3 rd Module: Organization, management and evaluation of the “Train – the – Trainers courses”

1. 3rd Module: Organization, management and evaluation of the “Train – the – Trainers courses” “A European network on cervical cancer surveillance and control in the new Member States - AURORA”

2. Partner www.aurora-project.eu This publication arises from the project «AURORA» which has received funding from the European Union in the Framework of the Health Programme.

3. Index 1. Identifying training needs 2. Training organisation 3. Practical issues 4. Methodology: theory concerning education and adult learning principles 5. Adult learning principles: Andragogy 6. Learning circle: how to explore and absorb new knowledge 7. Role of the trainer: facilitate learning 8. Pitfalls in small-group work 9. Getting it right: participants find small-group discussion rewarding when … 10. 9 steps: a practical guide to group work 11. Gaining audience interaction: participatory techniques 12. Training materials 13. Feedback and evaluation 14. Resources

4. Identifying training needs - 1 AURORA course will be a mix of a computer-based training and a self-managed learning What is training? Trainingis generally thought in terms of courses and training sessions that are trainer-led. It is also the case that too often ‘trainer-led’ isinterpreted as meaning delivering a lecture or presentation. But this ‘traditional’ course based learning should not be seen as the only way for participants to acquire and maintain knowledge, skills and behavioural attributes necessary to do their job effectively. In the health sector training has become part of professional life Training Vs. Education Education is most often described as focusing on knowledge to be transferred to the learner. Education is what takes place at for example universities. Training focuses on teaching someone how to do something; it focuses on developing skills. Training is therefore more concrete and specific, the objectives and expected outcomes are easier to define.

5. Identifying training needs - 2 The health sector needs not only to ensure that healthcare professionals are properly trained when they are newly appointed but also needs to ensure that quality standards in medical performances continue to be met • Why train? • Training is also part of the personal - professional development. • Training allows the trainee to develop his/her professional capacities and to have better performances. • Well trained healthcare professionals deal with cases more effective and will feel better and happier with their job. Training can work as an incentive. It will not only increase professional capacities and skills but also motivation and even team spirit, as contacts with other participants in training activities enrich the working environment.

6. Identifying training needs - 3 Why train? The training process has to start with a clear definition of needs of the trainees. The only way to ensure that needs are properly identified is finding a way to get information directly from the target group. This can be done by organising explorative meetings with representatives of the health sector or personal interviews with doctor and nurses. Also the results of AURORA’s “Analysis of Local Context” can be used to identify whether the activity met the needs of the participants.

7. Identifying training needs - 4 To write intended learning outcomes, we need to use appropriate language Examples of alternative learning routes: • Distance learning: Computer-based training and e-learning • Workplace learning: Mentoring, coaching and appraisal • Self-managed learning: Observations and sitting-in, reading, research, project work • Wider opportunities: Study visits, secondements and work shadowing, conferences and workshops • Clarifying intended learning outcomes! • to help trainers and trainees to focus on the essential content of the training. • to help to identify further training needs. • The learning outcomes must be: • Specific; • Manageable; • Attainable; • Relevant; • Time-specific.

8. Identifying training needs - 5 Specificities of the contexts in which the training will be carried out and specific hard to reach population groups should be considered Why must trainers spend time identifying and writing down the intended learning outcomes? The training should be pragmatic (i.e. applicable to trainees’ needs), attainable within the time available, able to be assessed to enable both trainers and trainees to appreciate what has been achieved. The course ensures that trainers and trainees know the specific objectives of the training. Choice of training technique. This training course is developed in the framework of AURORA Project and addressing professionals involved in Cervical Cancer Screening. The target group of training activities are healthcare professionals and in particular: gynecologists, family planner, nurses, general practitioners, etc. So, firstly, trainers have to define trainees needs in order to make a training affordable by each participant in the course.

9. Identifying training needs - 6 When we know how to identify the training needs and the target group the next step is to set objectives for the training activity It is fundamental to take into account all sources that contribute to the identification of training needs Setting the objectives of the training The identified needs should be translated into concrete topics that can be part of a training activity. At the same time, attention should be paid to the particular target group: which level of knowledge or skills is required and which method is appropriate (see also the chapters on methodology and training techniques). • It is advisable to follow a systematic and structured approach to translate identified needs into objectives for a training activity or programme. • A strategy might be as follows: • Gather identified needs together. • Identification, as specific as possible, of the skills, knowledge and behavioral attributes needed to achieve competence in relation to each need.

