The roles of personal interview and cognitive abilities at admission to medical school in predicting performance of medical students in their internal medicine sub-internship.

BACKGROUND: The medical school admission process is complicated, perhaps reflecting unresolved debates concerning the most important skills necessary to become an ideal physician. The Goldman Medical School at Ben-Gurion University in Israel is known for placing great emphasis on the personal attributes of candidates in addition to their academic excellence. To this end, 1-h consecutive interviews are embedded in the admission process. This study aims to determine whether there is an association between candidates' personal interview ratings and the ratings assigned to these students at the conclusion of their 6th year internal medicine sub-internship. METHODS: Our study sample included 136 students who were admitted to the medical school in 2015, and who completed their 6th year internal medicine sub-internship in 2019-2020. Our data were derived from the admissions information for each candidate and from structured interviews concerning medical competence and personal traits, which were completed by medical personnel who were in contact with these students during their clinical rounds. RESULTS: Higher interview ratings of candidates during the admission process were associated with a higher probability that students would be evaluated as top-rated internists 6 years later (Odds Ratio (OR) = 9.4, p-value = 0.049), independent of gender (OR for male vs female = 0.2, p-value = 0.025) and age (OR = 1.3 per each year, p-value = 0.115). Although significant, the numeric difference in interview rating was relatively small (median 9.5 and 9.4 for top-rated and not top-rated internists, respectively). CONCLUSIONS: Our study shows that high personal interview ratings assigned to candidates as part of the medical school admission process are predictive of high performance ratings of students after they complete their 6th year internal medicine sub-internships. These findings demonstrate the value and importance of using semi-structured personal interviews in the medical school admission process.

Gerenciamento de impressões e tomada de decisão em entrevistas de emprego / Management impressions and decision making in job interviews / Manejo de impresiones y toma de decisiones en entrevistas de empleo

O objetivo do estudo de delineamento experimental intersujeitos foi analisar as relações entre gerenciamento de impressões de candidatos a emprego e a decisão de contratação pelo entrevistador. Apresentou-se uma descrição de entrevista de cargo de nível médio, incluindo respostas de cinco supostos candidatos, cada um deles fazendo uso de uma das estratégias de gerenciamento de impressões: autopromoção, insinuação, exemplificação, intimidação ou suplicação. Participaram 99 profissionais de gestão de pessoas, aleatoriamente distribuídos em cada uma das cinco condições experimentais. Para o teste de hipóteses, foram usadas análises de correlação, de variância e o Teste-t. A ANOVA evidenciou que as estratégias de autopromoção e de exemplificação foram mais associadas à decisão de contratação. As estratégias de autopromoção relacionadas a comportamentos não verbais (manter postura ereta, olhar fixo nos olhos) também repercutem favoravelmente na decisão de contratação. O tempo de experiência do entrevistador aumenta as chances de o candidato que faz uso da estratégia de autopromoção ser contratado. As relações entre comportamentos não verbais e atributos físicos e pessoais do candidato foram evidenciadas somente para as estratégias de autopromoção e de insinuação. Há indícios de que o uso de estratégias de GI e o comportamento não verbal têm um papel importante na decisão de contratação.(AU)

The aim of the study, that used between-subject experimental design, was to analyze the relationship between impression management by job seekers and the interviewer's hiring decision. A description was given of a mid-level position interview, including responses of five supposed candidates, each using one of the impression management (IM) strategies: self-promotion, ingratiation, exemplification, intimidation, or supplication. The participants were 99 human resource professionals, randomly distributed in each of the five experimental conditions. For hypothesis testing, analyzes of correlation, variance and T-test were used. The ANOVA showed that the strategies of self-promotion and exemplification were more associated with the decision to hire. The self-promotion strategies related to non-verbal behaviors (maintaining upright posture, holding eye contact) also had positive impact on the hiring decision. The interviewer's length of experience increases the hiring chances for the candidate who uses the self-promotion strategy. Relationships between nonverbal behaviors and personal, physical attributes of the candidate were found only for the self-promotion and ingratiation strategies. There is evidence that the use of IM strategies and nonverbal behavior play an important role in the hiring decision.(AU)

El objetivo de este estudio que contó con un diseño experimental intrasujetos fue analizar las relaciones entre el manejo de impresiones de candidatos a obtener un empleo y la decisión de contratarlos por parte del entrevistador. Se presentó la descripción de una entrevista para un puesto de nivel medio, incluyendo las respuestas de cinco supuestos candidatos, cada uno de ellos utilizando un tipo de estrategia de manejo de impresiones: autopromoción, insinuación, ejemplificación, intimidación y ruego. Participaron 99 profesionales de recursos humanos, aleatoriamente distribuidos en cada una de las cinco condiciones experimentales. Para poner a prueba las hipótesis se realizaron diversos análisis de correlación, varianza, test de la t y ANOVA que evidenciaron que las estrategias de autopromoción y de ejemplificación fueron las más asociadas a la decisión de contratación. Las estrategias de autopromoción relacionadas con comportamientos no verbales (mantener una postura erguida, mirar fijo a los ojos) también repercuten favorablemente en ser contratado. El tiempo de experiencia del entrevistador incrementa las posibilidades de que el candidato que utiliza una estrategia de autopromoción sea contratado. Las relaciones entre comportamientos no verbales y atributos físicos y personales del candidato sólo resultaron evidentes para las estrategias de autopromoción e insinuación. Hay indicios que el uso de estrategias GI y de comportamiento no verbal tienen un papel importante en la decisión de contratar.(AU)

