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How we adapted a CE model for our clinical lab.

The need for continual learning in the clinical laboratory is a fact of life. Lab workers are bombarded with new technology, procedures, and information. Attending continuing education programs is a good way to keep up with developments. Yet it is not easy to provide ongoing CE programs that meet the needs of both management and a busy staff.

In my experience, laboratory staffs tend to designate someone as the official CE person. It then becomes that person's regular responsibility to provide educational programs for the laboratory staff. Although this procedure often works well, it keeps the planning out of the hands of those who will attend the programs. Partly as a result, participation may dwindle to nonexistence over time.

In 1985, when I obtained my master's degree in education, our laborator director turned over to me the existing continuing education program, which was in need of redirection. I immediately chose to adopt the concept promulgated by educational theorist E.J. Boone by which all persons who will be affected by a continuing education program are involved in developing what is to be offered.' My hope was that including my colleagues in the planning stages would encourage greater participation. The project worked extremely well. We had needed a goal-oriented program and more participant enthusiasm; with our new model, we achieved both. Since that time, a system wide CE program at the medical center has made excellent presentations available to all its labs. But the procedures we used might help other laboratorians who must devise their own CE materials.

Boone's model consists of three subprocesses: planning; design and implementation; and evaluation and accountability. The planning process consists of identifying and analyzing the needs of adult learners. First, the target group-those to whom the program will be presented-is identified. The design and implementation process consists of outlining and presenting the actual programs. In the evaluation and accountability process, the effectiveness of the program is judged via observations by the planners or feedback from the participants. The program must be accountable to the needs of the organization as well as to those of participants.

Once our laboratory began to use this concept for both one-time offerings and serial programs, more employees helped to plan CE programs and at least twice as many attended them. First, however, we had to adapt the model to our own needs. * Planning. Boone's planning process includes communicating ("linkage") with the target group, understanding the target group, and identifying major macro-) objectives. Linkage with the target group is accomplished through one-on-one communication, small-group meetings, or written surveys. We developed a CE committee comprised of a staff member, the program planner (continuing education coordinator), and a representative from each lab shift.

one responsibility of the shift representatives was to talk with coworkers about what they thought they needed to learn, and then to share this information with the program planner. We found that one-on-one surveys inspired far greater response than written ones. The program planner served as a liason between management and other committee members and designed the lectures or other learning experiences.

The staff committee member supervised overall operations and served as a liaison between the committee and program presenters recommended by employees. Our committee member worked out the timing of presenters, trying to get as many as possible to appear before all three shifts (a remarkable number were willing). The committee member also suggested specific topics that other employees would like covered, such as concentrating on crystals in a program on urinalysis. The CE committee operated informally. No meetings were called for the entire committee. Instead, communication between members occurred between shifts and through written correspondence. This arrangement made it possible for the committee to operate without interrupting their own work as well as others'. Another phase of the planning process is understanding the target group. To design effective CE programs, the planner must have a basic understanding of how adults learn and what incentives drive medical professionals to participate in such programs.

Darkenwald and Merriam have described four characteristics of adult learners 2:

1. Each adult brings to any educational environment a unique collection of experiences and learning needs. No two adult learners have the same background; everyone hopes to gain a unique mix of information. Participants learn from each other as well as from program presenters.

2. Adults are self-directed learners: They know where, when, and how much they want to learn and can plan and participate in their own learning experiences. In the CE program developed in our laboratory, staff members as well as management had opportunities to participate by joining the CE committee, sharing opinions with committee members, offering feedback on evaluation forms, giving lectures, conducting workshops, and, of course, attending the programs themselves.

3. Adults have an immediate need for knowledge that is applicable to solving current problems. Understanding this characteristic led our lab to:

Categorize each program as basic, intermediate, or advanced so that anyone who wished to participate could determine whether the learning experience was likely to prove an effective use of his or her time.

Develop programs according to our staff's needs. One example is a program we called "The Bone Marrow Unit and the Laboratory, " When the bone marrow transplant unit was first created at our hospital, we were not familiar with the procedures or what reports would be required. Lymphocytes in these patients' differentials for example, looked different from those usually seen; but was it important for the physician to know about their atypical appearance, or was it their presence alone that mattered? The lab employees wanted to learn more about the patients' and medical staff's needs so that we could serve them better. One medical technologist researched the subject, gathering questions from other laboratory employees and asking the medical and nursing staffs on the new unit what they expected from us. The resulting program was so popular that it had to be offered twice. 4. Adults have responsibilities that take precedence over learning experiences. Our CE committee was well aware that our coworkers were in the laboratory to work, not to attend school. Therefore, we made an effort to offer programs that complemented the work environment and did not interrupt the workflow. Committee members worked closely with supervisors to insure that work continued smoothly while each program was being presented. Programs were announced well in advance to enable supervisors to make any arrangements necessary that would allow more interested persons to attend. In addition, in-lab activities, such as slide/cassette and video recordings, were offered. An advantage of in-lab activities is that employees can take advantage of them as time permits. Whenever possible, programs were offered more than once and at different times of day so that workers on all shifts could participate in them. When a lecturer could not repeat a program, we prepare handouts to distribute to those who were unable to attend the session. On rare occasions, programs were rescheduled because a heavy work load required the presence of the entire staff on that shift. * Why people attend. Beside understanding the adult learner the coordinator must recognize medical professionals' reasons for participating in CE programs Richards and Cohen have identified five such reasons, which in my experience apply equally well to laboratory personnel:

