Training Strategies for Clinical Trainers

Original Editor - Wanda van Niekerk based on the course by Claire Boulanger

Top Contributors - Wanda van Niekerk and Jess Bell  

Introduction

Effective training design and delivery are important skills for anyone training adult learners. It is helpful to identify and understand the training needs of your target audience with a training needs assessment. Creating well-structured and measurable learning objectives will guide the design of learning sessions, while proper planning of sessions and modules will add to the success of your training. Efficient communication and facilitation skills are key characteristics of successful trainers.

Training Needs Assessment

When the training of adult learners is approached systematically and appropriately, it can improve their skills and performance. By identifying, understanding and assessing the training needs of the rehabilitation workforce, an organisation can ensure confidence, know-how and various new skills that will enhance the preparedness of individuals and teams.

A training needs assessment should be carried out before the start of a training programme. A needs assessment can provide insight into the learner’s current knowledge level, skill level and learning needs. Furthermore, it allows the trainer to define the learning objectives of a training module, select appropriate training materials and develop a suitable module. Important issues to cover in a training needs assessment are the current problems and needs of the workforce, as well as what the desired situation should be. This will help the trainer assess the “performance gap” (i.e. the difference between the actual and desired situation). The needs assessment can also be used to identify barriers to performance, the required skills and knowledge and what the overall purpose of the training session should be. The training needs assessment can also help with the analysis of the target audience and provide trainers with an overview of the demographics, roles and responsibilities, connections between, reasons for attending, level of interest and specific needs and interests of participants.

The training needs assessment can be done formally or informally through various methods, including interviews, documentation reviews, observation, focus group discussions, questionnaires and surveys.

Designing Learning Objectives

A learning objective can be defined as "a statement that communicates the purpose of instruction using an action verb and describes the expected performance and conditions under which the performance should occur." Five elements should be included in an effective learning objective: 1) who, 2) will do, 3) how much or how well, 4) of what and 5) by when.

SMART Objectives

The SMART mnemonic is helpful to describe all the elements of a learning objective.

S = specific; M = measurable; A = attainable; R = relevant; T = time-bound

Some practical tips for writing effective learning objectives:

• identify the content and knowledge areas that learners are expected to learn
• choose action verbs that are measurable and observable (e.g. describe, identify, select, develop, classify)
• use high-order action verbs when appropriate (e.g. compare, validate, design)
• avoid verbs such as "understand", "learn", "know", "be familiar with"
• a learning objective should be separate; different actions, such as diagnosis and rehabilitation, should not be combined into one objective
• start the objective by specifying the condition in which the action will occur - a good way is to start the statement with: At the end of the training / course / learning activity, the learner will be able to …
• remember SMART learning objectives

The video below provides a short overview of how to write learning objectives using Bloom's Taxonomy, a framework that can help you create clear and measurable learning outcomes.

Designing Training Sessions / Programmes for Adult Learners

When designing training sessions, consider the stages of the learning cycle. Individuals with different learning styles will enter the cycle at different stages according to their preferences. Kolb’s learning cycle stages include active experimentation (trying out what you have learned); concrete experience (having the experience); reflective observation (reflecting on the experience) and abstract conceptualization (learning from the experience).

You can refresh your knowledge of different learning styles here: Adult learning styles and principles.

Learning Session and Module Format

A learning session usually takes place over a couple of days (usually one to six days) and the session is divided into learning modules. Modules are usually around one hour and 30 minutes long, with breaks in between. The scheduling of a learning session may depend on local culture, habits and the participants' preferences. There can be an overall learning objective for the learning session, but each learning module should also have objectives.

A learning session typically consists of an opening module, followed by a progression of a series of modules and a closing module.

Components of the Opening and Closing Modules of Learning Sessions

Opening

The opening of a learning session has two main components: the official opening and setting the tone. During the official opening, organisational representatives address all participants, followed by the handling of administrative and logistical matters.

