Less than optimum clinical placement practice remains a growing concern. With Governments liberalizing educational policy, rapid expansion of students enrollment in medical/health courses is being experienced. Without commensurate growth in health service facilities to cater for clinical placement inherent in medical education and training, the quality of instruction is bound to decline. This is confounded by ever growing deficiencies of faculty/clinical instructors, preceptors, mentors. Now with the entrenchment of quality of service in the legislative and policy frameworks, quality improvement is imperative. We posit that establishing linkage of quality training to health service outcomes would be a compelling incentives for health system policy makers, managers, providers and implementers to engage and invest in quality improvement
I agree with you. We increasingly need evidence to substantiate what we claim to be doing including training. In the health sector we need evidence that cognitive, affective and psychomotor skills have been learnt and this is only possiblbe if we measure the skills levels before and after the intervention/training.
In addition we assume that there are role models in the clinical sector, only to find that the mentors themselves are dying for training to remedy their own skill deficiencies and the conditions under which they work compound the situation, e.g staff shortages, risk of litigation etc. The best training approach is on the job, bearing in mind the staff shortages as well as high skills retention levels since there is no loss attributed to skills transfer.
Janet you raise several important points: One is to do with pre-clinical assessment, the second one is support and mentoring of mentors, the third is on job training, and finally the concept of skills transfer. It would be helpful to collate as many experiences as possible around this issues, especially in the African context. While we can continue dialogue on the earlier issues, for now I would like to start with the skills transfer. It is widely perceived that the problem is time consumption without due recognition and reward. While is oft stated that skills transfer is in the job descriptions of clinicians. This may be implicit or explicit. The problem is that without specific recognition for high performance, many go about it in a route manner. If enough evidence could be generated to show that when clinicians engage in skills transfer activities, they also increase their own skills and performance, then this could be sufficient incentive for their time investment.
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