Quality and Relevance: Overview

This section focuses on ensuring pre-service education programs are relevant to national needs and produce quality graduates. This section discusses processes to ensure education is of sufficient quality and relevance, describes the use of core competencies to guide curricula and assessment and adaptation of content and curricula, and explains how to use educational standards to ensure quality.

Ensure that pre-service education programs and strategies are of sufficient quality and relevant to national needs - globally competent and nationally relevant. (WHO 2010). To ensure that education is relevant, the competencies for each cadre may be determined by analyzing the responsibilities of the job, often called task analysis. Based on the country’s existing human resources for health (HRH) plan, task analysis can be used to determine the work each cadre should perform to provide relevant care in the target communities. Then, appropriate core competencies expected of each cadre relevant to the national HRH plan or health priorities can be established. This process helps ensure that education produces competent health workers with skills relevant to the national health priorities (Crisp, Gawanas and Sharp 2008).

Review and evaluate core competencies for each cadre. To produce competent and relevant health workers, health worker education should be competency-based. Competency-based education emphasizes the competencies, or knowledge, and set of skills and attitudes needed that are developed during educational preparation. Focusing on competencies produces health care workers able to inquire, synthesize information, and make decisions, building a foundation for continued education and learning (AAMC and HHMI 2009; Frenk and Chen, et al. 2010). Determine core competencies during early key stakeholder meetings and before any significant curricular, institutional, or clinical site interventions. International scopes of practice or competencies are useful for determining desired competencies for a particular cadre.

Frame interventions around established accreditation or educational standards. A quality assurance system based on international standards is needed to ensure quality in education. Standards of performance expectations form the foundation for interventions to strengthen educational institutions and faculty. Typically, these interventions include an investment in infrastructure, including resources and financial and management capacity (Dal Poz, et al. 2009). If standards were not applied in the accreditation process, using standards for interventions will identify gaps and allow programs to tailor interventions based on needs. Below are activities often identified as gaps and addressed in educational interventions.

Adapt educational curricula to ensure core competencies are achieved. For example, standardizing midwifery curricula, including statements of the expected outcomes of competency-based midwifery education, is an internationally-recommended best practice (Fullerton and Leshabari 2010). Revise educational curricula, licensing assessments, and continuing education materials to match national health priorities and identified core competencies (Crisp, Gawanas and Sharp 2008). The curriculum should fulfill the desired core competencies—those tasks essential to practice for each cadre (WHO 2006). Changing content has broad impact across the curriculum; therefore, changes require early and broad involvement of faculty, professional councils, patients, and other key stakeholders (WHO 2006). This process may limit the speed and number of decisions, but is the only way to provide legitimacy (WHO 2006). Collaborate with a national working group to form a Technical Advisory Group (TAG) to help revise the curriculum (both didactic and clinical) in collaboration with relevant ministries. The Pre-service Implementation Guide outlines a step-by-step process for revising national curricula.

Review national student admission standards to ensure that students will meet the desired deployment goals. For example, in many countries, large numbers of urban students adversely impact the success of rural deployment. There is increasing evidence that local recruitment is a strong predictor of long-term retention (Dal Poz, et al. 2009; WHO 2006, WHO 2010). Some countries and schools have revised their selection criteria and recruitment policies to draw students from local communities who will be more likely to accept rural deployment (Dal Poz, et al. 2009). An appropriate range of selection criterion including student investment in the community, understanding and interest in the profession, as well as cognitive ability to succeed, will all lead to increased success, deployment, and retention. Work with key stakeholders to review and revise the selection criteria, if needed. This step is important if the program has significantly revised the expected scope of practice or deployment strategies. Assess integration of national admissions standards with institutional criteria.

Lessons Learned: Quality and Relevance: Overview

 Analysis of desired performance is a critical step to determine desired and relevant core competencies. Even if funding is limited, a brief activity with recent graduates will provide minimal but important data about work realities and evidence for future recommendations.

 Involve the working group in comparing existing policies, national health priorities, job descriptions, and core competencies against current pre-service education programs. This process helps build consensus in making changes to ensure education is relevant.

 Curricular revisions require attention to both classroom and clinical education to ensure graduates are competent upon graduation. Ensure clinical education is reviewed and revised for quality and relevance.