Skills assessment in primary health care training

This paper describes the development and field testing of a competency-based approach to evaluating primary health care (PHC) training. Using the "Objective Structured Practical Examination" (OSPE) model developed by Abbatt, the authors evaluated the outcomes of a 2-week training course for PHC supervisors and managers in Niger State, Nigeria. Results show that use of an OSPE contributes to training quality, because the OSPE emphasizes the importance of skill mastery and allows trainers to conduct additional systematic observations of trainees" skills. The skills assessment also demonstrated that: (1) not all course material is mastered by trainees -- improvements in training quality or repeated training may be needed to improve skill levels; (2) both training follow-up and clinic-based supervision are essential parts of continuing education in PHC. The paper also discusses the limitations of the OSPE, including possible testing errors and the formidable time and human resources required to carry one out, concluding that full-scale OSPE"s may not be practical for short courses of the type frequently used for inservice PHC training. Efforts to develop simpler, more easily implemented versions of the OSPE are described in conclusion. Includes 19 references.