Gerenciamento de impressões e tomada de decisão em entrevistas de emprego / Management impressions and decision making in job interviews / Manejo de impresiones y toma de decisiones en entrevistas de empleo

O objetivo do estudo de delineamento experimental intersujeitos foi analisar as relações entre gerenciamento de impressões de candidatos a emprego e a decisão de contratação pelo entrevistador. Apresentou-se uma descrição de entrevista de cargo de nível médio, incluindo respostas de cinco supostos candidatos, cada um deles fazendo uso de uma das estratégias de gerenciamento de impressões: autopromoção, insinuação, exemplificação, intimidação ou suplicação. Participaram 99 profissionais de gestão de pessoas, aleatoriamente distribuídos em cada uma das cinco condições experimentais. Para o teste de hipóteses, foram usadas análises de correlação, de variância e o Teste-t. A ANOVA evidenciou que as estratégias de autopromoção e de exemplificação foram mais associadas à decisão de contratação. As estratégias de autopromoção relacionadas a comportamentos não verbais (manter postura ereta, olhar fixo nos olhos) também repercutem favoravelmente na decisão de contratação. O tempo de experiência do entrevistador aumenta as chances de o candidato que faz uso da estratégia de autopromoção ser contratado. As relações entre comportamentos não verbais e atributos físicos e pessoais do candidato foram evidenciadas somente para as estratégias de autopromoção e de insinuação. Há indícios de que o uso de estratégias de GI e o comportamento não verbal têm um papel importante na decisão de contratação...

The aim of the study, that used between-subject experimental design, was to analyze the relationship between impression management by job seekers and the interviewer's hiring decision. A description was given of a mid-level position interview, including responses of five supposed candidates, each using one of the impression management (IM) strategies: self-promotion, ingratiation, exemplification, intimidation, or supplication. The participants were 99 human resource professionals, randomly distributed in each of the five experimental conditions. For hypothesis testing, analyzes of correlation, variance and T-test were used. The ANOVA showed that the strategies of self-promotion and exemplification were more associated with the decision to hire. The self-promotion strategies related to non-verbal behaviors (maintaining upright posture, holding eye contact) also had positive impact on the hiring decision. The interviewer's length of experience increases the hiring chances for the candidate who uses the self-promotion strategy. Relationships between nonverbal behaviors and personal, physical attributes of the candidate were found only for the self-promotion and ingratiation strategies. There is evidence that the use of IM strategies and nonverbal behavior play an important role in the hiring decision...

El objetivo de este estudio que contó con un diseño experimental intrasujetos fue analizar las relaciones entre el manejo de impresiones de candidatos a obtener un empleo y la decisión de contratarlos por parte del entrevistador. Se presentó la descripción de una entrevista para un puesto de nivel medio, incluyendo las respuestas de cinco supuestos candidatos, cada uno de ellos utilizando un tipo de estrategia de manejo de impresiones: autopromoción, insinuación, ejemplificación, intimidación y ruego. Participaron 99 profesionales de recursos humanos, aleatoriamente distribuidos en cada una de las cinco condiciones experimentales. Para poner a prueba las hipótesis se realizaron diversos análisis de correlación, varianza, test de la t y ANOVA que evidenciaron que las estrategias de autopromoción y de ejemplificación fueron las más asociadas a la decisión de contratación. Las estrategias de autopromoción relacionadas con comportamientos no verbales (mantener una postura erguida, mirar fijo a los ojos) también repercuten favorablemente en ser contratado. El tiempo de experiencia del entrevistador incrementa las posibilidades de que el candidato que utiliza una estrategia de autopromoción sea contratado. Las relaciones entre comportamientos no verbales y atributos físicos y personales del candidato sólo resultaron evidentes para las estrategias de autopromoción e insinuación. Hay indicios que el uso de estrategias GI y de comportamiento no verbal tienen un papel importante en la decisión de contratar...

A medida do talento: evidências de validade de uma escala para aferir talento em organizações / The measure of talent: evidence of the validity of a scale to measure talent in organizations

A alta competitividade no mundo dos negócios tem levado organizações a uma disputa agressiva por profissionais de alto talento. Essa disputa tem gerado debates, tanto no âmbito organizacional quanto no âmbito acadêmico, sobre como definir o fenômeno e acessar sua ocorrência na população. Neste estudo revisou-se a literatura referente à conceituação de talento, e formulou-se uma definição mensurável do construto, extensiva a diversos contextos organizacionais. Elaborou-se um conjunto de itens referentes a três dimensões do talento: qualidade, velocidade e autonomia na realização do trabalho. Em seguida, buscaram-se evidências de validade e precisão da medida elaborada. Participaram do teste empírico do instrumento 308 profissionais ativos no mercado de trabalho, 61 por cento homens, em média 35,1 anos de idade. Os participantes responderam um questionário contendo 20 itens referentes ao talento, uma escala de personalidade no modelo dos cinco grandes fatores e questões sobre experiência profissional. Análises exploratórias e confirmatórias, em acordo com a definição do construto, corroboraram a estrutura de três fatores do instrumento. Os índices de precisão de todas as dimensões foram satisfatórios, coeficientes alfa superiores a 0,80. As correlações observadas entre os fatores do talento, de personalidade e experiência profissional fornecem adequadas evidências de validade para o instrumento. Pessoas com altos níveis de talento apresentam escores altos em conscienciosidade, foram promovidas mais frequentemente, e receberam ofertas de trabalho de outras empresas. Discutem-se as possibilidades de uso do instrumento na área acadêmica e em situações aplicadas.(AU)

