Summary of Findings

A total of 106 questionnaires from 47 individuals were received.  Most participants returned more than one questionnaire, as they attended three different TUTOR training sessions.  Informant interviews, using the questionnaire as a guideline, were conducted during the training session in Surket, Mid-Western, Nepal, and during group sessions at NPHL, Kathmandu.

Computer skills of participants:

Over 50% of the participants had never used a computer before, and 37 or 79% rated themselves as beginner computer users.  Only 15 students felt confident that they could use the interactive TUTOR programs without the help of an instructor. 26 participants thought that they needed support by a teacher and 6 felt they would not be able to use the TUTOR programs independently.

Therefore, for this first evaluation, individual use of the TUTOR programs, for self-paced learning seemed difficult and plenary training sessions and group sessions supported by an instructor seemed most appropriate.

During the third day of the training program, several participants used the TUTOR program sitting in front of a 19-inch computer screen while others gathered behind.  All individual users had some difficulties maneuvering their way through the program; guidance by a trainer was required.  However, even those who had no prior computer knowledge grasped the mechanics fairly easily and could use the program after instructions on use of mouse and some practice.  It was encouraging to see that during these individual learning sessions both experienced technologists and laboratory assistants interacted with great enthusiasm learning from the TUTORs and from each other.

In Nepal, like in many developing countries, students are accustomed to learning styles as described by Freire (13), with teacher-narrated lectures and the student at the receiving end.  In this context it is understandable that students have to get gradually accustomed to an interactive, self-paced learning style.

Educational background of participants:

The participants in the study were 29 laboratory assistants, who completed one year non-academic, vocational training; 8 laboratory technicians, who attended two-year academic training in medical laboratory technology; 8 technologists, with a bachelors degree in laboratory technology; 1 pathologist and 1 pharmacist.

Teaching method:

Considering that many participants were not familiar with the use of computers it is important to note that 81% of participants thought the method of instruction was easy to understand.  The majority 43/47 considered the computer-aided interactive software programs a better way of teaching image-based laboratory test than teacher-narrated lectures supported by textbook-based images.  92% of the participants felt that the systematic and step-by-step description of the TUTOR programs was closer to practical work and that the visual images supported learning retention better than imaginary images of a lecture.  Some commended the interactive aspect of the TUTOR programs as it allowed self-paced learning, and comparison of normal and rare pathogenic images, while asking questions at the same time.

Digitized images quality:

The digitized microscope images of the TUTOR programs were perceived by many participants to be comparable to patient samples.  Some remarked further that the images were superior to photographic images in textbooks as the digitized computer images had the same dimension as microscopic images.  

On the other hand, 27% of participants commented that the images of the TUTOR program were not comparable to what they usually saw under the microscope during routine work.  Most attributed this discrepancy to inferior quality of microscopic images due to poor quality of stains available at their laboratories.

In Nepal, image-based laboratory tests are taught through lectures, often not even supported by textbook images.  When textbook images are at hand, the image quality is often poor and few available textbooks have to be shared by a sizeable student body. At peripheral laboratory units, there is a general lack of supervision and the quality of stains and reagents is often questionable. 

Learning transfer:

Resource-based learner-centered learning tools, such as the TUTOR programs facilitate learning transfer from the classroom to the workplace. The TUTOR program eases the transition between the classroom and the work environment as described by Wills (14).  Participants particularly noted that the TUTOR program�s teaching method was closer to practical work. Supervised bench-level instructions and practical work did not provide them with enough opportunities to see rare pathogenic specimens. Participants perceived that the TUTOR programs were systematic, easy to understand and that the digitized microscopic images made it easier to remember details.  All participants suggested that other subjects be taught in this way.

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The Public Health Care Laboratory - 2001 � Gabriele Mallapaty