Ensuring competent health workers at graduation: Summary of the evidence on elements of effective preservice education

There is a common body of understanding about the elements of preservice education (PSE) that contribute to competent entry-level health workers and which factors most affect competency from graduation to deployment and professional practice. Jhpiego conducted an integrative review of the evidence-based literature to identify what further research is needed to demonstrate the importance of certain elements that are frequently cited as essential to successful PSE programs for health occupations and professions. A total of 1,742 peer-reviewed articles from the year 2000 onwards from multiple databases, including PubMed, Medline, the Cochrane Library, and CINAHL, were identified between January and March of 2011 and reviewed and graded. The categorization scheme was based on the design adopted by Jhpiego for a synthetic review of peer-reviewed, published, articles (systematic reviews, randomized controlled trials, and program evaluations) that focused on the effectiveness of various teaching/learning approaches used within in-service or continued professional education activities. Additionally, classification of the literature according to Kirkpatrick's four-level model of training evaluation was used as a strategy to affirm that the studies in this review addressed the broader spectrum of process and outcomes of PSE. A conceptual model representing the proposed relationships between PSE, competency and health outcomes was developed. Some expected findings, such as the importance of a competency-based curriculum, student support, and the advantages of alternative learning technologies were confirmed. Evidence-based support for other factors was, surprisingly, very limited. The findings of the literature review and the visual conceptual model that emerged will be presented and discussed.