In section B, we are resuming our discussion of objectives and content for

our training programs.

Again, as we've mentioned, objectives are measurable, observable.

And a nice acronym has been developed for judging the quality of objectives

whether they are appropriate and these are known as SMART objectives.

S for specific.

M for measurable.

A for attainable.

R for realistic.

And T for time-bound.

Objectives that clearly mention who will do what, when and how are specific.

These objectives draw on available data such as our baseline diagnosis and

target specific aspects of knowledge, attitudes, skills, and behaviors.

We want to make sure that we don't say something like

the trainee will know how to treat a child with fever.

What does that knowledge consist of,

what are the attitudes involved such as the importance of prompt treatment.

We want to be able to specify as much as possible

what the trainees will do as a result of their training.

So we've mentioned before good training or learning or instructional objectives.

Should be measurable, we want an objective way

of determining whether the objective itself has been achieved.

We want to provide opportunities for trainees to behave in such a way

that demonstrate that they have learned the knowledge, skills or attitudes.

Therefore, if we can observe, we can count and measure and

we can compare before and after.

So it's only through observation and

measurement that we can evaluate whether an objective has been attained.

Thus, objectives that have within themselves the basis for

evaluating a training program.

So we said the objectives are like a roadmap.

They tell you where you want to be.

They also have within them a statement that says what we're looking for,

what we want to measure, what we want to observe,

in order to have evidence that we have actually achieved that,

that we have actually arrived where our map said we were going.

And the importance of action verbs that are measurable, we can listen or

read if a person is listing out either verbally or

on a piece of paper the available appropriate drugs for

malaria, and we can check those off if they're correct or not.

We can certainly list or read if a person describes the steps involved

in treating a two year old child with malaria.

And a useful, measurable verb would be demonstrate.

If the trainee would demonstrate how to detect whether a child has

elevated temperature.

Prepare, if we're trying to train village health workers or

mothers to use oral rehydration solution with local salt and sugar.

An objective can say that they would prepare salt sugar solution and

we can watch and tick off the steps that they performed correctly or not.

Construct, mention, all of these are action verbs

that help us measure whether the skills and knowledge have been actually acquired.

When we're concerned about an objective being obtainable,

we have to look a lot at the resource base that we have.

Do we have the money, the time, the personnel?

Other logistics, such as the space, the right kinds of equipment.

To run the training program in a way that allows people to attain the objectives.

If we are talking about the trainees acquiring a skill in community

senseless taking before they do a distribution for ivermectin.

Do we have transportation?

Do we have the time to take them to a village to do a practical section?

So if we don't, then such an objective may not be attainable.

Again, the issue of attainability implies that a particular

objective is inextricably, interwoven with the overall planning process.

We need to make sure that we have the resources needed

to allow the trainee to acquire those skills within the time available.

In order for an objective to be realistic, it must be based on the expected outcomes.

The knowledge, skills, attitudes that are relevant and

appropriate for the job description.

Are we training a village health worker to do what is appropriate for them, such as

providing a village drug box and counting out appropriate tablets for Malaria?

And inappropriate, or unrealistic skill would be

to teach them how to give injections, which they demand, but is inappropriate.

It's not realistic, it's not safe, in a community situation.

Are the objectives realistic in terms of the community's culture?

As we mentioned before people expect that health includes both treatment and

prevention, and so if a village health worker is trained with

an objective that only focuses on providing education communication,

the community may not be happy.

The trainee also needs to understand people's expectation

about certain kinds of medicines.

So we need to be aware of the setting in which the trainee will work and

make sure that the objective that we set gives them realistic knowledge and

skills that will be accepted and applicable for their work setting.

If we're training in a community program on sexually transmitted diseases,

we could involve quite a number of people.

Village volunteers, high school teachers, community nurses, youth peer educators,

laboratory staff, physicians.

The issue of what is realistic or

appropriate to the kind of work contribution that each of these sets of

people would make toward the program need to be considered.

The village volunteers or the peer educators may be good at the counseling.

The peer educators might appropriately distribute condoms.

But when it comes to more medical or technical things,

when it comes to identifying and treating people who have STDs.

These may need to be referred to the community nurses, the physicians.

The laboratory staff would have a role.