10. Identifying training needs - 7 • Decide on a priority order of which needs are most important to the performance. • After discussion, evaluate the size of the training gap and produce a needs index. • Consider any other evidence that is relevant to the problem. • Reach a final conclusion based on: • Priority of the need to the performance of the role. • Results of the needs index and size of the training gap. • Evidence from other sources. • The likely duration of the need- some problems disappear with time. • The proportion of the target population to which the identified need applies. • The cost, both in social and financial terms, of ignoring the need. With this systematic approach it is less likely to omit important aspects of the problem.

11. Training organisation - 1 • Identifying training resources • In planning the training, think about training resources. Try to identify them using a checklist as follows: • People: trainers who have participated in AURORA “Train the trainers” programme, experts, general practitioners, health professionals, the participants themselves, patients, etc… • Places: visits to relevant medical centres, hospitals, universities, etc. • Written or on-line materials: AURORA e-learning material, books, newspapers, hand-outs, manuals, videos, on-line materials, etc.

12. Training organisation - 2 Establish the best possible learning environment Whatever methods are adopted, there is one general issue which needs to be addressed: how ensure that trainees feel comfortable and receptive. In other words, how to establish the best learning environment? Location: providing an environment geographically distinct from the working place of trainees is helpful. In this way, there will be less chances of interruption on work-related issues (mobile phones should be definitely turned off!) making easier to achieve training aims and outcomes. Accommodation issues: physical comfort is important. Consider: • room temperature; • room ventilation; • seating capacity; • seating arrangements – can everyone see the speaker? Can the speaker see every member of the audience? Are there enough rooms (or areas for ‘breakout’ small-group activities)?

13. Training organisation - 3 Deciding on materials and methods The (team of) trainers should decide at an early stage how they want to conduct the training. This means they should identify: - What materials the trainees will be provided, either in advance or during the training (programme, handbooks, readers, hand-outs, manuals). - Which tools would they like to use? (PowerPoint, overhead projector, video/DVD, flipchart) • Deciding on the activity • Timing: duration of the event (one day, several days) • Level of training: for experienced participants or beginners? • Aim of the course: transfer of knowledge or skills, change of values or attitude? Formulate the intended learning outcomes in advance; they are the basis for all further decisions and preparations.

14. Training organisation - 4 • Practical organisation • 1. Send the invitations or the confirmations of participation to the trainees. (min. 2 months in advance) • 2. Send the materials well in advance to trainees, so that they will have enough time to prepare themselves. (min. 2 weeks) • Inform the trainers and trainees about the ‘house rules’. • Prepare the evaluation tools (pre and post training questionnaires, etc.) • 5. Prepare the badges for participants and trainers. • 6. Coffee breaks/ lunch: ensure that coffee, tea and lunch are available at the right time. • 7. Prepare the documents to be distributed at the venue. • 8. Prepare PowerPoint, overhead projector, flipcharts and pens etc. • 9. After the event: compile the evaluation results and plan a follow-up. Discuss the evaluation outcome with the trainers and within the training institute.

15. How to establish the best learning environment • Timing • How to make the trainees feel at ease • Ground rules Practical issues - 1 Establishing the best learning environment Too much running around to make last minute arrangements for equipment and materials is not professional and does not invite the trainee to have confidence in the trainer. Therefore, you should be sure before the training course, that trainers have identified any equipment needed (e.g. in relation to overhead projectors, PowerPoint, flipcharts, etc.) so that you can start on time and in an organised manner. Distribute the definitive programme (including intended learning outcomes) 7-14 days before the course to trainees (in written format, or electronically). At the beginning of the course, highlight (e.g. by PowerPoint or overhead projector slide or by referring to written support material) the intended learning outcomes and explain why these have been considered relevant.

