JOURNAL REPORT Payumo , Pelayo , Quiogue , Rodriguez block U

JOURNAL REPORTPAYUMO, PELAYO, QUIOGUE, RODRIGUEZBLOCK U

University of the Philippines – Philippine General Hospital

Department of Family and Community Medicine

THE JOURNAL

TEACHING FOR BETTER LEARNING: A guide for Teachers of Primary Health Care Staff

By: F.R. Abbatt, Revised and republished by Network Learning, August 2002

Rationale: The journal article discusses the importance of assessment which is needed to keep track of the BHWs, helping us to know if the training is successful and will help us to identify areas for improvement

Outline

Why must students be assessed? What makes a good assessment? Making sure that the assessment really

tests important skills and abilities Making assessment reliable Using assessment to help learning Continuous assessment Self-assessment Using students to assess each other’s

performance

The Declaration of Alma Ata Primary health care:

Includes at least: education concerning prevailing health problems and the methods of preventing and controlling them; promotion of food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and child health care, including family planning; immunization against the major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment of common diseases and injuries; and provision of essential drugs

Relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained - socially and technically - to work as a health team and to respond to the expressed health needs of the community.

5-year program in San Juan, Batangas:Objectives tree

50% decrease in morbidity in Children (0-12years) due to infectious diseases (pneumonia, diarrhea, URTI, pediculosis), dental caries, impacted cerumen, disabilities and malnutrition at the end of 5 years

Improved nutritional status Good Environmental SanitationImproved Personal Hygiene

Access to SanitaryToilets Sufficient water resource (access & quality)

Good Waste mgtImproved dental health

Better access to food

Proper diet & food intake

Well developed H20 sys

Well maintained H20 System

Sufficient H20 source in all areas

Increase in knowledge on health

Improved Access to health care

Healthy practices

Improved attitude

Increase in govt funds

Increased family income

More livelihood opportunitiesAvailable medicines, efficient referral system

Better access to the health care system

Accessible health services

5-year program in San Juan, Batangas:Program Components

•Health• Livelihood

Program• Environment• Administration

– Community (for children 0-5 years old)Training of barangay health

workers in the Integrated Management of Childhood Illnesses (WHO guidelines)

Municipal-wide information campaign in the proper care of children’s health (primarily led by the barangay health workers)

– Elementary School (for children 6-12 years old) Training of teachers in the physical examination of

their students Child to Child Program (Training of Grades 5 and 6

students to become teachers and models of younger children in the school)

Dental Program – Municipal Nutrition Program– Municipal Rehabilitation Program for the Disabled– Municipal Herbal Program– Diabetes Study

BHW training in IMCI moduleVital signs trainingDanger signs trainingCough module trainingDiarrhea module training-At present we are in the process of the

diarrhea module implementation. Knowing how to properly assess the training would help in the identification of areas that needs improvement

Assessment

Assessment is needed to keep track of the BHWs’ application of their training

One of the most important parts of any teacher’s job is to find out how much students have learnt.

Assessment

This can be done by setting exams or watching students at work.

Whichever method you use, the process is called assessment.

Teacher For Better Learning by FR Abbatt

Community Development Theory Lecture

Assessment

Quesada’s Principle of Evaluation:

Assessment is an on-going process in Community Organization.

Efforts should be made to assess the gains of any mobilization or social action, its strength and weaknesses and to sum-up the lesson learned.

Teacher For Better Learning by FR Abbatt

Why must students be assessed?

There must be a check that the students will be able to do the job reasonably well. This of course is specially important in all the health professions.

Exams and tests encourage the students to work harder.

Why must students be assessed? The assessment can be used to

guide the students about which topics or skills they need to learn more.

The assessment can also guide the teacher about which parts of the course have been successful and which parts need to be improved.

2 Different Approaches to Teaching Health Workers

1. Conventional Schooling Education that resists change

2. People-centered Learning Education for change

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

Tests and exams serve mainly to help the teachers judge students.

Tests and exams serve to let both instructor and students to know how well the instructor is teaching.

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

Tests may motivate students to study harder but for faulty reasons—fear of failing exams rather than eagerness to understand and use what they are learning.

Tests motivate students by helping them find out what they need to learn in order to serve their people better.

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

A grading or pass-fail system is used that compares ‘good students’ with ‘bad students’.

No grades. No pass or fail. If any student who wants to learn falls behind, this reflects the failure of the group, not the individual, because quick learners are expected to help teach slow learners.

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

Tests encourage competition between students (some come out on top, others on the bottom).

Tests encourage cooperation and sharing (everyone helps each other come through together).

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

Atmosphere of distrust. Teacher watches or ‘polices’ students during tests. Cooperation between students during tests us called ‘cheating’.

