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A competency-based orientation program for new procedures.

The lightning-fast pace of technological change makes it increasingly difficult to remain professionally competent. Since technology is the foundation of the clinical laboratory, we must find innovative ways to incorporate these changes without letting quality and efficiency suffer.

To keep pace with the barrage of new test procedures, some laboratorians attend as many workshops, seminars, and conferences as they can. But to remain competitive in today's health care market, we must begin our continuing education at "home," insuring that we can demonstrate both understanding and competence in all assigned test procedures.

Most labs conduct programs to orient new members to their assignments. But few have formalized plans to keep them oriented as new procedures are introduced and old ones discarded.

Too often, the lab adds a new instrument or methodology without adequately preparing those who will perform it. The new test may be announced in a department meeting, discussed at an inservice gathering, posted on the bulletin board, or passed on by co-workers--or it may just appear as a new page in the procedure manual. These approaches do not insure adequate understanding of the test principles or consistently acceptable performance.

Why not? Basic human psychology is one reason. We expect educated people to be independent learners who are motivated to set and achieve goals and evaluate their efforts. But studies conducted at the college level in the United States have shown that many students lack well-developed study skills and fare poorly at acquiring information on their own.

This is why the casual introduction of a new test produces uneven results. The independent learners are able to grasp both theory and practice quickly; others perform the test without full comprehension; and some simply don't bother to learn the procedure at all. The knowledgeable, competent technologists become the laboratory's local experts, performing most of the new tests, answering questions, and troubleshooting.

Meanwhile, the rest of the lab suffers the consequences. Other members of the technical staff lose the opportunity to grow professionally through added job variety, responsibility, and independence. Ill-informed or uncertain laboratorians must work more slowly, repeat procedures, and seek assistance. Lab managers lose in dollars, morale, and efficiency.

To keep the staff knowledgeable and capable in spite of change, consider using a compentency-based orientation program. Adapted from the competency-based vocational education movement, the program specifies the desired outcomes in knowledge, skill, or attitude; establishes evaluation criteria; and holds the learner accountable for meeting the objectives.

Competency-based orientation is derived from educator Benjamin S. Bloom's theory of mastery learning. In his research, Bloom found that most students displayed similar learning ability, comprehension rate, and motivation for further study when provided with favorable learning conditions--defined as the opportunity for feedback and correction. Simply, the student should be able to ask, "How am I doing?" and receive helpful responses such as "Try this."

Competency-based vocational education begins with the development of instructional units. These units have four essential components: performance objectives, learning activities, time for mastery, and evaluation. Using this principle, you can develop mini-units of instruction for introducing technologists to new procedures. Let's examine each component in detail.

* Performance objectives. The point of this phase is to ask, "Where am I going?" First you must decide what you want technologists to know about the new procedure, what you want them to be able to do, and how well. As background, use journal articles, reference books, continuing education materials from professional societies and manufacturers, audiovisual materials, promotional materials, and resource people such as industry representatives, physicians, educators, and other laboratorians who are already using the procedure.

Easy-to-read articles, promotional and audiovisual materials, and lectures are frequently effective. Books and professional journals, while more informative, may prove somewhat daunting to less experienced personnel. Try to keep learning material very palatable and user-friendly.

NExt, write a brief performance objective for each of your expectations, describing the procedures you want the technical staff to learn. Performance objectives should use action words such as define, describe, explain, demonstrate, prepare, calculate, analyze, evaluate, or troubleshoot.

* Learning activities. This phase asks, "How am I going to get there?" Now you need to select activities that will help the technical staff achieve the knowledge and performance goals specified in the objectives. Most of these activities should be designed for individual pursuit since the entire staff is rarely free at once.

Your choice of activities will depend on the type of procedure being introduced, lab size, time constraints, and available resources. Possible choices include: reading copies of selected journal articles, book excerpts, or manufacturer's materials; writing article summaries; preparing informative articles about new procedures for the hospital newspaper; independent research for additional information; composing case studies that include the test; answering study questions; listening to prerecorded or live lectures and discussions; completing worksheets; and observing the procedure.