A great competitiveness in business has led organizations to an aggressive race for top talent professionals. This dispute has generated debates, in both the organizational, and the academic field, about how to define the phenomenon and how to assess its occurrence in the general population. This study reviewed the literature about talent, and proposed a measurable definition of the construct, which can be extended to various organizational contexts. We developed a set of items related to three dimensions of talent: quality, speed and autonomy when performing the work. We then searched for evidence of validity and reliability of the measure. Participants on the empirical test of the instrument were 308 professionals active in the labor market, 61 percent men, mean age 35.1 years. The participants answered a questionnaire containing 20 items related to talent, a personality scale based on the Big Five factors and questions about employment history. Exploratory and confirmatory analyzes, in accordance with the definition of the construct, supported the three-factor structure of the instrument. Reliability indexes of all dimensions were satisfactory, showing alpha coefficients above .80. The observed correlations between talent and personality factors and professional experience provide adequate evidence of validity of the instrument. Individuals with high levels of talent scored high in conscientiousness, received promotions more often and had job offers from other companies. We discuss the possibilities of using the instrument in academic and applied situations(AU)

La alta competitividad en los negocios ha llevado las organizaciones a una disputa agresiva por los profesionales de gran talento. Esta disputa ha generado debates, tanto en el contexto organizacional como en el contexto académico, acerca de cómo definir el fenómeno y estudiar su incidencia en la población. Los autores examinaron la literatura sobre el concepto de talento, y concibieron una definición mensurable del constructo, que se puede extender a diversos contextos organizacionales. Generaron una serie de ítems relacionados con tres dimensiones de talento: calidad, rapidez e independencia en la realización del trabajo. Posteriormente buscaron pruebas de validez y confiabilidad de la medida elaborada. Participantes del test empírico del instrumento fueron 308 profesionales activos en el mercado laboral, 61 por ciento hombres, edad media 35,1 años. Los participantes respondieron un cuestionario con 20 ítems relacionados con talento, una escala de la personalidad en el modelo de los cinco grandes factores y preguntas acerca de la experiencia profesional. Los estudios exploratorio y confirmatorio, de acuerdo con la definición del constructo, fueron compatibles con la estructura de tres factores del instrumento. Los índices de confiabilidad de todas las dimensiones fueron satisfactorios, coeficientes alfa superiores a 0,80. Las correlaciones observadas entre los factores de talento, personalidad y experiencia profesional proporcionaron pruebas suficientes de la validez del instrumento. Las personas con altos niveles de talento tienen puntuaciones altas en responsabilidad, reciben promociones con mayor frecuencia y recibe ofertas de empleo de otras empresas. Se discuten las posibilidades de utilización del instrumento en situaciones académicas y aplicadas.(AU)

A medida do talento: evidências de validade de uma escala para aferir talento em organizações / The measure of talent: evidence of the validity of a scale to measure talent in organizations / La medida del talento: evidencias de la validez de una escala para medir el talento en las organizaciones

A alta competitividade no mundo dos negócios tem levado organizações a uma disputa agressiva por profissionais de alto talento. Essa disputa tem gerado debates, tanto no âmbito organizacional quanto no âmbito acadêmico, sobre como definir o fenômeno e acessar sua ocorrência na população. Neste estudo revisou-se a literatura referente à conceituação de talento, e formulou-se uma definição mensurável do construto, extensiva a diversos contextos organizacionais. Elaborou-se um conjunto de itens referentes a três dimensões do talento: qualidade, velocidade e autonomia na realização do trabalho. Em seguida, buscaram-se evidências de validade e precisão da medida elaborada. Participaram do teste empírico do instrumento 308 profissionais ativos no mercado de trabalho, 61 por cento homens, em média 35,1 anos de idade. Os participantes responderam um questionário contendo 20 itens referentes ao talento, uma escala de personalidade no modelo dos cinco grandes fatores e questões sobre experiência profissional. Análises exploratórias e confirmatórias, em acordo com a definição do construto, corroboraram a estrutura de três fatores do instrumento. Os índices de precisão de todas as dimensões foram satisfatórios, coeficientes alfa superiores a 0,80. As correlações observadas entre os fatores do talento, de personalidade e experiência profissional fornecem adequadas evidências de validade para o instrumento. Pessoas com altos níveis de talento apresentam escores altos em conscienciosidade, foram promovidas mais frequentemente, e receberam ofertas de trabalho de outras empresas. Discutem-se as possibilidades de uso do instrumento na área acadêmica e em situações aplicadas.

