Novel approaches to empowering health workforce: a scoping review

Abstract

Background

The development of health workers is crucial for achieving national and global health objectives. This study aims to identify novel methods and approaches for empowering the health workforce through in-service training.

Methods

A scoping review was conducted following the Arksey and O'Malley framework in five steps. A comprehensive search was performed in three databases—PubMed, Web of Science, and Scopus—using MeSH terms and keywords until December 4, 2022. The study utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to carry out the investigation and present the results.

Results

A total of 3257 articles were retrieved, of which 34 articles were included in the scoping review. The majority of the articles (n = 23, 68%) were published between 2018 and 2022, with physicians being the primary target group (n = 16, 47%). Most studies employed a combination of several methods, with simulation methods, virtual training, practical and field training, coaching, group interaction, flipped classrooms, case studies, peer experiences, teaching through surveys and research, small group training, and problem-solving approaches being the most commonly used strategies.

Conclusion

Implementing innovative training methods to empower healthcare personnel enhances skills, improves training effectiveness, and ultimately leads to better performance and the delivery of higher-quality healthcare services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12960-026-01079-7.

Background

Trained and empowered human resources are the primary assets of an organization [1, 2], playing a crucial role in its growth, dynamics, and achievement of its goals [3, 4]. To develop these resources, training is viewed a competitive advantage that organizations consistently leverage to improve quality, performance, and problem-solving capabilities [5]. Furthermore, organizations must recognize their employees as vital investments for the future, ensuring they can optimize the use of their human resources when necessary [6].

In the health sector, the development of empowered and motivated health workers is pivotal for achieving global and national health goals [7], as well as for delivering quality health services [8, 9]. Conversely, the lack of development among health workers can hinder the success of health system policies. In-service training strategies are employed to enhance performance [10], and should be designed to increase the competencies and skills of the healthcare workforce [11]. However, studies have raised important questions regarding the effectiveness of training programs [12].

To address these challenges and improve educational outcomes, it is essential to adopt new educational models that not only enhance theoretical knowledge but also improve technical capacity, service quality, and encourage innovation [13]. Consequently, this study aims to identify innovative methods and approaches for empowering the health workforce through in-service training.

Methods

In this study, the scoping review approach developed by Arksey and Malley's was employed [14]. The approach consists of five steps: identifying the research questions, identifying relevant studies, selecting studies for inclusion, charting data, and summarizing and reporting the results.

Step 1: identifying the research question

The study aimed to answer the following research questions:

1. What new methods have been utilized in different countries to train and empower the health workforce?

2. What are the outcomes associated with the use of these methods?

3. What limitations or challenges have been identified to these methods?

Step 2: identifying relevant studies

To identify relevant studies, a comprehensive search was conducted in three databases: PubMed, Web of Science, and Scopus until December 4, 2022. Additionally, search engines such as Google Scholar were utilized. Mesh terms and keywords were employed in the search strategy, including "continuing professional development" OR "In-service training" OR "on-the-job training" OR "continuing medical education") AND (new OR effective OR improve OR strengthening OR reinforce OR Enhance) AND (model OR approaches or framework).

Step 3: study selection

The search results were imported into EndNote software (Thomson Reuters/version X8). After removing duplicates and applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) [15], articles were screened based on their title and abstracts. Full texts of the remaining articles were then reviewed, and those meeting the inclusion and exclusion criteria were included in the scoping review. To ensure data validity, two independent reviewers conducted the study selection process, and disagreements were resolved through consensus.

Inclusion criteria comprised articles that examined the implementation or utilization of new approaches, models, or methods for empowering or training human resources, studies published in English, articles with full-text accessibility, and studies conducted between 2000 and 2022. Exclusion criteria were studies for which full texts were not available.

Step 4: charting the data

Data charting was carried out using a customized Excel form. The form included general information such as the title, first author, publication year, and country, as well as specific details about the study objectives, methods, main findings, limitations, and other relevant information.

Step 5: collating, summarizing, and reporting the results

Data summarization was conducted in line with the research objectives. Initially, one researcher collected and reported the data. To enhance the study's validity, several articles were independently reviewed and their information was extracted by another researcher. The information obtained from the two reviewers was then compared, and any disagreements were resolved through consensus.