1. To upgrade skills. The CE committee strove to offer work shops that provided hands-on experience. These included body fluid analysis, Gram stain review, and instrument troubleshooting. 2. To keep abreast of developments in the field. The CE committee worked with management to obtain books and professional journals for the laboratory. 3. To validate new knowledge. Because adults are self-directed, they like to follow up on developments in the field about which they have heard or read. Therefore, we brought in experts to validate employees' recently acquired knowledge. In 1987, for example, our laboratory employees were confused about what measures to take to protect ourselves against the spread of AIDS. he guidelines for AIDS precautions kept changing. We invited a searcher to speak to us about his work and precautions we should be taking. The program, "AIDS update," attracted laboratory workers from all over the university. As with most of our presentations, participants were invited o ask questions. This program as overwhelmingly successful.

4. To attain personal objectives. These include completing CE requirements and solving specific problems. Whenever possible, the continuing education committee provided programs for which we can award CE units as delineated in guidelines set by our laboratory administration.

5. For a change of pace. Medical professionals view CE programs as a time to relax, learn, and interact with colleagues. We presented lectures in comfortable surroundings that provided a brief but refreshing respite from the work setting. The committee invited personnel from other labs at the hospital to attend as well, in an effort to give personnel an opportunity to interact.

While the education coordinator could not incorporate into any given program all four characteristics of the adult learner and all five reasons medical professionals attend CE presentations, a careful mix of these elements contributed greatly to success. The education coordinator, after combining this mixture with information collected by the committee, outlined the overall objectives macro-objectives) of each program-the guidelines by which the committee would develop the program. As stated by our CE committee, one macro-objective was to "provide continuing education programs that will upgrade current job skills and stimulate professional development. " * Design/implementation. During this process, the program planner set specific goals for the upcoming program that stated exactly what would be offered. An example: "The program will offer a lecture on identifying urine sediment. " The CE committee created an evaluation form to be used when the proceedings ended. The multiple functions of the form included gaining an understanding of how participants felt about the program and collecting suggested topics for future programs.

An effective evaluation form asks: Did you gain the information you expected from the program? What other information do you wish had been included'? Would you like more information on the subject? What other continuing education programs would you like us to offer?

The CE committee reviewed responses to these questions and used the collected information to improve future programs. Negative responses served functions as constructive as those of positive ones. Responses on our follow-up evaluation form, for example, indicated that the room in which we were holding many of our continuing education offerings was too noisy. We scheduled succeeding programs to be held in a more suitable environment.

Using two standard evaluation forms for all programs@ne fo lecture presentations, the other for audiovisual and other self-instructional materials-relieved the burden of paperwork for the program planner. Because using the same form each time made it harder to collect specific information about any given program, however, the planner needed the freedom to revise the forms as needed for a particular program.

The CE committee identified and contacted people likely to present good programs. The staff person on the committee and the program planner explained the target group's learning needs to presenters and worked with them to determine the course objectives. An example: "Participants will be able to identify transitional cells in urine sediment." Course objectives were included in announcements about upcoming programs so that potential attendees could determine whether the program would teach them what they wanted to know.

During the design and implementation process, the CE committee identified other learning resources available to the laboratory At our hospital, these included the school of medical technology, the medical center library, and the clinical and research laboratories.

in addition, committee members scanned professional journals for ideas. One successful program resulted from a tiny blurb in a journal about a medical technologist who had to go to court about test results. During National Medical Laboratory Week that year, we presented a forum on the legal responsibilities of lab workers.

Evaluation/accountability. The continuing education committee kept in mind that change tends to lead to improvement. A willingness to review and revise was maintained during all phases of developing CE programs. We found feedback from everyone involved, including guest lecturers, committee members, staff, and program participants-as well as from those who chose not to participate-very important for improving future programs.

The information collected from nonparticipants in our lab indicated that certain CE programs had been offered at an inconvenient time or location. We used this information to offer more self-instructional programs that could be pursued and completed in the laboratory as time permitted.

The CE committee summarized program evaluations for participants, staff, and any other individuals to which it was accountable. In our lab, this communication was usually accomplished informally. Committee members talked at their leisure with other employees to inform them of the success of each program. We wanted our immediate laboratory supervisor to be included, partly because that person was an excellent source for suggesting areas in which people would benefit from instruction. Our accountability process proved highly effective.

Since our laboratory adopted our protocols for developing continuing education programs in 1985, the number of persons attending and participating such programs increased. Several participants became involved in the actual developing process, helping to keep the CE program going. This was so primarily because the energy and interest of one committee member inspired another member to continue. Through this process of developing continuing education programs, educational activities became a part of the routine of the laboratory rather than a periodic and occasionally unwelcome interruption of the workflow. n
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Title Annotation:continuing education
Author:Crews, Belinda M.
Publication:Medical Laboratory Observer
Date:Jun 1, 1990
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