Approach to Training Best Practices in Maternal and Newborn Care Jhpiego in partnership with Save the Children, Constella Futures, The Academy for Educational Development, The American College of Nurse-Midwives and IMA World Health Session Objectives By the end of the session, the participant will be able to describe: Mastery learning: − Acquisition − Competency − Proficiency Adult learning Competency-based training Humanistic training 2 How did you learn to make bread? Discuss in pairs of two Following two-by-two discussion, have several people describe to the larger group how they learned to bake bread Label as types of learning/teaching and use as reference examples throughout rest of session 3 Mastery Learning Assumes that all learners can master (learn) the required knowledge, attitudes or skills provided sufficient time is allowed and appropriate learning methods are used Goal: 100 percent of the learners will “master” the knowledge and skills on which the learning is based 4 Mastery Learning (cont.) Takes differences into account: Some learners are able to acquire new knowledge or new skills immediately Others require additional time or alternative learning methods Individuals learn best in different ways—through written, spoken or visual means Use a variety of teaching methods 5 Mastery Learning (cont.) Based on principles of adult learning: Learning is participatory, relevant and practical Builds on what the learner already knows or has experienced Provides opportunities for practicing skills Uses behavior modeling Is competency-based Incorporates humanistic learning techniques 6 Stages of Learning Skills learning usually takes place in three stages: Skill acquisition. The learner sees others perform the skill and acquires a mental picture of the required steps. The learner then attempts to perform the procedure, usually with supervision. Skill competency. Next, the learner practices until skill competency is achieved, and s/he feels confident performing the procedure. Skill proficiency occurs with repeated practice over time. 7 Skill Acquisition Knows the steps and their sequence (if necessary) to perform the required skill or activity but needs assistance Skill Competency Knows the steps and their sequence (if necessary) and can perform the required skill Skill Proficiency Knows the steps and their sequence (if necessary) and effectively performs the required skill or activity 8 Skill Acquisition Bread-baking example: The learner can bake bread as long as s/he has a recipe that outlines all of the ingredients as well as a colleague to guide the learner in the steps. Learner needs assistance. Skill Competency The learner can bake bread and needs to refer to the recipe only occasionally, and needs minimal coaching from a colleague. Learner can perform the required skill, although hesitantly. Skill Proficiency The learner can bake bread without referring to the recipe and does not need coaching. Learner effectively performs the skill of baking bread. 9 What is meant by “Behavior Modeling”? And how does it help learning? Have you ever used it? If so, how/when? 10 Behavior Modeling When conditions are ideal, a person learns most rapidly and effectively from watching someone perform (model) a skill or activity Trainer must clearly demonstrate the skill or activity so that learners have a clear picture of the performance expected of them 11 Question ?? How is competency-based training different from any other training? Which type of training do you most commonly see used? 12 Competency-Based Training Learning by doing Focuses on the specific knowledge, attitudes and skills needed to carry out the procedure or activity How the learner performs (i.e., a combination of knowledge, attitudes and, most important, skills) is emphasized rather than just the information learned Competency in the new skill or activity is assessed objectively by evaluating overall performance 13 Competency-Based Training (cont.) Break down the skill or activity into essential steps Analyze each step to determine the most efficient and safe way to perform and learn it (standardization) Once a procedure has been standardized, develop competency-based learning guides and evaluation checklists to make learning the necessary steps or tasks easier and evaluating the learner’s performance more objective 14 Coaching An essential component of CBT First explain a skill or activity, then demonstrate it using an anatomic model or other training aid, such as a video Once the procedure has been demonstrated and discussed, observe the learners and guide them in learning the skill or activity, monitoring their progress and helping them overcome problems 15 Coaching (cont.) Coaching ensures that the learner receives feedback regarding performance: Before practice —Teacher and learners meet briefly before each practice session to review the skill, activity, and/or tasks During practice—Teacher observes, coaches and provides feedback to the learner as s/he performs the steps/tasks outlined in the learning guide After practice—Immediately after practice, the learning guide is used to discuss the learner’s performance, including strengths and specific suggestions for improvement 16 What is “Humanistic Training”? 