16. Practical issues - 2 • Timing • How to make the trainees feel at ease • Ground rules • How to make the trainees feel at ease • Ground rules Making the trainees feel at ease The needs of adult learners differ from other groups such as undergraduate students. The training environment can be an uncomfortable one. So, consider the arrival at training location: is the process of welcoming each trainee appropriate? (Does a member of the training team welcome each trainee as they arrive? Is there coffee? Are name badges issued? Does the training team try to mix with participants during breaks or at meal time?) Timing Time is a resource, but timing is a potential hazard. Consider starting and finishing times: can the audience realistically get to the venue from their homes in time for the start of the session? Will too late a finishing-time prompt some to leave early to get home at a reasonable time? Periodic breaks are necessary for revitalising the audience – but be aware that the time taken to serve coffee is usually much longer than trainers estimate.

17. Practical issues - 3 • How to make the trainees feel at ease • Ground rules Pay attention to your opening session: are the intended learning outcomes clearly specified? Maintain a supportive climate: be sensitive to possible signs of anxiety and be ready to provide encouragement and reassurance where necessary. Keep the sessions short and provide break times. But also make sure there is enough time for discussion and time to respond to questions to help ensure that training is proceeding at the pace needed by trainees not that desired by the trainers. In formal sessions, present information in a highly structured and organised way, and make use of overviews/summaries/headings, etc. (for example, by means of ‘PowerPoint’). Keep the content relevant to the audience and use a variety of modes of presentation to maintain interest. It is important to provide opportunity for practice or application: case studies, group discussion and reporting-back, role play simulations, etc.

18. Practical issues - 4 • Ground rules Establish appropriate ground rules It may be considered appropriate to ensure trainees understand their responsibilities. In other words, do not assume that each trainee is a willing learner! You, the trainer are responsible for ensuring that trainees co-operate by following basic ‘ground rules’, most of which are matters of mere basic courtesy to others. It is always better to lay down the law at the start of training to prevent misunderstandings later. • Consider : • Attendance throughout the course is expected – any tendency to disappear early can be addressed by circulating claim forms at the very end of training; • Timing: you will lose time if you do not show that the timetable is not for mere guidance: try to start at the allotted times and finish promptly. • Participation is essential– it could be necessary to explain that especially small-group training methods (see chapter 6) require active participation.

19. Methodology: theory concerning education and adult learning principles Designed to help trainers (trainers of health care professionals) to: • understand the importance of ensuring participation in training and variety in the methods selected • identify the knowledge, skills, attitudes and values which are part of health training • develop specific strategies and training methods for cervical cancer screening • draw up guidelines of good practice in cervical cancer screening training which will assist trainees and trainers in recognising when the training is effective

20. Adult learning principles: Andragogy Health care professionals involved in cervical screening: (gynecologists, nurses, GPs etc.) already have: • Proven professional experience and knowledge; • Demand on identifying learning needs; • Interest in practical results and knowledge; • Need to be handled as peers • The perfect learning process will cover all four elements

21. Learning circle: how to explore and absorb new knowledge • Concrete experience: role play, demonstrations • ‘do it the right/wrong way’: e.g. communication strategies with HTR in cervical cancer screening • Forming abstract concepts: structured discussion about the experiences of the trainees and their conclusions • Multiple choice • Mind-mapping • Observation and reflection: Lecture/presentation • Research: the trainees are provided with some literature and should find themselves the most suitable theory to solve a case study/answer a question. • Testing in new situations: • The trainee makes a checklist, based on the theory. The trainees assess if in a case study the theory was applied correct or wrong.

22. Role of the trainer: facilitate learning - 1 • Identifying training needs • Improving communication strategies according to HTR needs • Determining desirable training outcomes • Appropriate communinaction of trainees in order to promote cervical cancer screening participation, • To improve follow-up and • Communication of smear results • Design courses and programmes • According to local settings of cervical cancer screening • Considering and selecting resources and methods • According to trainees (health care professionals involved in cervical cancer screening) and local resources • Conducting a training • Trainees-tailored • Evaluating and analysing the results of the training • ‘Sparring partner’ for the training institute to discuss training requirements

23. Barriers Role of the trainer: facilitate learning - 2 Training techniques • Organisational (related to training course settings) and individual (in connection with trainees) • Solution: • Training tailored to the needs of the audience • Health care professionals involved in cervical screening: (gynecologists, nurses, GPs etc.) • Involving a range of participatory training techniques • Choosing the appropriate methodology promotes: • Changing the inappropriate attitudes of trainees • Reinforcing existing positive attitudes • Sensitising trainees to accepting the need to promote and perform cervical cancer screening • The correct method keeps learners interested