Atmosphere of trust. Teacher may leave room during tests. ‘Cheating’ makes little sense because the main purpose of test is to help the instructor teach better and be sure that everyone understands the material. The teacher or other students may assist those who have trouble understanding the questions.

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

Strong emphasis on memorizing. Students usually are forbidden to use notes or open books during exams.

Strong emphasis on understanding. Notes or books may be used during most exams. Since exams test how well students can apply their learning in real life situations, the use of books and other available resources is encouraged.

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

Tests reward those students who learn to repeat like parrots.

Test questions are designed to help the students think, not simply to repeat.

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

Strict time limit for tests. Slower students fail questions they do not have time to answer.

No strict time limit. Extra time is allowed after the test so slower readers can finish. Or they can take tests home to complete.

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

All test questions have a right or wrong answer, not open to question by the students.

Some questions do not have clear right or wrong answers, but ask for students’ opinions. These help them to recognize unsolved problems, or to examine their own attitudes.

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

Tests review only material and ideas already covered in class. Nothing new. So tests are usually boring.

Tests try to introduce new ideas and understanding, building on material covered in class and the experience of the students, Focus is on lifelike problem solving. This can make test fun!

Helping Heathworkers Learn by David Wermer

The Function of Test and Exams in 2 Different Approaches to Teaching Health WorkersConventional Schooling

People-centered Learning

Teachers usually corrects the tests.

Students often correct each others’ tests during a group discussion.

Helping Heathworkers Learn by David Wermer

Teacher For Better Learning by FR Abbatt

What makes a good assessment?When you design the assessment

methods for a course or for a lesson there are five questions that you should ask:

A. Does the assessment fit the regulations for the course?

B. Is the assessment reasonably economical in materials and time?

A. Does the assessment test really important skills and abilities? (Is it valid?)

B. Are you sure that the marks gained by each student are accurate? (Is it reliable?)

C. Does the assessment give information which will help students to learn better and help teachers to improve their teaching?

Making sure that assessment really test important skills and abilities Health workers and students are

often asked about facts which are not important: “I couldn’t answer the questions,I couldn’t see why I needed to know these things."

The solution is to test only those skills and abilities which are important.

Making sure that assessment really test important skills and abilities For example, a health educator will probably do jobs

like explaining hygiene or persuading mothers to breastfeed babies. This explaining and persuading is performance. Ideally the assessment should test whether the student can do the job successfully.

If the assessment does do this it is valid In the assessment of vital signs monitoring a

standard checklist is being used to test whether the BHW could perform the task successfully. Also, in the Satelite and Hugom clinics the interns give preceptorials and practical tests for the BHWs to assess their skills and abilities.

Making the assessment reliable In a recent exam the students were asked to

write about the treatment of burns. The papers were marked by the teacher who had taught the course.Then another teacher marked the same exam papers. The scores given by thetwo teachers were very different. For example one student was given 45% by one teacher (a fail) and 70% by the other.

This illustrates that in this exam the marking was not reliable.

Making the assessment reliable Clearly, the final mark should be reliable or

it becomes meaningless. But how can you be sure that a mark really is reliable?

The answer is to try to cut out the errors right through the assessment process. Do this by choosing assessment methods which are less likely to lead to errors. (For example multiple choice questions are better than essays)

The pre-test and post test of each module are in the form of multiple choice questions

Techniques which help the markers work to a uniform standard check-lists are also useful .

For example, in the assessment of vital signs monitoring, a uniform standard checklist is being used.

The assessment should give information which will help students to learn better and help teachers to improve their teaching

Based from the analysis of our post-test the BHWs still have difficulty in the classification of diarrhea,making the interns emphasize more on this part during the training

Helping Health workers learn by David Werner

Guidelines for preparing appropriate test questions

Try to ask questions that: Make people think Present a problem solving situation similar to ones

health workers may encounter in their villages Deal with priority needs Are stated simply and clearly Test and strengthen skills rather than just testing

memory Do not simply review information already covered,

but help healh workers form new ideas or gain practical experience

Helping Health workers learn by David Werner

Things that cannot be measured in written tests

Manual skills: giving injection, cleaning a wound

Communication skills such as giving preventive advice in consultation, leading nutrition classes for mother

Leadership and organizational skills such as planning and getting people to work in the community

Thinking and problem solving skills needed to deal with unexpected difficulties

(Example: What to do when a mother refuses to take a gravely ill child to the hospita?)

