Sexually Transmitted Diseases  >  Program Guidelines  >  Training and Professional Development

Program Operations Guidelines for STD Prevention
Training and Professional Development

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Sections on this page:

• TRAINING PROCESS
• Assessment of Training Needs
• Training Approach
• Areas of Training Need
• Delivery of Training
• Training Providers and Resources
• Frequency of Training
• Evaluation of Training Activity
• Post Training and Education Application
• Assessing Effects of Skills Development on Performance

TRAINING PROCESS

Assessment of Training Needs

The training needs assessment is part of a systematic process to assess the skill proficiency levels of persons performing given functions and to determine what skills deficiencies need to be addressed by training and other staff development methods. Conducting such needs assessments should be a continuing responsibility of all STD prevention programs.

Programs should systematically review the need for improving performance within the STD workforce, utilizing such sources as performance outcome data; performance management review; individual employee issues and concerns regarding development; and changes in mission, functions, or processes. The training needs assessment process should be used to determine what specific skills are needed and what skills development responses may be required to address performance concerns identified by those sources.

The purpose of the training needs assessment process is to 1) identify the skills and levels of proficiency that a targeted group of workers may need to perform specific disease prevention activities; 2) determine the current level at which the targeted group is in command of these skills; and 3) assess the gap (i.e., the skills deficiency) between these two levels and thus determine the training need (USAID Handbook on Control of STDs). A training needs assessment is not a survey of employee training wants. It must address the skills development required of specific workers to perform an essential program related function.

Skills deficiencies are likely to occur when 1) a worker is new to a given function and the related skill requirements; 2) the skill requirements of a given function have changed owing to advances in methods, techniques, or processes; 3) the worker skills have decayed owing to improper use or lack of use; 4) a worker's basic skill levels need enhancement to make it possible for an individual to perform more advanced tasks and responsibilities.

The training needs assessment will help program management determine development and training needs and establish the basis for developing training responses most appropriate to develop workers' missing skills or to strengthen their existing skills (Quality Assurance Guidelines, 1985).

The training needs assessment process should apply to both staff and external partners. Although program management can control the training needs assessment process internally, it does not have the same authority with external partners. The project area should, however, coordinate with appropriate external partners to offer assistance in assessing skill levels of those personnel performing essential STD prevention functions and offer training to address specific skills deficiencies. The results of staff training evaluation may provide an indication of the training needs of external partners.

Program management should apply a three-phase plan for assessing the training needs of STD prevention workers. The first phase is to perform a preassessment or planning stage to determine what is already known about the skills and training needs and to establish the plan for gathering and evaluating data on the needs assessment. The second phase is the main assessment or data gathering, which includes collecting, analyzing, and synthesizing the information and opinions regarding skills development needs, and providing criteria and recommendations for the resultant training responses. The third phase of the process involves the post-assessment which includes developing and explaining the plan to implement the recommendations of the main assessment.

Programs should define the purpose for the needs assessment. As part of this process, the program should 1) identify the specific disease prevention activity and the related functions or tasks to be assessed; 2)identify the target group responsible for performing these functions or tasks, and 3) identify the levels of proficiency needed to perform these functions or tasks. Any known performance concerns related to these functions or tasks should also be identified.

Existing reference documentation that may be helpful in collecting training need data should be selected. These reference documents include qualification standards, position descriptions, and performance standards related to the targeted activity. It should also include existing standards of competence established for specific public health functions (Appendix T-B). Existing relevant course training materials, program policies, guidelines, and regulations may be a source of data.

The three basic types of data to be collected to determine training needs are listed below.

1. Target participant characteristics. The training needs assessment should address the following :
   • educational levels of the targeted audience;
   • length of time in the current job;
   • length of time working in public health;
   • trainees' ideas about what is needed to perform requisite tasks or functions (e.g., enhanced personal knowledge, skill, ability; better communications; supervisory involvement); and
   • trainees' preferences for certain training methods.
2. Activity information. The training needs assessment should answer such questions as:
   • Are the functions or tasks expected to change?
   • How well are the target participants currently performing the functions or tasks?
   • What barriers might affect successful performance?
   • Which functions or tasks are most critical?
3. Knowledge, Skill, and Ability information. The training needs assessment should be conducted in a supportive environment. Training needs assessment can be viewed by a worker as an intimidating experience instead of creating opportunity for performance enhancement. The training needs assessment should answer such questions as: What knowledge, skills, or abilities do the targeted participants need to perform at the level of proficiency expected? What knowledge, skills, or abilities do expert performers possess?

The sources from which to collect such data include incumbents who are performing the targeted activity; supervisors and managers who are involved in setting the expectations for the targeted participants; technical or content experts on the targeted activity; and internal or external "customers" served by the targeted participants. The methods for collecting the data may include direct interviews, surveys, expert panels or focus groups, direct management observation, and performance review analysis (OPM Training and Development Services, 1994).

