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Findings from an Integrative Review of the Literature: Evidence to Support Effective Design and Delivery of In-Service Training Interventions
by: Julia Bluestone1; Peter Johnson1; Judith Fullerton2; Catherine Carr1; Jessica Alderman3 and James BonTempo1 1 Jhpiego, 2Independent Consultant, 3Johns Hopkins University

Background
Context: Continuing education of health professionals

Technique Matters Most

Didactic techniques (passive) such as reading and lecture have no-to-low effect on learning outcomes

Recommendations: Setting
n Workplace (or similar) located learning can result in
better skill performance outcomes

n A systematic review of the literature was conducted to

answer: n What evidence is there to support educational techniques, timing (single vs. repetitive), settings and media used to deliver instruction? n What evidence exists about the outcomes (knowledge, skills, attitudes, provider behaviors, patient outcomes) of continued health professional education?

LESS
Lecture Reading

n Select setting based on whether it will support effective

techniques, and: n Reduce absenteeism n Address workplace quality assurance n Reduce costs and increase productivity

n Increase use of a mentored, facility-based approach for

skills practice and feedback portion of training

Inclusion Process
n Peer-reviewed literature searched, 20002011 n Databases: PubMed, Cochrane, CINAHL and others
Journal Database
Titles and Abstract Review

Media: Mobile
n e-IMCI: 84.7% performance compared to 61% (DeRenzi) n Extremely promising for reminders/reinforcement
Case-based learning, simulation, and practice and feedback are all supported as effective educational techniques (Zurovac)

n Promising for point-of-care decision support via a mobile

device, as compared to print-based job aids (Leung)

MORE
Simulation

n In cardiopulmonary resuscitation, poor for psychomotor

skill measures in performing CPR (Choa)

244
First Quality Review: 81 excluded

Recommendations: Media
n Be aware that computer-based instruction can be as
effective or more effective than live instruction

133 Grade One

30 Grade Two

Second Quality Review: 100 excluded

Casebased Practice and feedback

n Select media based on whether they will support

effective techniques and more effective learning

161 First Tier

Additional Time and Setting Hand Search: 8 added

n Use appropriate technology to deliver instruction

efficiently

69 First Tier

Recommendations: Techniques
n Select techniques that help the learner process and
37 Systematic Reviews 32 Randomized Controlled Trials integrate information

n Be aware that case-based learning, problem-based

learning and simulation are all supported by the evidence

Reported Educational Techniques

n Case-based learning n Didactic instruction/lectures n Games n Feedback n Interactive learning n Point-of-care n n n n n n
Problem-based learning Team-based learning Readings Reminders Self-directed learning Simulations

n Prioritize simulation for emergency skills n Increase feedback and interaction between learners and
educators to result in positive learning outcomes

n Avoid passive techniques; choose case-based learning

and simulations

Recommendations: Timing
n Use repetitive instructions, which is significantly
superior to single interventions for learning outcomes

n Leverage technology to provide short, repeated

exposures

n Aggressively explore the use of spacing and testing n Provide shorter, repeated workplace-based training
events for skills practice