Attitudes toward people in need

For evaluating skills and attitudes, careful

observation is more helpful than written

tests

Exams

Can encourage students to do more work

Can tell the students what they need to spend more time on

Case Scenario

Part 1 Part 2 Part 3 Part 4Student A / x x / Student B / / x /Student C / / / /Student D / / x xStudent E / / x x

Comments on the test results• For part 1, we can be happy for the result• For part 2, you should advise student A– Try to make time to explain to student A

• The results for part 3 show that this is generally poorly learnt – Probably this part needs to be taught again– Here the teacher gets a feedback about his own

performance• Part 4 shows that two students need more

guidance but it would probably be a waste of time to repeat part 4 for the whole class

In the case of the Diarrhea Module in Hugom

Majority of the BHWs made a mistake on question number 3, meaning that we should put extra emphasis on the classification especially on persistent diarrhea

CONTINUOUS ASSESSMENT

Advantages of continuous assessment

• Because there are several assessments an error in any one assessment is less important-Continuous assessment tends to be more reliable

• Tension and worries of single final exam are removed

• Motivation to pass exams is spread over the whole of the course-So students tend to work harder over the whole

course instead of a single desperate effort at the end

Advantages of continuous assessment

If students do poorly in one test, they have time to correct their errors before the end of the course Continuous assessment gives more

guidance to both teachers and students Students are shown right through the

course what standard is expected

Forms of continuous assessment Written tests Practical application

* Whatever system is followed, continuous assessment offers important advantages in both helping students to learn and in making more accurate and reliable judgments about how much the students have learnt

SELF- ASSESSMENT

Self-assessment

Students/ BHWs assess their own performance.

They may not be responsible enough or do not know enough at the beginning of the course.

BHWs will be working with very little supervision after they have qualified. So in the job they must assess themselves.

It is a good idea to give the students some experience of self-assessment whilst they are still being trained.

It will help to save time and will give students a greater sense of responsibility.

However, in Cluster 12, especially in Laiya Aplaya, the number of patient consults deters appropriate and thorough assessment of BHWs on application of their training.Interns’ assessment may not be enough.Issues may arise regarding presumption of BHW incompetence.

Self-assessment

JOURNAL APPLICATION In self-assessment, the

students need clear guidance about what standards are required. They must also be given a very clear idea of the task.

The student can compare his own work with a "correct answer" and so learn whether his work is satisfactory.

Notice that cheating is not a problem, because the purpose of self-assessment is to learn – not to score points in an exam.

Given 10 sample cases:1.Assess if each patient has

danger signs.2.Fill in IMCI forms with

correct assessment and classification depending on trainings attended.

3.Suggest plan of management according to patient’s classification.

4.Compare with actual accomplished IMCI form.

Self-assessment

This may be viewed as an exam; an open-book (open-module) type is encouraged.

Open-book tests place value on looking things up when in doubt, rather than trying to rely purely on memory.

This can help health workers develop a careful approach to looking for answers to problems in their communities.

Self-assessment

It is a good idea to give the students some experience of self-assessment whilst they are still being trained.

It will help to save time and will give students a greater sense of responsibility.

This results in fewer mistakes and better health education, and helps take some of the magic out of modern medicine.

Self-assessment

Self-assessment focuses more on a BHW’s knowledge and problem solving skills.

It is important that each health worker develop an attitude of self-criticism.

PEER-ASSESMENT

Peer-assessment

Students assess each other, as an alternative to self-assessment.

This can be encouraged and guided by the teacher.

Peer-assessment

Peer-assessment can help to make field experience much more meaningful and purposeful. Instead of vaguely trying to do a job as well as possible, each student will be supervised by a fellow student who is there to watch and advise.

In Cluster 12, both in Laiya Aplaya and Hugom, there are several BHWs.This is conducive to peer-assessment.BHWs have undergone more or less the same training, such that they can assess each other’s performance.As an alternative, midwives may also supervise the BHWs.

Peer-assessment

JOURNAL APPLICATION Students can be given written

instructions for doing a job. Then one of the students attempts to do the job while the other one watches and comments. At the end the students change over and the second student does the job watched by the first one.

The teacher must of course provide the written instructions or check-lists. These can be prepared either from the teacher’s own experience or from a manual.

A BHW can serve as a “practice patient.” Based on their red book on vital signs taking:

1.One BHW assesses another BHW per step of vital signs taking.

2.He/she writes down the patient’s vital signs.

3.They switch roles, then compare the resulting vital signs.

Peer-assessment

Peer-assessment can focus on a BHW’s manual skills and communication skills.

It is important that each health worker develop an ability to accept friendly criticism from others.

Summary

Assessment is an on-going process in Community Organization and efforts should be made to assess the gains of any mobilization or social action, its strength and weaknesses and to sum-up the lesson learned.

The assessment can also guide the teacher about which parts of the course have been successful and which parts need to be improved.

Summary

No assessment method is perfect. Each has some advantages, some disadvantages.

The teacher should therefore use a variety of methods whenever this is possible.

Ideally the teacher should first decide what skills need to be assessed. These skills are, of course, the objectives of the course. Then the best method should be chosen for assessing these skills.

The method should be chosen on the basis of:

1. regulations for the course2. economy of time3. reliability4. validity5. value as a learning tool

THANK U!!!