PROTOCOL AND TRAINING FOR HEALTHCARE PROFESSIONALS

Developing protocol and training for Healthcare Professionals

Developing protocol and training for Healthcare Professionals to improve compliance in patient treatment plans

The efficacy of continuing professional education (CPE) to change health care professionals' (HCP) behaviors is a subject of ongoing debate. Instructional programs for HCP can be evaluated in multiple ways. One way of conceptualizing training outcomes is a four-level typology originally proposed by Kirkpatrick (1967). The most basic result of training is HCP satisfaction (first level) with the training program, which may lead to changes in HCP knowledge or attitudes (second level) about the training topic.

Changes in knowledge could then potentially generate changes in clinical performance (third level), as measured based on HCP behavior in the practice setting. If HCP change their behaviors, then improvements in patient health status (fourth level) may result (Bates, 2004; Kirkpatrick, 1967). Although trainees' intentions to change their behaviors after training are not specifically part of Kirkpatrick's typology, the construct of intention is commonly thought to mediate between knowledge and action (e.g., Ajzen & Fishbein, 2004), and intention is an additional measure often assessed at the conclusion of training in studies of CPE. Obstacles to training success may occur at any of the four stages. For instance, if trainees are dissatisfied with the training experience they may not pay attention, which would limit knowledge gain.

Trainees who do not learn a skill cannot apply it, but even those who do may not be able to put new knowledge into practice for a variety of personal or organizational reasons (e.g., not part of a job description, not in line with clinic policies, not feasible in terms of time or money). Trainees' intentions also may play a role in the transition from knowledge to behavior. Finally, even when a new skill is enacted successfully, it may or may not lead to better patient health outcomes. Kirkpatrick's typology proposes that these outcomes arise sequentially: Satisfaction with training, therefore, is a prerequisite for knowledge change, knowledge is required for behavior change, and behavior change must occur before patient outcomes can improve. These propositions may or may not be true in the real-world context of training. HCP practice behavior changes, which can be defined as the transfer of skills learned during instruction to on-the-job performance (Alliger, Tannenbaum, Bennett, & Traver, 1997), are a key training outcome within Kirkpatrick's typology. Unless HCP behavior changes, there is no way for instructional activities to affect patient care. Unfortunately, changes in knowledge, skills, and attitudes alone are insufficient for behavior change (Alliger et al., 1997; Umble & Cervero, 1996), but these are the most commonly reported outcome measures for CPE (Bates, 2004; Robertson et al., 2003; Umble & Cervero, 1996). This gap in the literature may be due to the time needed for evaluation, lack of valid measures, and the number of possible confounds when evaluating practice behavior.

These evaluation challenges exist for any instructional program but are particularly acute in CPE, where the need for instruction is ...