung fields for any patient.
|
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For the total group of 481, optic fundi were
examined only nine times and rectals were
performed in only six cases; two physicians
did not percuss the lung fields for any patient.
The greatest amount of time was sPent in
discussion of nutrition and child development.
The single most frequent topic on which
advice was rendered in well-child care con-
cerned toilet training. The authors of this
|
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] |
I
B.rg-"n, A., Probstfield, J. and Wedgewood, R- Per-
formance analysis in pediatric practice: preliminary report'
J o urnal o f M e dic al E d u cation, Y ol. 42 t 262 (19 67 ).
1 . 1 0
study concluded, "Few aspects of anll'child
cdre appedr to require tbe skill of a pbysician
. . . the question is also raised ds to uhether
current training programrnes are aggrauating
the physician manpower shortage by oaer'
to community beahb
training
needs."t
relation
in
This is a question that could apply to all
members of health teams in every country;
only task analysis or comparable empirical
studies will give us the answer'
-
the
target population.
|
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] |
Epidemiological studies
One of the most interesting of the newer
approaches to the use of such studies consists
three arbitrarily weighted
in combining
factors - disease incidence, individual dis-
to define
ability and social disruption
priorities in health care needs and, hence,
in educational effort. As initially developed
by Dr. John W. Williamson2 the three factors
are computed as follows: disease incidence
the
consists of a simple tabulation of
frequency of the disease (e.g. pneumonia)
or other medical condition (e.g. pregnancy)
Individual dis-
in
ability involves a determination of the extent
of patient disability or risk associated with a
given medical condition; an Individual Dis-
ability Weight (IDW) is calculated for each
condition from three elements: the average
length of hospital stay, mortality rates and
disruption
complication
the disruption
represents an estimate of
|
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condition from three elements: the average
length of hospital stay, mortality rates and
disruption
complication
the disruption
represents an estimate of
that would be produced by a given disease
or condition in the social grouP of which
the patient is a member; it is based on such
factors as cost of illness, age of. patient and
dependents, socioeconomic
number
standing and the like. For each discharged
patient a Total Priority Weight (TPW) is
calculated combining these elements. This
is then arbitrarily
Total Priority Weight
diagnoses.
among patient
apportioned
Finally, a cumulative total for each diagnosis
is calculated from the total patient sample'
The resultant ranking represents a quantit-
ative estimate of health care needs or priorities
for the population at risk.
|
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] |
rates. Social
of
2
willi"-*tt,J.
a t i o n . Y o l . 2 O l : 9 3 8
et al. Joumal of American Medical Associ'
( 1 9 6 7 ) a n d V o l . 2 O 4 : 3 0 3 ( 1 9 6 8 ) .
It is clear that even with unlimited resources
not all of these needs could be met in the
present state of our knowledge. The next
step therefore consists of determining what
portion of total health care needs can be met,
given our present understanding of disease
and our present treatment possibilities.
indicates the target arca for
This portion
application of professional skills and helps
to define educational priorities. The goals of
education for health service staff can there-
fore be defined as encompassing those areas
of health care needs which cause the greatest
total preaentable disability -
i.e. those which
cause the greatest total disruption that could
be reduced or minimized by early diagnosis
and appropriate intervention.
|
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] |
In his early studies u3;ing this method to review
hospital practice in two
large community
hospitals in widely separated metropolitan
areas in the United States, Dr. Williamson
that pregnancy, including uncom-
found
plicated delivery, ranked first or second in
in both hospitals, that cerebral
priority
vascular accidents ranked among the first
five diagnostic categories in both hospitals
and that fractures of the lower extremities
ranked among the first five in one hospital.
These particular conditions are mentioned
because in certain educational institutions
there is a general tendency to reduce the
amount of clinical instruction for the general
medical student in some of these areas. For
example, instruction in orthopaedic surgery
is often elective despite the fact that trauma
in general accounts for a very significant
proportion of total preventable disability.
|
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While the study reported above was limited
to hospital practice, the same method could
easily be applied to any level of health
practice. Secondly, while the findings from
such epidemiological studies and the particular
weights to be assigned to such factors as
individual disability and social disruption
will, of course, vary markedly in different
parts of the world, the approach is clearly
applicable to any sociery for which health
personnel are being trained.
In all parts of the world, use of such data
the goals and priorities of
will modify
institutions and the emphases
educational
in curricula by focusing far greater attention
on ambulatory medicine and on the more
common causes of disability.
|
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on ambulatory medicine and on the more
common causes of disability.