Results

A total of 3257 articles were obtained initially. Out of these, 225 duplicated articles were excluded. The remaining 3032 articles underwent screening based on their titles. During this screening process, 1182 articles were excluded. The remaining 1283 articles were then selected for abstract reading. From these, 101 articles were further selected for full-text reading. Finally, 34 articles were included in the scoping review (Fig. 1).

Fig. 1.

Study selection based on the PRISMA flow diagram

Study characteristics

Supplementary Table 1 presents the characteristics of the included studies. Among the 34 articles included, the majority (n = 23, 68%) were related to the years 2018–2022 [16–38]. The next most common period was 2013–2017 (n = 7, 20%) [11, 39–44], followed by 2008–2012 (n = 4, 12%) [45–48]. The studies were conducted in different countries, with the highest number of articles originating from Canada (n = 7, 20%) [22, 24, 25, 28, 30, 38, 48]. Other countries with multiple articles included the United States (n = 4, 13%) [23, 31, 32, 39], England, Taiwan, China, the Philippines, and Croatia (two articles each) [16–21, 26, 29, 45], and Norway, Iran, Japan, India, Malawi, Cambodia, and South Africa each having one article [11, 35, 36, 42–44, 46]. There was one study conducted jointly in Sweden and Bosnia [27], and another study included participants from various countries such as America, India, England, Italy, Spain, Brazil, Australia, Portugal, and Argentina [33]. Additionally, four studies were reviews or commentaries [37, 40, 41, 47] (Table 1).

Table 1.

Study characteristics

Study characteristics (n = 34)	N (%)
Year
2018–2022	23(68%)
2013–2017	7 (20%)
2008–2012	4 (12%)
Country
Canada	7 (20%)
USA	4 (13%)
England, Taiwan, China, Philippines, Croatia	10 (29%)
Iran, Malawi, Japan, Cambodia, South Africa, India	6 (18%)
Several countries	2 (6%)
Study type
Original article	18 (52%)
Report	5 (15%)
Innovation in education	4 (12%)
Methodology	3 (9%)
Other (commentary, short communication, action, short review)	4 (12%)
Target group
Physicians	16 (47%)
Health experts	6 (18%)
Pharmacists	2 (6%)
Nurses	2 (6%)
Other health workers	8 (23%)
The novel approaches mentioned in the studies
Simulation	10
Virtual learning	11
Practical and field training	8
Coaching and group interaction	7
Flipped classroom and case study	6
Using peer experiences	6
Teaching by survey and research	3
Training in small groups	3
Problem-solving approach	2

Regarding the types of studies included in the scoping review, the majority were original articles (n = 18, 52%) [11, 16, 18–21, 24, 26, 27, 29, 32, 34, 38, 43–46, 48], followed by reports (n = 5, 15%) [17, 22, 23, 40, 41], innovations in education (n = 4, 12%) [25, 28, 39, 42], methodology (n = 3, 9%) [30, 31, 35], and one each of short review, short communication, action, and comment (total of 12% for these categories) [33, 36, 37, 47] (Table 1).

The target groups of the studies varied, with the most common being physicians (n = 16, 47%) [17, 20, 22, 23, 25, 30–35, 37, 39, 40, 46, 47]. This was followed by health experts (n = 6, 18%) [19, 24, 26, 36, 42, 43], nurses (n = 2, 6%) [11, 38], pharmacists (n = 2, 6%) [18, 45], various health professions (n = 2, 6%) [21, 27], and one case each for other target groups [16, 28, 29, 41, 44, 48] (Table 1).

The findings revealed that most studies utilized a combination of methods. Among these, simulation methods and virtual training were the most commonly used (n = 10) [24, 25, 29, 30, 34, 37, 40–42, 46], followed by practical and field training (n = 8) [19, 23, 27, 29, 31, 34, 43, 45], coaching, (n = 7) [23, 31, 36–39, 47], group interaction (n = 7) [19, 21, 27, 29, 33, 36, 40] flipped classroom (n = 6) [18, 20, 23–25, 31], case study (n = 6) [18, 19, 38, 39, 43, 48], using peer experiences (n = 6) [32, 35, 41, 42, 46, 47], teaching through survey and research (n = 3) [27, 40, 48], training in small groups (n = 3) [41–43], and problem-solving approach (n = 2) [11, 31]. Other methods mentioned in the studies included role-playing, presentation of short and video modules, presentation of real videos of patients' lives, presentation of real-life examples, storytelling, face-to-face training, training through interdisciplinary teams, and cascade training (Table 1).

