Patient Safety Training Evaluations: Reflections on Level 4 and more (

Slide presentation from the AHRQ 2009 conference.

On September 15, 2009, Eduardo Salas, Ph.D. made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (346 KB). Plugin Software Help.

Slide 1

Patient Safety Training Evaluations: Reflections on Level 4 and more.

Eduardo Salas, Ph.D. 
Department of Psychology & Institute of Simulation & Training
University of Central Florida
esalas@ist.ucf.edu

 

Slide 2

Purpose Today.

  1. Challenge
    • Offer some observations & myths
  2. Proposal
    • Time to think differently
  3. Guide
    • Best Practices

 

Slide 3

A few thoughts about the science of training.

 

Slide 4

What do we know about training?

  • The science has evolved & matured.
  • The past decade-an explosion of research!
    • More empirical work
    • Research conducted in organizations
    • New, more & deeper theories and models
    • More evaluations reported
  • Huge military investment.
  • Influence of cognitive psychology.
    • Expertise

 

Slide 5

What do we know about training?

  • Much progress in.
    • Organizational needs analysis
    • Cognitive task analysis
    • Transfer of training
    • Instructional design
    • Feedback
    • Training evaluation
    • Simulation-based training
    • Individual characteristics

 

Slide 6

Observations From the Science

  • The quality and quantity of research has increased
  • The cognitive and organizational concepts is revolutionizing the field
  • The field is multi-disciplinary
  • The influence of technology will continue
  • Training is part of an organizational system
  • There are more guidelines, tools and approaches for practitioners

 

Slide 7

Framework for Training Effectiveness

 

Slide 8

Myths & misconceptions about training.

 

Slide 9

The Simplistic View of Training

  1. Unskilled Worker
  2. Training Program
  3. Skilled Worker
  • Uninformed About the Science
  • Erroneous Assumptions

 

Slide 10

Myth

Everyone Who Has Ever Learned Anything is a Training Expert
 

 

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Reality

  • Opinions aside, training is a behavioral/cognitive event that can be structured to empirical investigation.
  • There is a science of training that should be exploited to optimize training design.
  • Processes exist which, if appropriately and consistently applied, can help to ensure that effective training is designed.

 

Slide 12

Myth

TASK EXPERTS CAN ARTICULATE TRAINING NEEDS
 

 

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Reality

  • Experts do not have access to their own expertise.
    • Knowledge becomes "compiled"
  • Task experts do not necessarily understand the learning process or how learning progresses.
  • Task experts are crucial, but they must be paired with learning experts.
    • Partnership

Slide 14

Myth

Reactions to training = Learning

 

 

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Reality

  • Just because trainees are having fun, doesn't mean that they are learning anything.
    • Very little or no relationship
  • "Instrumentality" does seem to be a factor.
    • Does seem to be related to learning
    • Affects motivation to learn
  • Simple measures of training outcomes are insufficient to judge training quality.

 

Slide 16

Myth

Learning will translate into Behavior change
 

 

Slide 17

Reality


  • Training transfer is a very complex phenomenon.
  • Some of the factors:
    • Supervisor Peer support
    • Climate for Transfer
    • Opportunity to perform/practice
  • Even when trainees demonstrate learning after training, it does not mean that they can or will transfer back to the job.

 

Slide 18

Thinking Differently about Training Evaluation.

 

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Kirkpatrick's Model of Training Evaluation

  • Level 5 - Return on Investment
    Was the training worth the cost?
  • Level 4 - Results
    Did the change in behavior positively affect the organization?
  • Level 3 - Behavior / Training Transfer
    Did the participants change their behavior on-the-job-based on what they learned?
  • Level 2 - Learning
    What skills, knowledge, or attitudes changesd after training? By how much?
  • Level 1 - Reaction
    Did the participants like the training? Whad od they plan to do with what they learned?

Slide 20

This Model.

  • Has served as well!
  • Used, misused & abused!
  • Created a misconception that Level 1 is all one needs
  • Over simplified evaluations
  • Links among levels, weak
  • Minimal impact of training on Level 4
    • Clinical outcomes

 

Slide 21

So.

What if we reverse Kirkpatrick's model?

 

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Start as Level 4.

What are the outcomes/results we want out of this training?

 

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Level 3: Given these wanted outcomes.

What behaviors we want/need of our trainees?

 

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Level 2: Given these needed behaviors.

What KSAs we want our trainees to have?

 

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Level 1: Given those KSAs.

What reactions we want our trainees to have?

 

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What do you get by reversing Kirkpatrick's typology?

  • Precise learning outcomes
  • Better links among Levels
  • Better link of training to outcomes
    • Clinically-relevant
  • Hints for performance assessment/observation
  • Tailor training program better
  • Better accountability

 

Slide 27

Best Practices after Training Evaluation in.Healthcare, Aviation.

 

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Best Practices

  1. Even before designing your training, start backwards: Think about evaluation first.
  2. Accept that effective training does not exist without effective evaluation.
  3. Strive for robust, experimentation design in your evaluation: It is worth the headache.
  4. When designing your evaluation plan and metrics, ask the experts - your frontline staff.
  5. Do not reinvent the wheel, leverage existing data relevant to training objectives.

 

Slide 29

Best Practices (cont)

  1. When developing measures: Consider multiple aspects of performance.
  2. When developing measures: Design for variance.
  3. Evaluation is affected by more than just training itself: Consider organizational, team, or other factors which may help (or hinder) the effects of training (and thus the outcome of your evaluation)
  4. Engage socially powerful players early:
    Physicians, nursing & executive management is crucial to evaluation success.

 

Slide 30

Best Practices (cont)

  1. Ensure evaluation continuity: Have a plan for employee turnover at both the participant & evaluation administration team level.
  2. Environmental signals before, during, and after training must indicate that the trained KSAs & the evaluation itself are valued by the organization.
  3. Get in the game coach! Feed evaluation results back to frontline providers & facilitate continual improvement through constructive coaching.
  4. Report evaluation results in meaningful way.

 

Slide 31

Conclusions

  • Avoid Myths!
  • Training Evaluation matters!
  • Reverse Kirkpatrick's typology!
Current as of December 2009
Internet Citation: Patient Safety Training Evaluations: Reflections on Level 4 and more (. December 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2009/salas/index.html