Implications of applied research
on goals and priorities
It can be seen from the above that the means
are now at hand for supplementing expert
judgment with data derived from empirical
studies to assist us in defining the roles and,
hence, the skills required of students on
completion of programmes. If such studies
were carried out as a matter of course and if
the findings were used to develop explicit
the health pro-
educational objectives for
fessions, we should see revolutionary changes
in the kinds of health professionals produced
and in their training programmes. Further-
more, such changes would have a fat geatet
impact on meeting health care needs than
would simple expansion of educational
facilities of the conventional type.
|
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Here we should mention some simpler but
also more rapid and less costly techniques
which can be used to complement or replace
other methods. These methods are not
mutually exclusive:
- Interviews with members of the profession,
who are asked to describe what, in the light
of their experience, should be the functions
the health
and tasks of any member of
team.
- Questionnaires, made up of either open-
answer questions (what are the functions of
... ?) or closed-answer questions (which of the
tasks listed below . . . ?).
- The simplest method consists of asking
each of a group of colleagues to put himself
in the shoes of a person needing care and
to describe the functions and tasks that he
would wish a given member of the health
services to be able to perform. Comparison
of the lists submitted will lead to rapid agree-
ment on a common list of sufficiently high
|
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services to be able to perform. Comparison
of the lists submitted will lead to rapid agree-
ment on a common list of sufficiently high
quality to provide a basis for a productive
discussion on the relevance of the programme,
for example.
|
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] |
"Transformation of the present professionally
oriented technologically dominated health system
into a patient oriented system is the needed
ingredient for any successful curriculum change.
The patient should be the primary concern of both
education and service".
George A. Silver
1 . 1 1
example of services
provided by rural health units*
Each health unit is meant to serve a population of 5000 persons, normally in one village and
maybe a few smaller settlements around it. The healtb team of each of these rural health units
is made up basically of,
One physician (in charge)
One assistant midwife
One assistant sanitarian, and
One laboratory assistant.
The rural health unit provides the basic health services for the population it serves, i.e.'
r Maternal and Child Health work
r Communicable Disease Control work
r Vital and Health Statistics work
I Environmental Sanitation work, and
r Medical Care work.
|
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] |
r Maternal and Child Health work
r Communicable Disease Control work
r Vital and Health Statistics work
I Environmental Sanitation work, and
r Medical Care work.
I Adapted from "Three approaches to the analysis of health manpower functions". HMD/79.7,pp.69
This list was obtained using the questionnaire method and refers to a survey canied out in Egypt in 1969.
- 72'
Maternal and Child Health work
(a) Prenatal Care actiaities:
1 Comprehensive examination of new
patients.
2 Follow up examination of patients.
3 Urine analysis (sugar and albumin,
microscopic examination).
4 Taking blood samples and determin-
ation of haemoglobin percentage.
5 Weighing of pregnant women.
6 Measurement of blood pressure.
7 Prescription of treatment.
8 Referring patients to hospitals.
9 Giving hypodermic,
intramuscular
and intravenous injections.
10 Supervision of cleanlinessofpregnant
women.
Ll Carrying out
activities.
|
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8 Referring patients to hospitals.
9 Giving hypodermic,
intramuscular
and intravenous injections.
10 Supervision of cleanlinessofpregnant
women.
Ll Carrying out
activities.
health education
15 Conducting abnormal labour, and
transfer to hospital where necessary.
L6 Giving hypodermic,
intramuscular
and intravenous inj ections.
(c)
Postnatal Care actioities :
L7 Home visiting for puerperal cases.
18 Detection and treatment of
fever
cases.
t9 Giving hypodermic,
intramuscular
and inuavenous injections.
20 Carrying out health education and
f amily planning activities.
(d)
Cbild Care actiaities:
2I Weighing of children.
22 Supervision of child cleanliness.
23 Vaccination against poliomyelitis,
diphtheria and tuberculosis.
24 Temperature taking.
LZ Home visiting for non-attendants and
25 Carrying out medical examination.
during the ninth month.
(b) Natal Care actiaities:
13 Preparation of delivery bags.
|
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] |
24 Temperature taking.
LZ Home visiting for non-attendants and
25 Carrying out medical examination.
during the ninth month.
(b) Natal Care actiaities:
13 Preparation of delivery bags.
L4 Conducting normal deliveries at
home.
t . t 2
26 Prescribing treatment.
27 Referring patients to hospitals.
28
Isolation of communicable disease
cases.
29 Giving hypodermic,
intramuscular
54
Isolation of detected cases.
and intravenous injections.
30 Taking blood samples.
3L Circumcision of male children.