The ultimate goal of training is to improve job performance. Most skill-based performance problems are correctable with appropriate training, improved on-the-job communications, and more supervisory assistance. However, not all performance needs can be addressed through training. When a training needs assessment or individual supervisor recognizes a performance barrier or a problem related to attitude, motivation, or communications, training may not be the solution. The supervisor must determine if training can appropriately address the problem.

The training needs assessment process should identify barriers to job-related skills development. Such barriers may include poor communication of job objectives, responsibilities, priorities, organizational policy, and operational or administrative guidelines; lack of technical direction and support; poor physical work environment; or an employee's personal problems. These types of barriers are indicators of operational, administrative, or performance management problems which impede the identification of skills deficiencies and training needs, because of their impact on overall job performance. Often a worker has the job-related skills needed but is unable to apply them until such barriers are removed (Quality Assurance Guidelines, 1985).

Determination of the causes of unacceptable performance should be based on observation, documentation, and consultation, as well as any personnel development plans. It is the responsibility of the supervisor to observe, document, and consult with the employee to determine the causes of unacceptable performance. If unacceptable performance is determined to be caused by attitude, motivation, or communication problems, it is not a training issue and appropriate personnel actions should be pursued. If the unacceptable performance is related to skills deficiencies, then appropriate training and development should be offered.

Training Approach

Once it is determined which skills must be addressed through training efforts, then the program, with the aid of training experts, should determine the appropriate training approach. The emphasis of a training activity should be on demonstrable skills and should focus on measurable competencies. Competency-based or skills-based training for public health professionals should use adult learning methods. Such training efforts should also use techniques that engage students in solving problems or in discussing their experiences. The student then should have a chance to demonstrate the skills and behaviors. Specific participatory techniques can include small group discussions, demonstrations, role plays, case studies, and simulations. Focusing on competence and skill provides accountability and is helpful in considering issues of improving performance at the organizational and individual employee levels (Public Health Workforce) (USAID Handbook on Control of STDs).

Clearly identifying the purpose is a key element in an effective training program. All training activities or courses should have clear objectives that describe skills that participants will be able to perform and knowledge they will be able to use as a result of course participation. This is a critical step in selecting appropriate participants and in evaluating the effectiveness of the training (USAID Handbook on Control of STDs).

Areas of Training Need

There is increasing interest among public health agencies, including CDC, to assure that public health workers are knowledgeable about the core public health functions (assessment, policy development, and assurance) and competent to perform the ten essential public health services associated with those core functions (see Appendix T-B for a list of essential public health services). Competencies of public health workers to perform essential services should be assessed and training provided to correct any deficiencies. Staff in STD prevention programs may need training to assure that they are competent to provide the essential STD prevention functions of behavior change interventions at the community and individual level, medical and laboratory services, partner services, leadership, public health program management (i.e., planning, resource management, and evaluation), and surveillance and data management.

In many areas of skills development the need for specific training is universal. This is particularly true for new, inexperienced employees (e.g., new supervisors, new DIS, new clinicians). In such cases, a training needs assessment may not be required. Standard raining activities already address these  continuing skills development needs. Specific areas of skills development and existing training are identified in Appendix C.

In addition to basic training, all new employees should be immediately oriented to the organization, learning the program's mission and function, the employee's place in the organization, the employee's role in STD prevention, the performance expectations of the job, and coworkers' organizational roles and responsibilities.

All Disease Intervention Specialists new to STD prevention should receive an orientation on STD transmission and control that includes information on local epidemiology of STDs, factors affecting transmission of STDs, the relationship between other STDs and HIV, complications of STDs, factors affecting STD risk and prevention, and beliefs and practices about STDs. The CDC STD Employee Development Guide (EDG) is a recommended source for the orientation material on STD transmission and control. The EDG is in module format and is designed to give new staff members a comprehensive background in STD intervention. These orientation activities should be completed within four to six weeks of an employee's arrival on the job.

Clinicians and administrative staff who perform direct disease intervention functions should be provided an orientation within the first four to six weeks. These staff members should have the opportunity to observe and to participate in the intervention activities performed by experienced colleagues and other STD prevention staff members. Regional prevention training centers (PTCs) are also an excellent resource for providing training to new staff performing disease intervention services.

Delivery of training

In addition to the responsibility for determining the training or staff development needs and topics, (i.e., the knowledge and skills deficiency to be addressed) and for identifying the target audience, project area managers must determine the best method to get the instruction to the target audience. Consideration must also be given to available funds and level of expertise of individuals providing the training.