Study results

The results showed that the combination of methods used and the implementation of new empowerment approaches revealed improved knowledge levels among participants. One of the methods that is predominantly used is simulation. In particular, simulation was considered a suitable alternative to traditional training, leading to improvements in clinical competencies and increased self-confidence in applying learned skills in the workplace [24, 29, 31, 33–35, 42, 46, 48–50]. Additionally, the combination of simulation-based learning with personalized learning proved effective in achieving and maintaining competence in both knowledge and performance domains [24, 36]. Simulation training, combined with a problem-solving approach, also supported lifelong learning and the acquisition of new skills [40].

The use of real and prepared cases in education was another innovative approach. Case-based learning studies showed that it provided active learning experiences, promoted collaboration among healthcare professionals, and resulted in benefits such as self-awareness, understanding of team roles, the satisfaction of the participants, and application of educational content in the workplace [19, 22, 23, 27, 29].

The flipped class is an alternative educational approach in which learners are provided with educational content before their instructional sessions. The instructor's video contact with the learners nurtures familiarity and establishes mentoring relationships, thereby enhancing training effectiveness [23]. One article examined the implementation of the flipped classroom method and electronic case analysis discussions to update professional theory and enhance pharmaceutical care skills. This innovative approach was deemed highly beneficial for the future education and career development of pharmacists [18].

The findings demonstrate that e-learning, such as utilizing films and videos, can significantly enhance participants' knowledge [16, 20, 29, 30, 33]. Additionally, the use of instructional materials like infographics, podcasts, and blogs effectively delivers crucial instructional messages to facilitate faculty members' development [28].

Field studies were also identified as a novel educational method that led to an improvement in doctors' competence following field training [34].

In a study that used a combination of small-group instruction and peer learning, all participants highly recommended the program. Furthermore, 100% of the learners reported feeling adequately prepared for examinations and experienced increased comfort in performing musculoskeletal procedures. Moreover, participants acknowledged important non-procedural outcomes, such as improved ability to prioritize referrals, initiate primary care, and communicate effectively with patients. Notably, within eight weeks of the course, at least two participants had established their clinics [36].

The studies also highlighted the effectiveness of workshops and practical projects. In one study, pharmacists reported enhanced performance in patient counseling, drug treatment monitoring, medical information, patient education, and evaluation of outcomes [45].

In a study utilizing a collaborative research approach and multi-professional working groups, the evaluation of the program yielded highly positive results. Learners expressed the intention to provide more advice, communicate and collaborate with other healthcare providers, adopt a team approach, and develop and share knowledge with their peers [48].

Active group discussions, which rely on teamwork, were identified as another educational innovation. These discussions facilitate practical skills development while enhancing learning and interactions. The results revealed that an online hybrid model of team-based learning was effective and provided a positive learning experience for healthcare professionals. The study proposed a practical on-the-job training model that combines innovative online learning, which could serve as a reference for the training of various healthcare workers [21].

Identified limitations or challenges

However, some limitations were identified in these studies. One limitation was the potential bias in participant selection, as young and motivated individuals who could work online may have volunteered, making the participant group unrepresentative of the broader community of health workers [17, 21, 33]. Another limitation was the inability of learners to participate in all training sessions due to clinical work or meetings [29, 33, 35, 48]. Several studies lacked control groups and did not evaluate training effectiveness [16, 22, 26, 29, 35]. Other limitations included small sample sizes [17], language barriers [16], and technical issues with virtual and online learning methods, such as software and structural problems, frequent internet interruptions, and sound issues [22, 25, 39]. Financial limitations were also identified as a key challenge for implementing educational innovations, particularly in developing economies [29, 33–35, 48].

Discussion

This study aimed to identify new approaches for training and empowering human resources in the health system in different countries. Simulation-based learning was found to be a suitable alternative to traditional training, with benefits including improved clinical competencies, maintenance of knowledge and performance competence, acquisition of new skills, and increased self-confidence. The effectiveness and feasibility of simulations were also supported by the studies conducted by Sanseau [51], Saarinen et al. [52], and Khamis et al. [49]. They found that simulation-based training is a valid method that enhances learners' knowledge, attitude, and skills.