32 Prescribing the diet.
33 Home visiting for non-attendants.
(e) Miscellaneous technical actiaities:
34 Preparing the clinic.
35 Sterilization of
instruments and
supplies.
36 Training of midwives and assistant
(d) Actiaities related to deatbs,
55 Receiving notifications of deaths and
search for relations.
56 Examination of
the dead and
establishment of death certificates.
57 Recording
in
the
appropriate
|
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] |
55 Receiving notifications of deaths and
search for relations.
56 Examination of
the dead and
establishment of death certificates.
57 Recording
in
the
appropriate
registers.
58 Issuing of burial permits.
midwives.
Vital and health statistics work:
37 Preparation of drugs for distribution.
59 Recording of births and deaths
Communicable disease control work:
(a) Actitsities related to cases:
Isolation of cases.
38
39 Disinfection of cases (during and
after treatment).
40 Dusting of cases (for disinfestation).
4l Giving
instructions
at
home
(education).
+2 Supervision of domiciliary treatment
of tuberculosis patients.
43 Recording in communicable disease
register.
44 Search for the source of infection.
in the appropriate registers.
60 Making weekly and monthly reports.
6l Calculation of death ratios, etc.
62 Making statistical studies and inter-
pretations.
Environmental sanitation work,
|
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60 Making weekly and monthly reports.
6l Calculation of death ratios, etc.
62 Making statistical studies and inter-
pretations.
Environmental sanitation work,
63 Numbering of houses and population
census.
64 Mapping areas and facilities.
65 Ensuring cleanliness in and around
dwellings.
66 Hygienic disposal of refuie.
67 Constructing latrines in village houses.
(b) Actiaities related to contacts:
68 Control of bilharzial snails.
45 Surveillance of contacts
46
Immunization of contacts.
69
Identification of breeding places of
mosquitos.
70 Mapping
breeding
places
of
(c) General preaentiae actiaities:
mosquitos.
47 Vaccination against poliomyelitis,
7t Checking hygiene of public latrines.
diphtheria and tuberculosis.
72 Carrying out measures ordered by
48 Noting names of non-attendants.
doctor.
49 Preparation of list of families.
50 Carrying out periodic dusting.
5l Recording in disinfection and dusting
|
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] |
48 Noting names of non-attendants.
doctor.
49 Preparation of list of families.
50 Carrying out periodic dusting.
5l Recording in disinfection and dusting
registers.
52 Controlling insects and rodents.
73 Supervision
of
sanitation activities.
environmental
74 Examination of food in public places.
7 5 Taking samples from food.
76 Destroying spoiled food.
53 Carrying out epidemiologic surveys
77 Surveillance of market and street
for case finding.
vendors.
r . L 3
78 Taking water samples from public
1 0 1
Catheterization.
standpipes.
79 Enforcement of
cemeteries.
laws concerning
80 Examination and certification of
food handlers.
81 Carrying
activities.
out
health
education
Medical care work
(a) Diagnosis actioities:
82 Preparing the patient.
83 Taking the history.
84 Recording clinical observations.
85 Weighing the patient.
86 Taking the temperature.
87 Counting the respiration.
|
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] |
82 Preparing the patient.
83 Taking the history.
84 Recording clinical observations.
85 Weighing the patient.
86 Taking the temperature.
87 Counting the respiration.
88 Counting the pulse.
89 Measurement of blood pressure.
102
Application of hot and/or cold
compresses.
1 0 3
Administration of enemas and use of
stomach pump.
IO4
1 0 5
106
t07
108
LO9
1 1 0
1 1 1
Suction of mucus.
Making dressings.
Eye painting and irrigation.
Making surgical stitches and per-
forming minor operations.
Removal of surgical stitches.
Carrying out health education and
supervising patient's diet.
Observing patient's condition.
Application of external treatment
(ointment).
Llz Radiotherapy.
173 Physiotherapy.
90 Clinicalexamination.
Administrative work:
9I Requesting laboratory tests.
92 Taking blood samples and administer-
ing transfusions.
93 Microscopic examination of blood
and blood grouping.
94 Urine examination
|
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9I Requesting laboratory tests.
92 Taking blood samples and administer-
ing transfusions.
93 Microscopic examination of blood
and blood grouping.
94 Urine examination
for parasites,
chemical analysis and microscopic
examination of urine.
95 Requesting X-ray examination.
96 Examination of stools.
ll4
Assignment of jobs and activities.
115 Checkingattendance.
Ll6 Giving leave permits.
I77 Conductinglegal investigations.
118 Management of equipment and
supplies.
Ll9 Management of financial matters.