A great competitiveness in business has led organizations to an aggressive race for top talent professionals. This dispute has generated debates, in both the organizational, and the academic field, about how to define the phenomenon and how to assess its occurrence in the general population. This study reviewed the literature about talent, and proposed a measurable definition of the construct, which can be extended to various organizational contexts. We developed a set of items related to three dimensions of talent: quality, speed and autonomy when performing the work. We then searched for evidence of validity and reliability of the measure. Participants on the empirical test of the instrument were 308 professionals active in the labor market, 61 percent men, mean age 35.1 years. The participants answered a questionnaire containing 20 items related to talent, a personality scale based on the Big Five factors and questions about employment history. Exploratory and confirmatory analyzes, in accordance with the definition of the construct, supported the three-factor structure of the instrument. Reliability indexes of all dimensions were satisfactory, showing alpha coefficients above .80. The observed correlations between talent and personality factors and professional experience provide adequate evidence of validity of the instrument. Individuals with high levels of talent scored high in conscientiousness, received promotions more often and had job offers from other companies. We discuss the possibilities of using the instrument in academic and applied situations

La alta competitividad en los negocios ha llevado las organizaciones a una disputa agresiva por los profesionales de gran talento. Esta disputa ha generado debates, tanto en el contexto organizacional como en el contexto académico, acerca de cómo definir el fenómeno y estudiar su incidencia en la población. Los autores examinaron la literatura sobre el concepto de talento, y concibieron una definición mensurable del constructo, que se puede extender a diversos contextos organizacionales. Generaron una serie de ítems relacionados con tres dimensiones de talento: calidad, rapidez e independencia en la realización del trabajo. Posteriormente buscaron pruebas de validez y confiabilidad de la medida elaborada. Participantes del test empírico del instrumento fueron 308 profesionales activos en el mercado laboral, 61 por ciento hombres, edad media 35,1 años. Los participantes respondieron un cuestionario con 20 ítems relacionados con talento, una escala de la personalidad en el modelo de los cinco grandes factores y preguntas acerca de la experiencia profesional. Los estudios exploratorio y confirmatorio, de acuerdo con la definición del constructo, fueron compatibles con la estructura de tres factores del instrumento. Los índices de confiabilidad de todas las dimensiones fueron satisfactorios, coeficientes alfa superiores a 0,80. Las correlaciones observadas entre los factores de talento, personalidad y experiencia profesional proporcionaron pruebas suficientes de la validez del instrumento. Las personas con altos niveles de talento tienen puntuaciones altas en responsabilidad, reciben promociones con mayor frecuencia y recibe ofertas de empleo de otras empresas. Se discuten las posibilidades de utilización del instrumento en situaciones académicas y aplicadas.

Modelos lógicos e avaliações de treinamentos organizacionais / Logic models and organizational training evaluations / Modelos lógicos y evaluaciones de entrenamientos organizacionales

A área de treinamento tem produzido pouco sobre análises organizacionais, de forma que avaliações de treinamento em níveis abrangentes tendem a ser escassas na literatura científica. Este estudo teve por objetivo propor um modelo lógico de avaliação de treinamento sobre o desempenho de uma organização pública, bem como testar sua avaliabilidade. Para tanto, foi realizada entrevista coletiva com 11 funcionários para identificação de treinamento capaz de alterar o desempenho da organização, entrevista com um funcionário para escolha de indicadores de desempenho organizacional sensíveis ao treinamento, entrevistas com sete funcionários com vistas à seleção de material para proposição do modelo, grupo focal com 28 funcionários para validação do modelo lógico. Ainda que a avaliabilidade do curso não tenha sido plenamente constatada, o modelo lógico permitiu a clarificação das relações entre o treinamento e o desempenho organizacional, principal entrave em processos avaliativos desta natureza.(AU)

The area of personnel training has produced little about organizational analysis, so that evaluations at broader levels of analysis tend to be scarce in the literature. This research aimed to propose a logic model for training evaluation on the performance of a public organization, as well as test their evaluability through: group interview with 11 employees to identify a training capable of impacting the organization's performance, interview with a qualified employee to choose organizational performance indicators sensitive to the selected training, interviews with seven employees to select material for the proposition of the model, and focus group with 28 staff members to validate the logic model. Although the evaluability of the training model has not been fully established, the logical model has served to clarify the possible relationship between training and organizational performance, the main obstacle in evaluation processes of this nature.(AU)

El área de entrenamiento ha producido pocos análisis organizacionales, por lo que evaluaciones de la formación en niveles más amplios tienden a ser poco frecuentes en la literatura científica. Esta investigación objetivó proponer un modelo lógico para evaluar el impacto de una capacitación en el desempeño de una organización pública, así como poner a prueba su posibilidad de evaluación. Para ese fin, fue llevada a cabo una entrevista colectiva con 11 empleados para identificar una formación con la posibilidad de modificar el desempeño de la organización, entrevista con un trabajador para elección de los indicadores de desempeño de la organización sensibles a la formación, entrevistas con siete empleados para elección de los materiales para la composición del modelo, grupo focal con 28 funcionarios para validar el modelo lógico. Aunque la evaluabilidad del curso no fue totalmente verificada, el modelo sirvió para aclarar las relaciones entre la formación y el desempeño de la organización, principal obstáculo en ese tipo de evaluaciones.(AU)

Modelos lógicos e avaliações de treinamentos organizacionais / Logic models and organizational training evaluations / Modelos lógicos y evaluaciones de entrenamientos organizacionales

A área de treinamento tem produzido pouco sobre análises organizacionais, de forma que avaliações de treinamento em níveis abrangentes tendem a ser escassas na literatura científica. Este estudo teve por objetivo propor um modelo lógico de avaliação de treinamento sobre o desempenho de uma organização pública, bem como testar sua avaliabilidade. Para tanto, foi realizada entrevista coletiva com 11 funcionários para identificação de treinamento capaz de alterar o desempenho da organização, entrevista com um funcionário para escolha de indicadores de desempenho organizacional sensíveis ao treinamento, entrevistas com sete funcionários com vistas à seleção de material para proposição do modelo, grupo focal com 28 funcionários para validação do modelo lógico. Ainda que a avaliabilidade do curso não tenha sido plenamente constatada, o modelo lógico permitiu a clarificação das relações entre o treinamento e o desempenho organizacional, principal entrave em processos avaliativos desta natureza.