24. Group work Role of the trainer: facilitate learning - 3 Working with small groups • Involves co-operative or collaborative learning techniques: • Such as tasks and responsibilities, discussion, explanation, exchange of opinions and asking for help • Homogeneous groups: participants feel safer, interact more easily with each other • Group composition based on former professional experience and knowledge on cervical cancer screening • Heterogeneous groups: might hamper collaborative learning (reluctant to participate in discussions) • Working with groups requires specific skills of the trainer • Source of information/role model • Opportunity for group discussion • Careful preparation to obtain: • a satisfying discussion • conclusions of direct use to professional practice (guidelines) • 3 types of discussions: • Directed-teaching discussion group – there is one correct answer, the aim is to arrive at the correct answer. • Non-directed discussion group – there is no one correct answer, the aim is to explore the topic through getting participants to interact in the group in a positive and constructive way. • Seminar-type discussion – there is no hitherto accepted correct answer, discussion will attempt to get some constructive conclusions which may lead to some collective decision from the competing alternatives available.

25. Pitfalls in small-group work • Already existing relationships among trainees (collegues) • Readily dismissing certain ideas and accepting others as obvious without recognising their limitations (entrenched habits in former experince) • Too many references to examples from personal experience • Not clarifying expectations and purpose of the discussion • Uninteresting or not stimulating tasks • No qualitative discussion materials • Personality-centred rather than task-centred groups • Too large groups do not to ensure proper participation • Group members may not know each other • The choice of group members may make open discussion difficult • Too many tasks for the group • Insufficiently prepared group leader • Dominating group leader • Not appropriate accommodation for discussion

26. Getting it right: participants find small-group discussion rewarding when … • They have the chance to contribute: • Share and acquire knowledge and experience • The purpose of the discussion is clear • The atmosphere is warm and friendly • There is a good leadership • They feel they are learning something relevant

27. 9 steps: a practical guide to group work 1: Understand the group: special composition according to local settings • Motivation, Previous experience, Barriers (entrenched habits in former experince) 2: Plan the group exercise (topics on cervical cancer screening) 3: Ensure the group understands the tasks and intended learning outcomes • Identifying rules, tasks, resources 4: Ensure the group understands the role of the group leader • Facilitating discussion 5: If conducting a discussion, use an appropriate range of well-timed and well-focused questions • Opening discussion, promoting discussion and continuity 6: If allocating tasks to smaller groups • Identifying pairs, monitoring progress, stepping in 7 [if necessary]: Deal with the awkward member appropriately • Maintaning the group’s purposes and central concerns. 8: Summarise • The relevance of the activity to professional practice in cervical cancer screening 9: Review – self-check list after group discussion

28. Brainstorming Gaining audience interaction: participatory techniques - 1 Snowballing or pyramiding • Following a presentation • Audience is asked to respond with ideas • To list and to reject attempts at premature discussion • Subsequent discussion / analysis / categorising • In pairs or threes or fours • Discuss a topic for a brief period of time • Then with another pair/three • Followed by a general discussion • Interaction in a relatively ‘secure’ environment • Audiences of 4 – 40 • Requires a plenary ‘feedback’ session Buzz groups • 2-3 peopleasked to discuss a particular topic and then report back • When there is no oppurtunitiy to undertake a full-scale, small-group exercise • Given a clear, straightforward topic • Particularly effective in the early stages of a training course

29. Icebreakers Gaining audience interaction: participatory techniques - 2 Seeking audience responses Pre course tasks for the participants • Short exercises at the beginning of a training • To feel more at ease and to get to know each other quickly • To enable the trainer to identify members of the group • Timing Provides opportunity to gain insight into: • Views • Knowledge • Attitudes or • Values of the audience on the topic of how to promote cervical cancer screening amongHTR • Useful: providingtrainees some materials in advance (background information) • Provides basic knowledge • To identify relevant issues in daily work of trainees (real cases) Running a role- play • Practical application of theories • Helps the trainees to put in practice what they learned • Co-operative group work: everybody should be involved • Realistic situations • Feedback is essential