Another innovative method was the use of real and prepared cases. This approach provides active learning experiences and facilitates collaboration among health professionals during group and teamwork. It also promotes discussions about practical skills, learning independence and interactions, self-awareness, and understanding of each team member's role. Chetty et al.'s study confirmed the positive impact of collaborative interprofessional learning on technical capacity, work relations, organizational culture, and interprofessional learning [50].

The findings of this study demonstrated the advantages of the flipped classroom approach, where learners receive educational content before the educational sessions. This method was found to improve professional development, increase skills and innovative thinking, enhance participants' knowledge, and effectively deliver educational messages. Stark et al. [53] emphasized the importance of online education in developing countries and its potential to of online education in overcoming geographic barriers [54]. However, Praharaj and Ameen stated that online learning does not necessarily surpass traditional methods, and interactive elements are crucial for improving motivation and engagement among online learners [55].

Coaching and field training were also found to be effective educational methods. Coaching resulted in increased competence, confidence in clinical practice, job satisfaction, and improved knowledge, skills, abilities, and self-efficacy. It has been proposed as an important model for medical education, and combining simulation training with video-based coaching has shown successful results [56]. While mentorship is widely accepted in high-income countries, limited research in low-income countries demonstrates that coaching can improve the quality of care [57]. Ngabonzima et al. [58] suggested that coaching, combined with strong healthcare leadership, can yield positive outcomes in low-income countries with high maternal and perinatal mortality rates.

In their study, Giguere et al. emphasize the significance of in-field training. They assert that supervisors express a preference for instructors who possess extensive field experience and possess in-depth knowledge of local community resources. Additionally, the training should be tailored to the learners' experience, profession, workload, and the extent of their intervention. It is crucial for the training to be continuous and repeated, to afford opportunities for feedback on the learners' management of intricate cases [3].

The combination of small group training and peer learning was another effective approach identified in this study. Peer groups were found to be useful in managing difficult and complex work through work critique and mutual learning. Zaalouk et al., Bertman et al., and Kadlec et al. also highlighted the positive impact of peer interactions on learning and appropriate interactions [59–61].

Workshops and practical projects were mentioned in the articles as methods that improve performance, patient satisfaction, and adherence to guidelines. Espenschied et al. [62] and Giguere et al. [3]emphasized the importance of practical and repeated training to provide feedback on managing complex cases. Additionally, Melo et al.’s study [63] confirmed the positive and significant effects of training and practical interventions on the knowledge, attitude, and performance of mothers and childcare workers.

Some limitations discussed in the articles include the involvement of young and motivated individuals in new training courses, the inability of learners to participate in all educational sessions due to clinical obligations, the absence of a control group, lack of evaluation of training effectiveness, small sample sizes, and language barriers. Online learning also faced limitations such as software and structural problems, and internet and sound connectivity issues. Funding was identified as the primary challenge for implementing educational innovations. Language barriers were identified as time-consuming and costly challenges by Lindquist et al. [64]. Lack of time and cost were cited as barriers to accessing continuing professional development (CPD) training in the EU study, particularly in countries with large rural areas. Motivation and understanding of the benefits of CPD among employers were also mentioned as barriers. However, dentists in the same study reported no significant structural barriers to carrying out CPD activities [64]. The African region study conducted by the World Health Organization identified weaknesses such as lack of skills, uneven distribution of training, failure to evaluate effectiveness, and dependence on financial sponsorship. Lack of awareness, time constraints, financial limitations, negative attitudes, top-down approaches, and funding were also highlighted as challenges [65, 66].

Conclusion

In conclusion, implementing novel training methods and empowering healthcare human resources enhances skills, improves training effectiveness, and ultimately leads to improved performance and the delivery of higher-quality healthcare services.resource empowerment.

Author contributions

A.C. contributed to designing the study, analyzing the data, and writing and revising the manuscript. J.A. contributed to translating and revising the manuscript. S.V. contributed to revising the manuscript, analyzing the data. S.H.A. contributed to data extraction, screening the articles, and analyzing the data.

Funding

Not applicable.

Availability of data and materials

Not applicable.

Declarations

Ethics approval and consent to participate

This research was part of a Ph.D. thesis supported by the Iran University of Medical Sciences with the ethical number IR.IUMS.REC.1397.1326.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.