The area of personnel training has produced little about organizational analysis, so that evaluations at broader levels of analysis tend to be scarce in the literature. This research aimed to propose a logic model for training evaluation on the performance of a public organization, as well as test their evaluability through: group interview with 11 employees to identify a training capable of impacting the organization's performance, interview with a qualified employee to choose organizational performance indicators sensitive to the selected training, interviews with seven employees to select material for the proposition of the model, and focus group with 28 staff members to validate the logic model. Although the evaluability of the training model has not been fully established, the logical model has served to clarify the possible relationship between training and organizational performance, the main obstacle in evaluation processes of this nature.

El área de entrenamiento ha producido pocos análisis organizacionales, por lo que evaluaciones de la formación en niveles más amplios tienden a ser poco frecuentes en la literatura científica. Esta investigación objetivó proponer un modelo lógico para evaluar el impacto de una capacitación en el desempeño de una organización pública, así como poner a prueba su posibilidad de evaluación. Para ese fin, fue llevada a cabo una entrevista colectiva con 11 empleados para identificar una formación con la posibilidad de modificar el desempeño de la organización, entrevista con un trabajador para elección de los indicadores de desempeño de la organización sensibles a la formación, entrevistas con siete empleados para elección de los materiales para la composición del modelo, grupo focal con 28 funcionarios para validar el modelo lógico. Aunque la evaluabilidad del curso no fue totalmente verificada, el modelo sirvió para aclarar las relaciones entre la formación y el desempeño de la organización, principal obstáculo en ese tipo de evaluaciones.

Is It All Relative? Comparative Judgments and the Possible Improvement of Self-Ratings and Ratings of Others.

We argue that various types of evaluative social judgments about the self or others (e.g., employee job performance ratings, self-reported attitudes, ratings of others' traits) may be obtained more accurately using comparative ratings rather than absolute ratings. Comparative ratings involve relative judgments of a target in comparison with other individuals or groups, whereas absolute ratings involve judgments of a target on scales that do not explicitly reference other people. In industrial-organizational, social, and personality psychology research that has compared the validity of comparative and absolute ratings, we have found evidence of more valid measurement as a result of comparative judgmental ratings, despite the nearly exclusive reliance on absolute judgmental ratings in these areas. We offer a social cognitive and evolutionary explanation in support of the hypothesis that humans may often be able to make more accurate ratings using comparative measures. We also recommend an agenda for greater exploitation and understanding of relative judgments in psychological research and practice.

The nursing aspect of clinical audit.

PIP: Nurses in the UK play a significant role in the delivery of family planning (FP) services, especially in the areas of counseling and provision of routine health checks. Clinical audits of delivery of FP services, therefore, should follow a whole team approach which includes nurses. It is also easier to achieve the desired changes in practice after an evaluation if the whole service delivery team is involved in the audit. Audits of nursing practice available in a database include 1) administration of hormonal contraception and hormonal postcoital contraception, 2) the role of nurses in clinics, and 3) nurse-only clinics. Audits may also be considered to evaluate nurse counseling on topics such as choosing a contraception, effective condom use, and effective oral contraceptive use.^ieng

Assessing the impact of training on staff performance.

PIP: This pretested document was prepared as a management and reference tool for a world-wide audience of family planning (FP) policy-makers, program managers, service managers, and trainers. The report describes a training impact evaluation (TIE) process that helps managers identify and strengthen the links between training and staff performance. Introductory information deals with understanding training evaluation, the various types of training evaluation, and conducting a TIE. The following steps of the TIE process are then described: 1) identifying job performance issues (defining key job-related tasks and choosing indicators/setting standards); 2) collecting data (evaluation techniques and instruments, how to design an effective evaluation instrument, sample definition, and how to plan and organize the data collection process); 3) analyzing the data (tabulation, aggregation, cross-tabulation, and disaggregation); 4) interpreting the data (using a decision-tree); 5) reporting the findings (developing a written report and making an oral presentation); and 6) making changes (responsibilities for acting on recommendations, handling resistance to change, agreeing on a new or revised training course and/or changing organizational procedures or systems, and clarifying expectations for a training event). An example is provided of the process and results of a TIE conducted in the Central Asian Republics. The report ends with a discussion of ways to continue the TIE process, the comments of reviewers about various aspects of the process, and a checklist to use when making a TIE.^ieng

Situation analysis study establishes baseline for future assessment of progress in Senegal.