30. Gaining audience interaction: participatory techniques - 3 Running a case study Conducting a “report back” session • Presentation of a specific „story” (among HTRP) • case management of a given screening situation • managing behaviour of a HTRP person because of cultural/language etc. Barriers • Interpreting results and/or folow-up instructions • Relevant background information • Contents should be designed to achieve clearly defined aims and learning outcomes • More effective in small groups • Provides an opportunity for groups to report-back to others • Allows review of the activity • Identification of different viewpoints • Opportunity for others to share ideas • Difficulties: • responses and attitudes contrary to those which the trainer intended • ensuring that the reporting-back reflects the group’s views, rather than the views of the spokesperson for the group

31. Presentations Gaining audience interaction: participatory techniques - 4 Oral Presentations • Difficulties • Impression of the speaker • Hold the audience’s attention throughout the speech • Preparation and content • No irrelevant contents, clear and logical structure • Delivery • Considering setting, aids, speech speed • Ensuring time for questions/discussions afterwards • Can be used in a variety of situations and for a variety of tasks • lecture from an expert (trained by AURORA) • lecture followed by open discussion (or lecture with the opportunity to intervene during presentation) • short presentations from panel members followed by panel discussion (and with the opportunity to respond to questions from the audience) • short presentations from groups on allocated tasks

32. Trainingmaterials Introduction • Visual aids: • usewhere appropriate to what you say (not a gimmick!) • ensurethat they can be seen by everyone • keep them as simple as possible • Choice of materials: • size of the group to be trained • place of venue and available technical equipment • capacities of the trainer (to use for example PowerPoint) • physical condition of participants • sight or hearing disabilities require adaptedmaterials • Effectivetraining - appropriatetools and materials • Effectivematerials - intended learning outcomes • Visual aids help to: • understand structure of presentation • retaining attention • Forms of visual aid: • overhead projectors, slide projectors, PowerPoint presentations, computer graphics, black/white boards, flipcharts, videos, objects or hand-outs

33. Trainingmaterials Audio-visual aids • To put across a point with more effect. • To help trainees take more in – up to 75% of knowledge or information is gained through sight. • To maintain interest. • To focus attention in one spot/place. • To break up a lecture (particularly every 20 minutes). • To help the preparation of a talk. • To help keep the speaker (and the audience) on track. • To aid memory by providing a summary. • To help standardise presentations involving a number of trainers at different locations. • To add variety.

34. Training materials: Power Point and overhead projector • normal routine in many presentations • visualise the structure and key points of presentation • preparation stage • trainers can use slides to build the structure of their presentation (headlines and key remarks) • actual presentation • slides as the basis of the oral presentation, explanationoftheory and giving details • Slides • also to give new information (e.g. when video-presentations are integrated) • ensure active role of participants • integrate slides with questions for participants • short demonstrations or visual models • integrate links to internet sites • can be printed in a hand-out format • support for participants during presentations (no need to concentrate on making notes) • support the oral presentation • colours, fonts, formats and animations help to bring variety • but too many animations will distract the participants

35. Trainingmaterials Audio-visual aids • Make sure that the slides can be seen at the back of the hall: • use minimum font size 24 • text in a dark colour • You can consider revealing or unmasking the text gradually • You canuse a pointer for issues you wish to highlight • Stand beside the projector • Only turn theprojectoron when you are going to use it; and turn it off immediately after you have used it • NEVER turn your back on the class when talking • Check compatibility of your version of the Power Point with the version available at the location • Ensure you know how to link up the data projector and laptop/computer • Use these tools economically – avoid overkill. • Ensure that the content is relevant. • Use the slides to emphasise the key issues. • Practise using them in advance – make sure you know how to use the audio-visual resource • Not too many information at one time: do not overload the audience • No more than seven lines of five words each line on a slide • Give the audience enough time to read the content of any slide • Think about hand-out for distribution