17 Humanistic Training Techniques Use of anatomic models (and other learning aids) which closely simulate the human body Initially working with models rather than with patients allows learners to learn and practice new skills in a simulated setting: Reduces stress for the learner Reduces risk of injury and discomfort to the patient Always treat patient/client with utmost respect: Put the patient’s/client’s well-being first Respect dignity, modesty, socio-cultural background 18 Preparation for Clinical Performance Before performing a clinical procedure with a patient: The clinical teacher should demonstrate the skills and patient interactions several times using an anatomic model, role plays or other simulations Under the guidance of the teacher, the learner should practice the required skills and patient interactions using the model, role plays or other simulations and actual instruments in a setting that is as similar as possible to the real situation 19 How do you decide when a student is ready to begin working in a clinical situation (Clinical Practicum)? 20 Skill Competency Only when skill competency has been demonstrated should learners have their first contact with a patient May be challenging in a pre-service education setting due to large numbers of learners Before any learner provides services to a patient, however, it is important that the learner demonstrate skill competency using models, role plays or simulations, especially for core skills 21 Summary When mastery learning, based on adult learning principles and behavior modeling, is integrated with CBT, the result is a powerful and extremely effective method for providing clinical training When humanistic training techniques are incorporated, training time and costs can be significantly reduced 22 References Sullivan R et al. 1998. Clinical Training Skills for Reproductive Health Professionals, 2nd ed. Jhpiego: Baltimore, MD. Schaefer L et al. 2000. Advanced Training Skills for Reproductive Health Professionals. Jhpiego: Baltimore, MD. Sullivan RL. 1995. The Competency-Based Approach to Training. Jhpiego: Baltimore, MD. 23 “Every Pregnancy is at Risk”: Current Approach to Reduction of Maternal and Neonatal Mortality Best Practices in Maternal and Newborn Care Jhpiego in partnership with Save the Children, Constella Futures, The Academy for Educational Development, The American College of Nurse-Midwives and IMA World Health Session Objectives To review: Magnitude of maternal and neonatal mortality Causes of maternal and neonatal mortality Interventions to reduce maternal and neonatal mortality: − Traditional birth attendant − Antenatal care − Risk screening − Skilled attendant at childbirth − Postnatal care 2 What is Safe Motherhood? “A woman’s ability to have a SAFE and healthy pregnancy and childbirth.” 3 Maternal Mortality: A Global Tragedy Annually, 529,000 women die of pregnancy related complications: 99% in developing world ~ 1% in developed countries 4 Maternal Health: Scope of Problem 180–200 million pregnancies per year 75 million unwanted pregnancies 50 million induced abortions: 20 million unsafe abortions 30 million spontaneous abortions Approximately 600,000 maternal deaths (1 per minute) 1 maternal death = 30 maternal morbidities 5 Ask the group: What are the major causes of maternal mortality? 6 Causes of Maternal Mortality Anemia Sepsis 8% 11% Hypertensive Obstructed Disorder Labor 10% 7% Indirect 14% Hemorrhage HIV 31% 3% Other direct causes Unsafe 5% Abortion Unclassified 5% 6% Other direct causes include embolism, ectopic pregnancy, anesthesia-related. Indirect causes include: malaria, heart disease. Adapted from: WHO analysis of causes of maternal deaths: A systematic review. The Lancet, vol 367, April 1, 2006. 7 Neonatal Health: Scope of Problem Every year: 4 million neonatal deaths (first month of life): Of those who die in the first month, 2/3 die in the 1st week Of those who die in the first week, 2/3 die in the first 24 hours Eight neonatal deaths every minute 4 million stillbirths 8 Ask the group: What are major causes of neonatal mortality? 9 Causes of Newborn Death Other 3% Congenital Sepsis/ 14% pneumonia 27% Asphyxia 7% Infection 36% Sepsis Tetanus 11% 7% Diarrhoea Preterm 3% 28% 10 But