Setting the tone is important for creating an environment conducive to learning. This component involves presenting the learning objectives, outlining the workload, reviewing participants' expectations and establishing ground rules. Icebreaker sessions commonly form part of this opening phase. When selecting icebreaker activities, facilitators should choose activities that align with both the group's type and culture, while ensuring they support the training goals. It is also important to select activities that encourage participation from learners of diverse backgrounds, as effective icebreakers can improve learner participation and the overall learning experience. Some examples of icebreaker activities are listed in Table 1. Also, if you want to measure the learning improvement of participants, this is the session to submit a pretest and / or self-assessment questionnaires.

Table 1. Examples of ice breaker activities and their benefits

Icebreaker activity	Description	Key benefits
Online course icebreakers	Participants share personal elements through digital posts; meaningful quotes, life journey words, significant songs or distinctive characteristics	Digital engagement, community building
Human web	Participants create a physical web by passing a ball of yarn and creating interconnected string patterns while sharing connections, demonstrating group relationships through physical visualisation	Network building, collective unity
Imagine that	Participants creatively describe abstract concepts (for example, the colour of today, express joy as a taste, or mood as a colour)	Imaginative thinking, expression

Closing

The closing module includes three aspects: learning reinforcement, evaluation and the official closing.

Components of a Learning Module

The four steps of a specific or single learning module that will help with the learning process are (1) an opening section where the trainer can explore participants' initial knowledge of the subject, (2) a section for input where knowledge is provided to participants through presentations and / or demonstration, (3) an anchoring section where participants put into practice their newly acquired knowledge through various methods, such as case studies, role-play and group work and (4) a wrap up at the end of the learning module with a summary of the key concepts.

Table 2 provides a summary of the four steps of a learning module and some facilitation techniques that can be used during each section.

Table 2. The components of a learning module

Steps in a learning module	Duration in relation to total module time	Goal	Ideas / examples
Opening	10 to 20 percent of the module	Explore the knowledge of participants	Games, simulations, brainstorming, quizzes, quick reflection (individual or group)
Input	20 to 30 percent of the module	Provide knowledge and content to participants	Presentations, demonstrations, debriefing of opening activity
Anchoring	50 to 60 percent of the module	Participants put into action their conclusions, theories and activate their knowledge	Case studies, role play, simulations, group work
Wrap up	End of the module	Bring together all the key concepts of the learning module	Summarise and repeat key concepts, confirm the key lessons of the session

Efficient Communication and Facilitation

The Use of Visual Aids

Visual aids serve to strengthen learning and memory retention during training. By transforming text and data into digestible visual formats such as graphs, charts and graphics, visual aids capture attention and highlight key messages. They can help simplify complex concepts, improve participant understanding and enhance learning.

Trainers can use strategic approaches to maximise the effectiveness of visual aids. Ways to do this can include limiting the number of visuals, using minimal text and focusing on clarity through thoughtful design of these aids. The goal is to create visual aids that improve understanding and engagement without overshadowing the core training content or becoming distracting.

Examples of visual aids include flipcharts, chalkboards / whiteboards and PowerPoint slides.

Chalkboards / whiteboards offer a spontaneous, easy-to-use and inexpensive visual aid that serves as an attention-getting tool, effectively breaking lecture monotony while providing an erasable surface for dynamic presentations. However, there are several drawbacks, such as slow writing, and poor readability. Ideally, chalkboards can be used for small, informal meetings where spontaneous idea development and collaborative brainstorming sessions are useful.

Flipcharts can be inexpensive, easy to use and portable. They can be prepared in advance and allow trainers to present ideas in sequence. Colourful markers can be used. Drawbacks of flipcharts are that they are bulky, limited to writing and trainers often tend to write small to get all ideas on one page. They can also be expensive if they are professionally prepared. Flipcharts can be used effectively in small groups, in lectures with spontaneous highlighting of ideas, brainstorming sessions and to compile lists and procedural steps.

PowerPoint slides offer high-quality, portable, easy-to-operate visual aids. Photographic detail is easy to add and the slide presentation can be used with any size group. The ability to use a remote control for the slides allows trainers to move around during the learning session. A disadvantage of PowerPoint presentations is the possibility of the slides becoming the focal point of the learning session rather than the trainer and training.

The video below provides some tips on designing visual aids for maximum effect.