36. Trainingmaterials Flipcharts • Check in advance all practical issues: • Are the flipchart pens working? • Are they thick enough? • Is there enough paper? • Can the chart be seen by all participants? • Flipcharts are • easy to use • useful at times of reporting-back by groups • practise writing legibly and in capitals with big letters • try not to write and speak at the same time • size of lettering is: • 10 people; board 2m away: letters 2cm high and 3mm thick • 25 people; board 10m away: letters 4cm high and 3mm thick • 50 people; board 20m away: letters 8cm high and 5mm thick • up to 100 people; board 30m away: letters 12 cm high and 1cm

37. Trainingmaterials Videos and DVDs Trainingmaterials Handouts • alwaysexplainin advance why this is being used • freeze the video to discuss particular issue that should be considered • use theresources with consideration • someone does have sight or hearing problems? • consider time of day: will it send people to sleep? • to make life easier for trainees • to ensure that they will have a clear and logical text, guiding them through a presentation • add detailed information or references that you cannot include in spoken presentation • PowerPoint - possibility to print slides in a ‘hand-out format’ • you can decide how many slides to copy on one page, leaving space for trainee to make notes

38. Feedback and evaluation Why seek feedback? Introduction • Trainers need: • To know if intended learning outcomes have been met • To identify future training needs of trainees • To know what trainees thought of their performance in plenary and group sessions • Trainees need to know: • Whether they have met the intended learning outcomes • What can they do to make good the shortfall • Satisfaction of these outcomes is regarded as necessary for the proper discharge of job, etc. • To assess the effectiveness of the course • To identify future training needs • Collect information from all stakeholders: • Trainers • Trainees • Institute

39. Feedback and evaluation Learningcycle Takingstock: What do I know? (individual) Planning: Howcan I take my learningfurther? (developmental) Reflection: What do I need to know? (contextual) Feedback and Evaluation: How much and how well do I now understand? (relational)

40. Feedback and evaluation: Giving feedback to trainees • Important task of the trainer • Knowledge: how much did the trainees understand and they were able to apply their knowledge • Skills: feedback on the impact of training on performance • Trainee should first evaluate his own performance • Feedback should be specific, not general • Relate to the performance, not the trainee’s personality • Amount of feedback should be manageable – three or four points as maximum • There should be a balance between positive comment and constructive criticism • Giving feedback should be a continuous process • Comment from trainers to be given at various stages of training: • At the end of a role play • As part of audience interaction in plenary session • Wherever possible, try to relate the feedback to specific intended learning outcomes

41. Feedback and evaluation Givingfeedback to trainers and traininginstitutes • Trainees should be told why the feedback is being sought: • to improve the quality of future training • feedback should be anonymous • adequate time should be set at the end of the course • questions need to be designed to elicit useful responses • questions should relate both to performance of trainers and to perceived relevance or success of the training

42. Feedback and evaluation Identifyingfuturetrainingneeds • Identify the extent to which the current intended learning outcomes have been met • Seek to elicit ideas or suggestions for future training • Important message isthat training is tailor-made for specific audiences • Modes: course evaluation forms, end-of-course conclusion, small-group discussion, or even informal talkduring breaks • What went well (and why) • What improvements could have been made (and how)

43. Feedback and evaluation Disseminatinglessonsfromtraining • collateresources and makeavailable after the training • invite trainees to make available to their colleagues the materials presented • tapetalks from trainers/experts (or even videoed) and makethem available on website • establish some form of resource centre by asking participants to supply materials which could be used in future training activities

44. Resources • Knowles, Malcolm S. (1980) The Modern Practice of Adult Education;  From Andragogy to Pedagogy. Englewood Cliffs, NJ: Cambridge Adult EducationMerriam, Sharan B. and Rosemary S. Caffarella. (1999) Learning in Adulthood: A Comprehensive Guide. San Francisco: Jossey Bass. • Coetzee, M. (2002) Short course in Skills Development Facilitation. Pretoria: University of South Africa. • Gough, Jacqui (1996), developing learning materials, Institute of Personnel and Development • Sloman, Martyn (1994) A Handbook for Training Strategy - England: Grower publishing Limited • Tiberius, R.G. (1990) Small Group Teaching: A Trouble‐Shooting Guide, Toronto, OISE Press and the Ontario Institute for Studies in Education. • Gibbs, Graham (1992), Teaching More Students: Discussion with More Students, Oxford Brookes University, Oxford Centre for Staff.