Depending on the cost, content, and the instructional expertise required, managers should utilize a variety of means such as on-the-job training, classroom work, CDC-supported training, PTCs, and distance learning activities to address development needs. Traditional approaches to delivering instruction (e.g., classroom settings, lectures, conferences, written materials, etc.) are no longer the sole method for adequately preparing training participants to enter practice or for providing continuing education to a widely dispersed public health workforce. Field-based learning technologies, such as those involved in distance learning, should be implemented. These may include video conferences, computer-based training, Internet, video/audio tape, etc. (Public Health Workforce).

Training Providers and Resources

Training Centers. The STD/HIV Prevention Training Centers (PTCs), Regional Training Centers (RTCs), and AIDS Education and Training Centers (AETCs) are three CDC-recognized providers or resources for STD prevention related training. One role of the PTCs, RTCs, and AETCs is to respond to the need for specific training identified by the project area managers. The PTCs and RTCs provide training based on a list of core topics but can also develop specific training or in-service seminars based on program needs. Program managers should consider the location and the course work offered by the different centers and decide which one of the training centers best meets their program needs. Each type of center operates differently and has slightly different target audiences and each center may offer a slightly different curriculum.

The PTCs provide STD clinical, behavioral, and partner counseling training. The clinical training is provided regionally, and the health behavioral and partner counseling/partner services training is provided nationally. The PTCs also work directly with STD project areas to assist in identifying training needs and developing specific training responses. PTCs provide training for clinicians (physicians, physician assistants, nurse practitioners, RNs); laboratorians; health educators; public health social workers; mental health, alcohol, and substance abuse workers; disease intervention specialists, and family planning and other partners.

The RTCs provide reproductive, clinical, contraceptive management, supervisory, health education, HIV risk/harm reduction, and other training. The RTCs target health care audience is mainly health care providers who work in family planning, maternal and child health, gynecology, and other reproductive health programs.

The Health Resources & Services Administration (HRSA) AETCs provide targeted, multi-disciplinary HIV training programs for primary health care, allied health, minority health, and mental health care providers. The majority of AETC resources have been focused on areas of high HIV prevalence and incidence, with remaining resources allocated on suburban and rural needs. AETC activities are based on assessed local needs.

A list of training centers is provided in Appendix D. Programs should look to these training centers as resources to help them provide STD and HIV prevention training and needs assessments for their staff and external partners.

CDC, NCHSTP Division of STD Prevention. In addition to managing the grants for the Prevention Training Centers, the Division provides training and development support in such areas as first-line supervisory development; medical professional development; and STD surveillance, data management, and epidemiology.

Public Health Practice Program Office offers the Public Health Training Network (PHTN), which is a distance learning system designed to meet the training needs of the public health workforce nationwide. Some of the subject areas addressed by this program are general public health practice, core public health skills training, prevention program training, tuberculosis prevention, and HIV/AIDS and other sexually transmitted disease prevention.

NCHSTP, Division of HIV/AIDS Prevention, Training and Technical Support Services Branch provides training in HIV prevention counseling for state and local trainers (training of trainers). The Division also has field staff assigned to project areas who are available to conduct client-centered counseling training to direct service personnel. Training is offered in the areas of prevention counseling, quality assurance for prevention counseling, substance abuse, issues affecting patients who test positive for HIV/STD, men who have sex with men, and women's health care needs.

Schools of Public Health and Schools of Medicine. These schools offer medical professional training and education opportunities, as well as graduate-level development in the essential elements of public health and public health practice.

Partnerships. Partnerships may be created with academic institutions, managed care organizations (MCOs), speciality societies, and local or state medical societies to provide training, education, in- service seminars, and other methods of staff development. Partnerships that provide training assistance to external partners are often a highly effective way to leverage health department resources to strengthen collaboration and influence STD prevention efforts broadly in the community.

Topic Experts in local and state health departments, community-based organizations, family planning organizations, etc., may be good resources to provide in-service seminars or specific process training.

STD Project Areas. When training needs assessments identify needs that cannot be addressed by existing sources, local project area training management should develop the required training. This may include in-service information workshops, training workshops, or on-the-job training experiences. Training contractors can be used to meet specific project area training needs. The PTCs and CDC can also be used in developing and implementing specific training programs.

Frequency of Training

The intensity and content of training activities for health professionals may vary considerably. Training may take place as part of the formal professional or career development curricula, as part of continuing education activities, or as a specific event (IOM Hidden Epidemic, 1997). In all cases, training should be a part of a planned management effort consistent with program objectives, performance requirements, and required knowledge and skills proficiency. These should be the determining factors regarding frequency and content of training.