Nonverbal Communication

When facilitating a learning session, actions often speak louder than words. Make use of nonverbal communication techniques to strengthen the engagement of participants. Make eye contact to build connections and show attentiveness. Use open, welcoming body language with an approachable posture. Move closer to participants to actively include them in discussions. Nod and smile genuinely to show encouragement and create a positive learning environment. Finally, ensure that your facial expressions match your verbal communication (smile with your mouth and eyes). It has been reported that the appropriate use of nonverbal communication by teachers / trainers is important to enhance the learning outcomes of students.

Verbal Communication

Effective verbal communication requires an understanding of how your words and delivery of them as a trainer affect group dynamics. It is useful to regularly self-assess how your message is perceived. This will help bridge the gap between your intent and the group's perception of your words. An inviting learning space can be created by using encouraging phrases, such as "I'm glad you brought that up" or "Tell me more." Demonstrate active listening by building on others' ideas and use phrases like "To piggyback on your point, Jack, ...." or "As Jane mentioned earlier...." Validate emotions with emphatic responses, such as "I sense that you are upset by what I just said" or "You seem to feel very strongly about the issue." Using these communication strategies can create a safe space where participants feel comfortable sharing their thoughts and ideas.

Facilitation through Questions

The art of questioning is key to facilitators of adult learning. The aim is to ask questions that stimulate meaningful discussions and interactions, rather than eliciting simple factual responses. Open-ended questions beginning with "who", "what", "where", "when" and "how" are valuable as they encourage more detailed responses and engagement from participants. Although a question beginning with "why" is an open-ended question, it tends to make people defensive as they may feel that they should explain or justify their answers. The type of question should align with the desired outcome. For example, asking a general question to the whole group can allow participants to express their opinions. A variety of opinions can generate interest in the topic and prompt in-depth discussions. Specific follow-up questions can then be asked to explore the reasons behind specific opinions. An important aspect of facilitation through questions is the proper use of silence after asking a question. Allow at least 10 to 12 seconds for participants to formulate a response rather than rushing. These methods will help trainers create a learning environment with productive group discussions and learning experiences.

Response to Participant Questions

Adult learners are inquisitive and will ask questions and engage in discussions. This can sometimes make the interaction challenging. Some reasons why participants want an opportunity to ask questions during learning sessions are:

• to better understand and get more information
• to show off their knowledge to others
• to challenge or support the trainer
• to delay returning to work

Below are some guidelines for handling questions from participants as a trainer.

Set the foundation by establishing clear ground rules at the start of the session about when questions will be handled (throughout, at intervals, or at the end). If you allow questions throughout, be mindful of time management and the number of questions. When questions can only be asked at the end, encourage participants to write them down to refer back to at a later stage.

Repeat or paraphrase a participant's question before answering. Make sure that the whole group can hear the question and verify your understanding of the question. Use this brief moment to organise your thoughts. A recommended approach can be "If I hear you correctly, your question is .... Is that right?" Avoid phrases like "What you mean is..." or What you are saying is ..." or What you're trying to say is ..." as they may come across as condescending.

Make eye contact with the participant who asked the question while paraphrasing and direct your answer to the entire group. Choose your words wisely. Avoid condescending terms such as "obviously" or directing phrases such as "You have to understand..."

Maintain respect and inclusivity. "Never belittle or embarrass a participant." Handle repeated questions patiently without saying things such as "As I already mentioned...". Address questions from all parts of the room and manage individual concerns briefly - offer a one-on-one follow-up during a break or when appropriate.

In challenging situations when you don't know the answer, be honest about it. Offer to follow up on the question and provide resources for finding the information.

Alternatives for communication. Phrases such as "That's a good question" might seem patronising and "Does that answer your question?" after you provided an answer might suggest uncertainty about your answer. Better alternatives to consider are phrases like "That's an interesting question"; "What other questions do you have?" or "Would you like me to go into more detail?"

When responding to questions in learning sessions, maintain professionalism and respect at all times. Be inclusive of all participants and show genuine interest in questions. Be honest and confident and focus on creating a supportive learning environment for everyone.