LzO Filling in forms.
I2I
Book-keeping.
122 Correspondence.
(b) Tberapeutic actiaities:
123 Preparation of monthly and annual
97 Prescribing treatment and/or diet.
reports.
98 Giving hypodermic,
intramuscular
and intravenous injections and drips.
124 Recording attendance in waiting-
room.
99 Giving oral medication.
725 Supervising housekeeping of the unit.
100 Applying artificial respiration.
|
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] |
124 Recording attendance in waiting-
room.
99 Giving oral medication.
725 Supervising housekeeping of the unit.
100 Applying artificial respiration.
126 Supervisingtransportation.
!
t r t r n ! n D ! ! t r ! ! ! r - l D l n t r ! ! ! n
Please Note!
You are reminded that this list, drawn up in 1969,
describes the services as they were and not as they
sbould baae been. It might seem that preventive
activities deserved greater prominence.
!
! n
t ] ! ! t r ! n l c t r t r ! t r u ! ! n t r l !
7.1,+
1 .
2.
Take one category of health peroonnel (e.g. physician, or nurse, or midwife, or medical
assistant, or sanitarian) and circle the items on the preceding list corresponding to the
afivitieswhich that category of staff is supposed to @rry outin your country at prossnL
|
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-0.04352295398712158,
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0.02926141396164894,
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] |
Then think of lome mtivities whieh fiat same catqory doss not undrtake at pretent
but which you feel, in the light of your pe$onal exporionce, it shwld urllds&*o to improw
the level of hsalth of the population it sorvsd. Draw asgtram sround each of the mrr@onding
items on the lisa
3.
Describe belo1y any srttbtd mthitiec correryonding to the first two questions.
1 . 1 5
Pcnonal Nots
educational objective
(derived from professional tasks)
What the students should be
of a learning period that
beforehand.
able to do at the end
they could not do
o
o
Educational objectives are also called "learning
objectives" as opposed to "teaching obiectives".
They define what the student, not the teacher,
should be able to do.
The definition of the objective of a course is that
of the result sought, not a description or summary
of the programme.
7 . 7 7
relationship between professional
acts in the health field and
educational obiectives
|
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] |
7 . 7 7
relationship between professional
acts in the health field and
educational obiectives
Professional Functions
or GeneralObjectives
Professional Activities or
"l ntermediate" Educational Objectives
Tasks and Specific
Educational Objectives
Note: The size of the circles relates to the number of objectives: the more specific they are
the more numerous they are. The triangle indicates that at the general level objectives
are "Wide", brgad, Vagqe, and that SpeCifiC ObjectiVeS are "pUnCtual", nafrow, preCiSe.
1 . 1 8
types of educational obiectives
I
I
General obiectives: Correspond to the functions of the type(s) of health personnel trained
in an establishment.
Example: Providing preventive and curative care to the individual and the community,
in health and in sickness.
"lntermediate" objectives: Arrived at by breaking down professional functions into
components (activities) which together indicate the nature of those functions.
|
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"lntermediate" objectives: Arrived at by breaking down professional functions into
components (activities) which together indicate the nature of those functions.
Example: Planning and carrying out a blood sampling session for a group of adults in the
community.
Specific (or instructional) objectives: Corresponding to (or derived from) precise professional
tasks whose results are observable and measurable against given criteria.
Example: Using the syringe, to take a blood sample (5 ml.) from the cubital vein of an
adult (criteria: absence of haematoma; amount of blood taken within lOVo of the amount
required; not more than two attempts).
To gain better understanding of these three levels of educational objectives and the relationship
between them, study pp. 1.23 - 1.25 and 1.29 - 1.36.
1 . 1 9
data necessary for formulation
of educational objectives
Health needs, demands and resources of society.
Services to the patient (list of tasks).
|
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] |
1 . 1 9
data necessary for formulation
of educational objectives
Health needs, demands and resources of society.
Services to the patient (list of tasks).
Service to the community (list of tasks).
The profession itself.
The students.
Progress in sciences.
The scientitic method.
e t c . . . . . .
For more details refer to: Criteria for the evaluation of learning objectives in the education
of health personnel. Report of a WHO Study Group. World Health Organization Technical
Report Series,1977, No. 608. 47 pages*
a n d p p . 4 . 1 0 - 4 . 1 3 o f t h i s H a n d b o o k .
*
An annex to the report clarifies what different authors mean by educational obiectives, examines the different
levels and types of objectives, lists the potential benefits of taking the trouble to formulate obiectives and reviews
the data considered necessary
for this. There is also a short section on how to word objectives properly.
|
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|
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