So each of the different groups involved in a community health

program have a different job description, have different contributions to make.

And so objectives for the training of each of these groups would differ based on

the what is realistic in terms of their job performance and expectations.

In order to evaluate a program, we have to know when to expect our results.

And therefore,

objectives also need to have some element of timing in their framing.

Community health programs have time limits themselves, goals need to be achieved.

We need to achieve a certain level of immunization coverage by a certain time.

We need to get the ivermectin tablets distributed before the rainy season.

We need to get filters for getting worm control distributed before the dry season.

So therefore if the objectives are spelling out behaviors of the trainees,

the actual work they're going to do implies that the timing

of the performance of that objective has to fit in with the overall program.

Also, we need to recognize that there are some elements

of timing that need to be done prior to the trainee leaving the training site,

we would certainly hope that the trainee could demonstrate the skill

of measuring a person and counting out the correct number of ivermectin tablets.

We would hope that the trainee could demonstrate how to approach

people in a household and gather census information.

So these are things that you would want to see evidence before the person leaves

the workshop or seminar.

On the other hand, too, we want to make sure that within a certain period of time

the trainee actually goes out and performs these things in the community.

So we need to be aware of time issues in terms of the immediate workshop,

and we also need to be aware of those time issues that will

reflect performance of the new skills out in the community, back in the workplace.

We see some examples, three examples of objectives for

training patent medicine vendors in malaria treatment.

And the chart has tried to assess how SMART these objectives are.

The first one, by the end of training, patent medicine vendors will name

the first-line drug for treating childhood malaria.

Okay, that's quite specific.

It's focused on a specific drug.

It identifies the type of drug first-line.

It's measurable, we can hear if the person mentions or

states names of this particular drug.

It's attainable, it's something that can be done within an hour or so.

It's something that also the medicine vendor needs to be aware of and

fit into his or her job description in terms of keeping all this things in stock.

They need to name and know, distinguish the drugs they have.

It's realistic because,

again, it fits into their job description of selling these drugs.

The time bound aspect is that by the end of the training, we know that

the person should not leave the training site without being able to mention and

distinguish these drugs.

The second objective doesn't appear to be as SMART.

We need to figure why.

Patent medicine vendors will appreciate

that the child dosages are lower than adult dosages.

Okay, dosages of what?

It's not specific.

Is it measurable?

Well how do we measure appreciation?

We can't, again, get inside the person's head and

see if maybe there's someway we can do a CT scan and if they appreciate,

it will give off certain electrical charges are not but right now,

we don't have those kinds of tools to measure knowledge and appreciation.

Attainable, well, it's hard to say since it's not specific whether this is

something that we can do within the context of the training, possibly.

Is it realistic?

Well the idea of knowing knowledge of doses is important, something

we could achieve, but the way the objective is framed it makes difficult and

there is no time factor implied in or written into the objective.

Is this something that will happen two years from now,

is it something that'll happen within a one hour training session.

The third objective is a little better than the second.

Patent medicine vendors will count out the correct number of chloroquine tablets for

a 12 year old child.

More specificity about the behavior, the kind of medicine,

the age of the child, the behavior of counting.

We can measure that the person counts the correct number.

We have that information and we can watch and see if they

count out how many tablets, whether they divide in half or in quarters.

It's certainly attainable, it's something that they would do on the job,

it's part of their job description,

it's something we could do within the resources that we have.

Realistic?

This is a question that gets back to the legal aspects of medicine vending.

Yes, in most cases they buy drugs in bulk because it's cheaper,

and cheaper for their clients too, for their customers.

But it's not exactly legal for them to count tablets, so

we have to think twice about that.

And again, there's no time factor mentioned in this objective.

Looking back at our diagnosis of training needs for the patent medicine vendors as

we mentioned although they talk about the fact that they think they communicate with

their customers about drug dosage etc., only 20% actually do this when observed.

So if we were going to frame an objective about improving their

communication skills, which of the three would you choose?

Which of the three, if any, is SMART?

What about know the correct dose for a two year old child?

What about explain to the clients how to divide tablets for a two year old child?

What about tell parents how to take the drug?

Are any of these completely SMART objectives?

