Universities and educational institutions are rapidly integrating different approaches for learning that move beyond the classroom. Decreasing global resources and a pervasive critical shortage of skilled health workers are paralleled by an explosion in the increase of and access to information. The need to increase the effectiveness and efficiency of both pre-service education and continuing professional education (CPE) (in-service training) for the health workforce has never been greater. The research agenda calls for well-constructed evaluations of culturally appropriate combinations of technique, setting, frequency and media, developed for and tested among all levels of health workers in low- and middle-income countries. Limited data indicate that there may also be an effect on improving clinical practice behaviours. CPE can lead to improved learning outcomes if effective techniques are used. Media should be selected based on the potential to support effective educational techniques and efficiency of instruction. Setting should be selected to support relevant and realistic practice and increase efficiency. Targeted, repetitive interventions can result in better learning outcomes. ConclusionsĮducational techniques are critical to learning outcomes. Very limited quality data are available from low- to middle-income countries. Effective techniques can lead to improvements in knowledge and skill outcomes and clinical practice behaviours, but there is less evidence directly linking CPE to improved clinical outcomes. Computer-based learning can be equally or more effective than live instruction and more cost efficient if effective techniques are used. Settings similar to the workplace improved skill acquisition and performance. Repetitive interventions, rather than single interventions, were shown to be superior for learning outcomes. Didactic techniques that involve passive instruction, such as reading or lecture, have been found to have little or no impact on learning outcomes. Case-based learning, clinical simulations, practice and feedback are identified as effective educational techniques. The evidence suggests the use of multiple techniques that allow for interaction and enable learners to process and apply information. The research questions focused on the evidence supporting educational techniques, frequency, setting and media used to deliver instruction for continuing health professional education. The articles analysed included 37 systematic reviews and 32 RCTs. Articles selected for analysis after two quality reviews consisted of systematic reviews, randomized controlled trials (RCTs) and programme evaluations published in peer-reviewed journals from 2000 to 2011 in the English language. The initial review of titles and abstracts produced 244 results. MethodsĪ literature review was conducted from multiple databases including PubMed, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between May and June 2011. An integrative review of the education and training literature was conducted to identify effective training approaches for health worker continuing professional education (CPE) and what evidence exists of outcomes derived from CPE. In-service training represents a significant financial investment for supporting continued competence of the health care workforce.
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