* Time for mastery. This phase asks, "How will I apply what I've learned?" The learning activities provide a uniform knowledge base and prepare the participant to apply and practice what has been presented. Practice and demonstration are key activities.

Knowledge can also be practiced through problem solving, case studies, open-ended sentences, role playing, questioning, and discussion. Skills can be honed through demonstration followed by supervised practice that includes feedback, correctives, and flexible time limits.

* Evaluation. This phase asks, "How wil I know when I've arrived?" Participants are assessed to determine if they have achieve the stated performance objectives. Possible evaluation vehicles include written or performance tests, oral presentations, anecdotal records, self-evaluations, and projects. Evaluation helps diagnose learning strengths and weanesses, allowing all learners to meet the goals and offering additional assistance until they do. Those who fail to achieve mastery can be helped by recycling--going back though the procedure with someone who knows it and looking for the breakdown points.

In an actual lab situation, oral answers may prove a more practical form of evaluation than written tests. Just discussing results and their implications for the patient can illuminate a technologist's grasp of the material.

Here is an example of how these four components could be woven into a competency-based unit of instruction to orient technologists to a new procedure:

Subject: Compatibility testing with antibody enhancement solution.

Goal: After completing this unit by Sept. 30, 1985, the participant should be able to perform compatibility testing using the antibody enhancement technique with 100 per cent accuracy, and demonstrate understanding of the procedure and its applications by scoring 85 per cent on a written test.

Performance objectives: After completing this unit, the participant should be able to:

1. Describe the proposed action of the antibody enhancement solution in compatibility testing.

2. Recall the specimen requirements.

3. Assemble the needed equipment and supplies.

4. Explain the procedural steps.

5. Perform compatibility testing following manufacturer's recommendations for this product.

6. Discuss the advantages and drawbacks of this method of compatibility testing with a supervisor or co-worker who understands the procedure.

Learning activities:

1. Read the manufacturer's insert sheet.

2. Read the two journal articles posted on bulletin board one.

3. View filmstrip 101 on this topic in the conference room.

4. Review procedure with one co-worker.

Time for mastery:

1. Watch a practiced technologist perform the procedure.

2. Perform the procedure while a practiced technologist observes.

3. Practice the procedure on your own, using known control materials.


1. Score at least 85 per cent on the written test.

2. Perform the procedure with 100 per cent accuracy using known control materials.

3. Review if necessary.

Initially, the department supervisor or education coordinator will be the most likely candidate to prepare these mini-learning units. The units can be prepared along with procedure manual additions, often using the materials assembled when the test was being investigated.

The finished product offers several advantages. As the format is used and accepted, other interested technologists can prepare the units as an opportunity for professional growth. Keep in mind that JCAH recognizes all documented involvement in orientation for new technical procedures, by preparers and participants, as a source of continuing education.

This type of instruction also reflects the preferred learning style of most technologists. A study of more than 100 MTs found that most preferred a highly directed, well-structured learning environment as opposed to a more independent course of study. Technologists seem to learn best through such concrete methods as programmed instruction, manuals, demonstrations, field trips, and practice. Competency-based units of instruction contain many of these down-to-earth learning experiences.

For many laboratories, one factor limiting orientation is the lack of time to pursue it. But this concept can be effective even if you aren't able to outline an elaborate program with detailed performance objectives. A less complex implementation is still better than the haphazard, word-of-mouth method.

Competency-based orientation overcomes our natural reluctance to communicate our expectations clearly and to evaluate staff members' day-to-day performance. It keep sus from the common pitfall of saving our feedback until people make mistakes. And since most of us are not highly independent learners, this type of orientation takes the guesswork out of mastering new procedures. Knowing exactly what we must learn and how to learn it makes future shock less of a problem for the technologist and the laboratory alike.
COPYRIGHT 1985 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1985 Gale, Cengage Learning. All rights reserved.

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Author:Livingston, Diane
Publication:Medical Laboratory Observer
Date:Sep 1, 1985
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