Clearly, the first one starts off with a problem,

in the sense that it doesn't have an action verb, so we can't measure it.

We can observe in practice sessions and

in follow up visits the PMVs explaining the correct dosage and

procedures for administering tablets to the child.

So this is more specific although it's not time bound.

The third one, tell parents how to take the drug.

This one is quite vague.

It at least starts off with a verb that we could observe, but we don't

really know what we're going to observe, what is the correct action or not.

And as we said, our objective should be a roadmap to let us know,

as well as the trainee know, what it is that he or

she is going to do as a result of having been trained.

Now we're heading toward putting together a training guide.

Each of you, during the course, will be thinking about, recruiting trainees,

and developing a program for them.

And now that we have talked about formulating objectives,

what we want to do is turn these objectives into training plans.

An easy shorthand to help you get your plans organized is

seen in the matrix here for the objective

of the primary worker will provide prompt treatment for a child with malaria.

This training matrix puts together the content,

the simple steps, your tasks that are involved,

the methods that will be used to teach, and instruct, and learn.

The resources that it'll take to carry out those methods.

And ideas for how to evaluate whether the objective and the specific

tasks have been achieved, whether the skills have been acquired by the trainees.

So we will be using in our labs these types of matrices, and

building them up week by week.

You will start off, of course, having had set an objective.

And break that down as we talked about in our earlier lectures into the steps that

are necessary to perform that particular skill.

In terms of providing prompt treatment, we want to be sure that

the first step is an understanding of the need for prompt treatment

to prevent children from dying from malaria, and we again use verbs.

The trainee will explain why the treatment is necessary and why malaria is dangerous.

We can listen to that.

Again, we want to make sure that appropriate treatment is given and

the trainee will feel the child to determine if the temperature is elevated.

We don't want the trainee, the patent medicine vendor,

to make these decisions all alone.

The customer should be involved,

especially if we're talking about parent of a young child, so

the trainee will ask the mother about the history of the child's illness.

And based on the information gathered

determining if the child actually needs malaria medicine,

count out the correct number of tablets for the child according to its age.

So for each of these steps, we want to see what kind of methods are appropriate.

In our subsequent lectures we will talk about methods.

We will talk about resources and we will talk about evaluation.

But as we can see, these matrices will help us pull up all of our thoughts

together and we'll be submitting them as we go along, and

getting feedback, and continuing to fill in, step by step, week by week.

Ultimately, this will be used as the basis for

developing a full-blown training guide.

But these are some examples to get us started to see now that we've

developed some objectives.

And we've started talking about what the content is that's implied in those where

we are going.

A second example the matrix continues and we can see that there are more steps.

The fifth step would be to explain to the mother how the medicine should be given.

Encourage the mother to give the child extra fluids.

Record the treatment in a notebook.

Review the child's condition by the third day.

So for each of these we've talked about whether we're using role playing,

brain storming,

demonstrations, the kind of resources we need in terms of a flip chart.

Of course, you could use PowerPoint if you are in the city and

have electricity and a computer.

We want to make sure that we consider who are the trainers,

whether we need guest speakers to provide information.

We may need to provide handouts that write out scenarios for the role play.

We probably need samples of the different drugs for them to practice with.

Notebooks, pencils, those kinds of things that are necessary to record treatment.

We're estimating relative cost in local currency, for example,

to get an idea of building up a budget as we go along, that's an important resource,

the time that it will take to do each of these tasks is spelled out.

So these are all part of our resources and

they appear on these charts to help us plan more effectively.

Finally, the evaluation aspects of it,

there are some things we can do immediately.

As we go along or at the end of the session we can ask questions,

we can ask trainees to do what we call return demonstration or

repeat the demonstration for us and other trainees to observe and get feedback.

We can observe their role play,

various activities to see if they are gaining the skills.

Listen to what they're saying in terms of picking up on their attitudes

about the new skills.

And of course, as ultimately we get to the end of the training,

there may be tests that pull all of this together.

So as I mentioned before, we will be working on all of these steps,

all of these components with training plan through developing these matrices

after each lecture during each lab and

puling it all together and ultimately into training guide.

Lecture 4B: SMART Objectives

Training and Learning Programs for Volunteer Community Health Workers

Meet the Instructors