PIP: A situation analysis study was conducted by the National Family Planning Program of the Senegalese Ministry of Health and Social Action, with technical assistance from the Population Council's Africa OR/TA Project II, to evaluate the availability, functioning, and quality of family planning (FP) services at all 180 functional Service Delivery Points (SDPs) of Senegal's ten regions. Almost one-third of the SDPs had not received a supervisory visit in the seven months prior to the study, and an additional one-fifth had had no supervisory visits at all. 6% had written job descriptions for their personnel, 8% had a plan of activities, and 2% had an objective in terms of the number of clients to serve. Clinic infrastructure was generally satisfactory, although electricity and water were lacking in 30% of SDPs in rural areas. Six out of 87 SDPs in the urban sector had the minimum equipment needed. The majority of FP providers were midwives whose formal training had been limited to the management of pills and IUDs; 32% of providers had no training in administering injectables. Information, education, and communication materials were unavailable at most SDPs. 6% featured FP talks on site on the day of the research visit; six out of ten lacked a visible sign indicating the availability of FP services. On average, FP services were available four days a week, but 53% of the SDPs started services an hour late on the day of the research visit, and many were limited to four hours of service per day. 67% provided injectables, and 78% supplied IUDs. Inadequate management of contraceptive stock was partly responsible for method shortages. Records were incomplete. 81% of new clients had access to and obtained their preferred contraceptive method; however, other appropriate methods were not discussed during consultations, and counseling on method side effects was inadequate. 56% of new clients were asked about their reproductive intentions. Counseling regarding sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) was practically nonexistent. Health problems found during FP consultations were rarely addressed. Non-medical barriers to the utilization of contraceptive methods existed in terms of age, parity, and marital status. Client waiting time was long, while consultation time was short. Most women had follow-up dates on their identification cards; 95% were told to return for supplies. The majority of clients were generally satisfied.^ieng

Using situation analysis data to assess the functioning of family planning clinics in Nigeria, Tanzania, and Zimbabwe.

Situation analyses conducted in Nigeria. Tanzania, and Zimbabwe have revealed problems in the functioning of many of the subsystems of family planning service delivery, namely in supplies of commodities; in facilities and equipment; in staffing and training; in information, education, and communication; and in record keeping. Although a clear pattern of clinic use exists, in that only a few service-delivery points provide contraceptive services to the majority of new family planning acceptors in the three countries, an attempt to explain how clinics with more clients differ from those that are visited less frequently revealed only a weak association between subsystem functioning and use.

PIP: Family planning specialists analyzed subsystem data and the pattern of clinic use from family planning clinics in Nigeria, Tanzania, and Zimbabwe to illustrate how situation analysis can help program managers identify service delivery problems, possible remedial actions, and needs in a clear manner and evaluate specific interventions to improve the quality of family planning services. The Nigerian study included service delivery points in only 6 states. The Tanzanian and Zimbabwean studies included service delivery points countrywide. The researchers examined the functioning of family planning subsystems. They found considerable problems in supplies of contraceptive methods, in facilities and equipment, in staffing and training, in IEC (information, education, and communication), and in record keeping. In Nigeria, just 37% of service delivery points had disposable gloves. Only 56% of facilities had adequate water available in the examination area. In Zimbabwe, 84% and 86% of service delivery points did not have IUDs and injectables, respectively, which limited contraceptive choice. Tanzania had the most problems with subsystem functioning. Few service delivery points in any country provided contraceptive services to most new clients. Thus, there is much room to expand family planning services in most facilities which have few clients. A weak positive association existed between subsystem functioning and use, so the researchers could not explain the variation in number of new acceptors by level of subsystem functioning. They suggested a return visit to a few service delivery points, for a longer stay, as a way to learn ways the active facilities differ from the inactive facilities.

A situation analysis study of the Nairobi City Commission family planning clinics. Selected findings.

PIP: The Africa OR/TA Project assisted the Nairobi City Commission (NCC) in conducting a situation analysis of its 46 family planning clinics. An important element in Kenya's national family planning program, NCC provides more than 1/2 of all family planning services in Nairobi and accounts for more than 1/3 of all family planning acceptors in Kenya. In order to upgrade NCC services, researchers conducted staff and client interviews and observed provider-client interactions. In addition to quality of care, the study evaluated the functioning of each major family planning subsystem; logistics/supplies, facilities, staffing, training, supervision, IEC, and record keeping. The study found that record keeping and logistics were functioning relatively well, and that IEC activities compared favorably with the national family planning program. Significant problems, however, were noted in training, supervision, and equipment. Only 15% of nurses had undergone refresher training, about 1/2 of the staff reported receiving no external supervision, and essential equipment was either missing or not working in many clinics (39% of clinics lacked working sterilizers). Concerning quality of care, clients were receiving information on a range of contraceptive methods, and clients provider-client relations were generally good. But waiting times were long, service hours were curtailed unnecessarily, and often, clients received inadequate information on how to manage side-effects. More significantly, the study found low provider competence (only 49% of clients received aseptic services). As a result, NCC clinics scored low on quality of care.^ieng

A comparison of the performance of male and female CBD distributors in Peru.

This report presents the results of an operations research project to increase male involvement in family planning in Peru. Two community-based distribution (CBD) programs, PROFAMILIA of Lima and CENPROF of Trujillo, Peru, recruited male contraceptive distributors and compared their performance to that of female distributors recruited at the same time. Both programs found it harder to recruit men than women as distributors. Program supervisors, who were women, were less comfortable with men than with other women, even though there were no differences in distributor compliance with program norms. Male distributors were more likely to serve male clients and sell male methods (condoms), while female distributors were more likely to serve female clients and sell female methods (pills). Men sold as much or more total couple-years of protection than did women, and they recruited as many or more new acceptors. Gender was found to exert an impact on method mix independent of other distributor characteristics, such as age, education, marital status, and number of living children. The study suggests that family planning programs can influence method mix and client characteristics by recruiting men as CBD distributors.