Evaluation of Training Activity

To get the best results from training, the content and the process of training should be evaluated. In most skills-based or competency-based training, there is an associated need for enhancement of knowledge related to the skills being developed. One way to evaluate knowledge gains is through the administration of pre- and post-tests. These may include True/False or multiple choice questions, case based scenarios, written essays, oral review (tell what you know), self- assessment of knowledge, or direct observations. It may be useful to do a before and after self-rating by participants to address their perceived competency in performing the skills described in the behavioral objectives of the course. Skills evaluation may take place through direct observation by an expert observer or by written self-assessment.

Participant evaluations at the end of a workshop can be detailed and comprehensive, covering individual sessions and daily activities, and indicating satisfaction with the training. Participants' feedback on each session should be simple and should vary in format to address the main points covered in the course. Sample questions may include: What will you do differently as a result of this training? What was the most or least useful aspect of the session? Were trainee's opinions valued? and how? What went well or did not go well in the session? Such questions should be standardized through the use of a form. Opportunities for specific suggestions on ways to improve the course should also be made.

Participants, as well as the individual trainer or facilitator, should evaluate the following course components: venue, organization, quality of presentation, and quality of participants' participation. Elements such as meeting stated objectives, clarity of presentation, interest in the presentation, and responsiveness to participant's questions and concerns should be used in evaluating the trainer presentation (USAID Handbook on Control of STDs).

In many cases, these types of evaluation methods are performed by training personnel. Whenever possible, evaluation of training data should be provided by personnel not under the direction of project area management, but should be made available to the project area's program management staff. Additionally, similar evaluation methods should be used by the project area's program management staff for comparison over time.

Post Training and Education Application

The purpose of training, education, and other staff development efforts is to enhance existing skills and knowledge, develop new skills, and gain understanding of new ideas and technology that will be applied in job performance. However, the most significant phase of this development occurs on the job through effective practice of the newly learned skills and knowledge in a real work environment. Yet all too often, there is little effort by management to assure the application of new skills and knowledge. As stated in the section describing responsibilities, management and supervisory personnel should be knowledgeable about the training and staff development activities being provided to their employees, should clearly understand the associated knowledge and skills being developed by these activities, and should prepare workers to attend training or education events. After training, participants should be given the opportunity to review the developmental experience and determine how it should be put into practice on the job. Supervisors should reinforce application of new skills and knowledge through activities such as demonstration, performance observation and feedback, mentoring, and other on-the-job development activities. Supervisors should also encourage team interaction and support to reinforce the value of new skills and knowledge.

Assessing Effects of Skills Development on Performance

The assessment of training needs and the evaluation of training activity effectiveness, conducted in collaboration with the employee, are critical steps in improving individual and overall staff performance. Results from these efforts help management to identify and address skills deficiencies, improve resource utilization and cost-effectiveness of training efforts, and provide necessary feedback to training sources to improve the quality of the content and the process of training activities. These efforts also aid in identifying other program management needs that affect staff performance, such as improved employee and supervisory communications, administrative and operational policy and guidelines, and work environment. The evaluation of training activity effectiveness is a critical step in developing staff performance. Results of such efforts provide important information that addresses the effectiveness of skills development efforts and supports implementation of needed operational and administrative policy related to training and staff development. Programs should have or should develop specific plans to establish a system of quality assurance for training and human resource development. A quality assurance system includes documentation, procedures, and processes to assure that staff members are performing functions according to established standards of performance directly related to the accomplishment of an organization's mission and objectives. This relates to the performance management and review process, and to the associated job descriptions and performance standards or requirements.

The quality assurance system should recognize the importance of human resource development in meeting staff performance objectives. Program managers should work with the agency's Department of Human Resources or Department of Personnel to define, document, and establish responsibility for human resource development in support of staff performance. The quality assurance system should include documented procedures for identifying training and human resource development needs and for providing required training and development of personnel performing STD prevention activities. The system should also include an internal audit or assessment process to review effectiveness of training and staff development program efforts in developing the needed skills, knowledge, and expertise, and in improving the quality of job performance.

Direct observation of on-the-job performance is the best method to evaluate the skills of health care professionals. To ensure systematic, objective feedback, an observation checklist should be used, an assessment of skills and abilities should be provided, and results of the observed activities should be discussed with the individual. Direct observation should be conducted before and immediately after training and periodically thereafter.

Assessment of health care professionals at their work sites also provides information that can be used in future training sessions, such as additional topics or specific areas that need more emphasis (USAID Handbook on Control of STDs).

Training that is a one-time effort or that is not put into practice can waste precious human and financial resources. Supervisory and program support are critical to the effect of the training on actual on-the-job performance and to the improvement of performance in a given STD prevention activity. Supportive supervision also contributes significantly to an employee's application of new skills and principles. When participants are not able to apply new skills and information, they can become demoralized, and training can lose its credibility (Quality Assurance Guidelines, 1985).

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