JOURNAL REPORT Payumo , Pelayo , Quiogue , Rodriguez block U

1. University of the Philippines – Philippine General Hospital Department of Family and Community Medicine JOURNAL REPORTPayumo, Pelayo, Quiogue, Rodriguezblock U

2. 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

3. 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

4. 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

5. 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.

6. 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 Improved Personal Hygiene Accessible health services Good Environmental Sanitation Access to SanitaryToilets Sufficient water resource (access & quality) Good Waste mgt Improved dental health Well maintained H20 System Better access to food Well developed H20 sys Proper diet & food intake Sufficient H20 source in all areas Healthy practices Improved Access to health care Increase in govt funds Increased family income Available medicines, efficient referral system Increase in knowledge on health Improved attitude More livelihood opportunities Better access to the health care system 5-year program in San Juan, Batangas:Objectivestree

7. 5-year program in San Juan, Batangas:Program Components • 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 • Health • Livelihood Program • Environment • Administration

8. BHW training in IMCI module • Vital signs training • Danger signs training • Cough module training • Diarrhea 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

10. 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.

11. 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

12. 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. Community Development Theory Lecture

13. 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. Teacher For Better Learning by FR Abbatt

14. 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.

15. 2 Different Approaches to Teaching Health Workers • Conventional Schooling • Education that resists change • People-centered Learning • Education for change Helping Heathworkers Learn by David Wermer

16. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

17. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

18. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

19. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

20. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

21. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

22. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

23. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

24. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

25. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

26. The Function of Test and Exams in 2 Different Approaches to Teaching Health Workers Conventional 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

27. 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: • Does the assessment fit the regulations for the course? • Is the assessment reasonably economical in materials and time? Teacher For Better Learning by FR Abbatt

28. Does the assessment test really important skills and abilities? (Is it valid?) • Are you sure that the marks gained by each student are accurate? (Is it reliable?) • Does the assessment give information which will help students to learn better and help teachers to improve their teaching?

29. 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,Icouldn’t see why Ineeded to know these things." • The solution is to test only those skills and abilities which are important.

30. 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 thisit is valid • In the assessment of vital signs monitoringa 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.

31. 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.Thenanother teacher marked the same exam papers. The scores given by thetwoteachers 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.

32. 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

33. 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.

34. 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

35. 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

36. 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 Helping Health workers learn by David Werner

37. (Example: What to do when a mother refuses to take a gravely ill child to the hospita?) • Attitudes toward people in need

38. For evaluating skills and attitudes, careful observation is more helpful than written tests

39. Exams • Can encourage students to do more work • Can tell the students what they need to spend more time on

40. Case Scenario

41. 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

42. 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

43. Continuous assessment

44. 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

45. 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

46. 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

47. SELF- ASSESSMENT

48. 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.

49. 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 LaiyaAplaya, the number of patient consults deters appropriate and thorough assessment of BHWs on application of their training.Interns’ assessment may not be enough.Issuesmay arise regarding presumption of BHW incompetence.

50. 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: • Assess if each patient has danger signs. • Fill in IMCI forms with correct assessment and classification depending on trainings attended. • Suggest plan of management according to patient’s classification. • Compare with actual accomplished IMCI form.