PIP: The findings of an operations research (OR) project designed to compare the effectiveness of male vs. female contraceptive distributors in Peru are reported. The OR project was conducted by 2 private, nonprofit family planning agencies that have community-based distribution (CBD) programs: PROFAMILIA in Lima and CENPROF in Trujillo. The OR project sought to test 3 hypotheses: 1) male distributors would sell more condoms and female distributors would sell more oral contraceptives; 2) male distributors would serve more male clients and female distributors would serve more female clients; and 3) male distributors would sell less contraceptive protection than female distributors. Between 1987 and January 1988, the 2 agencies recruited new male and female distributors to serve in the project. Both agencies had a more difficult time recruiting male than female distributors. PROFAMILIA recruited 38 men and 171 women, while CENPROF recruited 52 men and 94 women. All but one of the supervisors in both agencies were female. The supervisors generally regarded the male distributors with skepticism, but the study found no significant difference in the reporting compliance of male and female distributors. The project confirmed hypotheses 1 and 2. In both agencies men sold twice as many condoms as did women, and women sold more oral contraceptives; and male distributors were more likely to serve men, while female distributors were more likely to serve women. The 3rd hypothesis, however, was unsupported. Men sold as much or more contraceptive protection than did women and recruited as many or more new acceptors. It is concluded that men can be effective CBD distributors, and that CBD programs can influence method and client mix by recruiting more men as distributors.

[Quality of care in family planning clinical services in Latin America]. / Calidad de atencion en los servicios clinicos de planificacion familiar en America Latina.

PIP: Quality of care in family planning is a difficult concept to measure because of the multitude of factors contributing to it and the subjective nature of many of them. Because family planning programs were developed largely in response to rapid demographic growth, their evaluation has concentrated on fulfillment of quantified goals such as numbers of new users, coverage, or prevalence. Such measures give no indication of the relative satisfaction or dissatisfaction of users. Family planning programs seeking high volume tend to have many new acceptors with low continuation rates, and a choice of methods limited to those considered highly effective and easy to distribute. In most Latin American programs, only oral contraceptives and surgical sterilization have high prevalence rates. In recent years, however, community pressure for greater attention to users needs and disappointment with results of programs oriented to obtaining high rates of new users have prompted greater attention top satisfaction of family planning clients and to quality of services. A recent review identified 6 crucial elements in determining the quality of family planning care: 1) free and informed selection of methods 2) information provided to clients 3) technical competence of service providers 4) interpersonal relations between clients and workers 5) mechanisms to promote continuation of use and 6) adequate provision of additional services. This work surveys the quality of family planning services in Latin America, using these 6 factors as a point of departure. The current situation, the ideal and minimal acceptable levels, and the most promising strategies for achieving improvements are assessed for each factor. Free selection of contraceptive method is restricted in most Latin American family planning programs because access is limited to a few methods, because inadequate information is provided to users, because high prices of some methods limit accessibility, or because some methods are considered inappropriate for particular clients or populations. The information provided to clients may be incomplete or biased, the personnel providing it may be inadequately trained, information provided by different types of workers may be incoherent of conflicting, or information provision may be neglected once the method has been chosen. Great regional differences have been found in the technical competence of family planning workers. Physicians working in family planning are usually technically competent for the most common techniques but often lack adequate training in other methods. Interpersonal relations often show a lack of concern for the needs of the client, a lack of warmth, and lack of respect for elementary modesty and privacy. Operational studies can be of great use in comparing results of different strategies to improve the quality of care on contraceptive acceptance and continuation rates.^ieng

Psychosocial aspects of NFP instruction: a national survey.

PIP: This publication reports and evaluates the findings of a national survey of natural family planning (NFP) teachers throughout the US, an effort to gather information concerning the preparation of NFP teachers in addressing the psychosocial problems encountered by couples. The survey involved NFP teachers representing several methods of instruction, including the ST method (Couple to Couple and other ST groups) and the OM (Billings, Twin Cities, and Creighton Model). Chosen from NFP teacher directories, 398 teachers responded to the survey. The survey inquired about the teacher's perceptions of the following: 1) the incidence and prevalence of psychosocial problems; 2) the degree to which they are prepared to manage such problems; and 3) the extent to which they refer couples to mental health or social services organizations. While the author acknowledges the methodological limitations of the study, he explains that the data reveals definite differences concerning the training and orientation of NFP teachers as it relates to the discussion of psychosocial problems. OM-Creighton teachers, who were more apt to teach in medical rather than nonmedical settings, expressed a higher degree of preparation. Teachers with psychosocial training also generally cored high in preparation. The results indicate that NFP teaching method, exposure to psychosocial issues during training, teacher perception of his or her preparedness to manage such problems, and continuous rather than discrete contact with clients are some of the leading factors involved in the teachers level of preparedness. The author discusses the implications of the study and provides recommendations.^ieng

Health care provider and contraceptive care setting: the relationship to contraceptive behavior.

This study examines contraceptive delivery characteristics and their association with contraceptive behavior. Data were collected in telephone interviews from a national sample of 1057 women who were using female contraceptives. The overwhelming majority of the sample obtained contraceptive services from gynecologists and other physician specialists and were seen in private facilities. Whereas nearly half of the providers recommended use of specific methods, only one-fourth discouraged use of particular methods. The pill was both the most frequently recommended and most commonly discouraged method. With regards to the provision of contraceptive information, practitioners were most likely to discuss the effectiveness of a method. In three of the four categories examined, a higher percentage of non-MDs than MDs gave information to their patients. Although the majority of women reported they were satisfied with the quality of care, mean satisfaction ratings were higher for female providers compared to male providers.

PIP: This study examines contraceptive delivery characteristics and their association with contraceptive behavior. Data were collected in telephone interviews from a national sample of 1057 women who were using female contraceptives. The overwhelming majority of the sample obtained contraceptive services from gynecologists and other physician specialists and were seen in private facilities. Whereas nearly half of the providers recommended use of specific methods, only 1/4 discouraged use of particular methods. The pill was both the most frequently recommended and most commonly discouraged method. With regards to the provision of contraceptive information, practitioners were most likely to discuss the effectiveness of a method. In 3 of the 4 categories examined, a higher percentage of non-MD's than MD's gave information to their patients. Although the majority of women reported they were satisfied with the quality of care, mean satisfaction ratings were higher for female providers compared to male providers.

Analyzing nurse-client interactions in family planning clinics.

PIP: The nurse-client interactions of 12 taped interviews in 2 family planning clinics were analyzed using 5 client self-care themes and 9 provider responses, and the results discussed in terms of Orem's self- care theory. The taped sessions took place at a Planned Parenthood and a health department clinic. content analysis were verified by outside raters trained in the methods selected. CLient responses emphasized past practice (29%) and knowledge (28%), over current intent to practice self-care (22%) and decision processing (19%). The nurses responded most often by asking questions and providing information, and less often by restatement, directives, support or suggestions. This pattern was found regardless of the nurse's education. The emphasis by nurses on providing information is likely a result of the agencies' focus on ensuring that the client makes an informed and voluntary choice. Research has shown, however, that new contraceptors' contraceptive continuation is correlated with support and even authoritative guidance given by the provider.^ieng

Barriers to modern contraceptive use in rural Peru.

This paper examines Quechua-speaking Indians' choice of contraceptive methods and discusses barriers to the use of modern contraceptives. A study conducted in a Peruvian highland community shows that contraceptive choice is strongly related to a couple's life experiences, their contact with urban centers, their economic status, and their emphasis on cultural values. Among contraceptive users, husbands are concerned with family size and encourage their wives to seek information about the use of modern contraceptives. A discrepancy in attitudes exists between spouses: the men's positive attitude toward modern contraception contrasts with the women's traditional desire for a large family. In this study population, modern contraception is a novelty that has reached only a few families. The majority of the couples practice natural and traditional family planning methods, which are not reliable. Villagers do not use modern contraceptives as a result of cultural barriers created by family planning services that do not take into account the lifestyle of these people, insufficient knowledge of human physiology, comments from dissatisfied users, and women's reliance on their reproductive role for self-esteem.

PIP: This paper, based on fieldwork done in 1984 in a Peruvian highland community with a population of about 3,500, examines Quechua-speaking Indians' choice of contraceptive methods and discusses barriers to the use of modern contraceptives. The village is poor, with many of the villagers involved in migrant labor, but there have been modernization influences: most villagers are bilingual, men average 8 years of schooling and wives 6. Government family planning programs (FP) were initiated at the local health post in 1982. This study, sampling 54 couples, 2/3 in consensual unions shows 1st pregnancy is usually at 18, and about 5 live births take place by age 31. Only 12 couples reported not using any form of contraception, 27 unreliable natural or traditional methods, and 15 modern methods. Non-contracepting women tended to breastfeed longer and have less schooling, and tended not to be working full-time. Contraceptive choice is strongly related to a couple's life experiences, their contact with urban centers, their economic status, and their emphasis on cultural values. Among contraceptive users, some husbands are concerned with family size (for economic, child welfare, and health reasons) and encourage their wives to seek information about the use of modern contraceptives. A discrepancy in attitudes exists between spouses: men's positive attitude toward modern contraception contrasts with women's traditional desire for a large family. Villagers do not use modern contraceptives because of barriers created by FP services that do not take into account the lifestyle of these people (e.g. language, work hours, respect for privacy), disturbing and poorly explained side-effects, especially of pills and injected depo-provera, insufficient knowledge of human physiology, contraception failures due to inappropriate use (often because of poor explanations by health post staff), comments from dissatisfied users, and women's reliance on their reproductive role for self-esteem.

Role of village practitioners in family planning service delivery system.

PIP: The acceptability of village practitioners (VPs) as providers of family planning service and their efficiency in delivery of such services is assessed. 120 VPs were selected on stratified random sample basis from 4 Thanas in Malaysia and were trained for 21 days on different aspects of family planning, MCH diagnosis and treatment of common ailments. Regular monthly meetings at the respective Thana Health Complexes were held to assess the progress of work on clinical discussion and for problem solving. The VPs showed interest in the training program and opined that such training programs should be organized on a continual basis. After training, the VPs were actively involved in distribution of contraceptives and referral of patients for clinical methods for 1 year. The compiled progress report on distribution of contraceptives in monthly meetings shows that the VPs contributed to 37% of the total performances of the population control division in the 4 Thanas. The use of contraceptives improved during the experimental project. 50% of the males and 36% of the females reported current use of contraceptives compared to 23% in the National Program.^ieng