The growing demand for professional updating and training within the health service has created a proliferation of post-registration courses, many of which fail to reach the appropriate personnel or the real training objectives of the participants and their managers. One reason behind this problem relates to the fact that many such courses are constructed and delivered in a haphazard way, without systematic reference to the direct and indirect consumers of the educational programmes. A more rational approach to post-experience provision of this sort might involve the methodical collection of information regarding the training needs of target health professional populations. Such a data base would afford a global overview of competencies and deficiencies, both within and between individuals. From this the content, level and focus of training could be customized to meet the reported needs, thereby streamlining the commissioning process to enhance efficiency and effectiveness. Previous attempts to rationalize provision through the prior use of training needs analysis instruments have been compromised by the shortcomings of the analysis tool. This study, then, was an attempt to redress this problem, using a training needs analysis instrument developed along traditional psychometric principles. The tool was intended to be used with primary health care teams because of the increasing role this sector of the health service will play in the future delivery of care, although this would not preclude its use with other health care professionals (following appropriate modification), since the principles behind its construction and format are transferable. The instrument has demonstrable construct, content and face validity and significant reliability. Moreover, preliminary investigations suggest that it also has criterion validity in the areas tested. These findings suggest that the instrument is unique of its kind. Early use of the tool has demonstrated its value in a variety of ways, such as in team building exercises and skill mix reviews as well as in precise and effective commissioning of training and education in a range of areas.

Background: There is a shortfall in midwives in Indonesia (an estimated 26 per 100 000 people), which means that the quality of antenatal, perinatal and postnatal care varies widely. One consequence of this is the high rate of maternal and perinatal mortality, which has prompted a number of health initiatives. The current study was part of a review of the existing complex system of midwifery training and the development of a coherent programme of continuing professional development, tighter accreditation regulations and clearer professional roles. Its aims were to identify the occupational profiles and development needs of the participating midwives, and to establish whether any differences existed between grades, geographical location and hospital/ community midwives.

Background: Indonesia's recent economic and political history has left a legacy of widespread poverty and serious health problems, and has contributed to marked inequalities in health care. One means of responding to these challenges has been through a reconsideration of the professional roles of nurses, to enable them to deal with the range and complexity of health problems. However, there are currently a number of obstacles to achieving these aims: there is a serious shortfall in trained nurses; the majority of nurses have only limited education and preparation for the role; and there is no central registration of nurses, which means that it is impossible to regulate either the profession or the standards of care. This study aimed to establish the occupational profiles of each grade of nurse, identify their training and development needs and ascertain whether any differences existed between nurses working in different regions or within hospital or community settings.

The role and professional boundaries of the nurse practitioner (NP) in the UK have not yet been unequivocally defined. This confusion has served to limit the expansion of the NP in both the acute and primary care sectors, despite a mounting body of evidence that attests to their value. This lack of coherence has necessarily impacted upon the educational provision currently available for NP development, with a range of courses of variable nature and standards being provided. The lack of nationally agreed educational criteria and the importance of taking account of local needs, together suggest that a formal training needs analysis might be valuable in systematizing and unifying the present position. Such a survey would have the function of informing both the definition and regional training requirements of NPs, provided the data were obtained through the use of a reliable assessment instrument. To this end a total population survey of all nurses employed in general practice within a large regional health authority was undertaken, using a psychometrically valid and reliable training needs analysis questionnaire. The information obtained provided a preliminary definition of the NP role and a clear index of the content and level of prospective educational provision. In addition, the survey offered an estimate of the numbers of potential participants on NP courses, by FHSA and preferred educational institution. In this way, the use of a scientifically constructed and specifically customized training needs analysis tool may have the potential to inform precise educational commissioning, thereby rationalizing resources and enhancing the quality of both training and ultimate care provision.

The current emphasis in the United Kingdom on evidence-based health care requires that medical and non-medical professionals ensure that their clinical practice is founded on scientifically derived findings rather than on intuition and ritual. To this end, many initiatives have been introduced which are intended to increase both the corpus of available research evidence and the extent to which it informs practice. To date, however, there has been a disappointing shortfall in published research in the paramedical domain, which has been largely attributed to a number of structural and organizational issues. This paper suggests that confusion about what constitutes valid and useful research may be an additional significant contributory factor in the documented research/practice hiatus. Moreover, the emphasis on experimentation and Randomized Controlled Trials (RCTs), with the relative marginalization of alternative, more qualitative forms of research may seriously limit the nursing research data-base because of its inappropriateness for many nursing investigations. It is suggested that a more eclectic approach to evidence-based care is considered, with more attention being diverted to qualitative methodologies at the funding and dissemination stages. In this way, a comprehensive and balanced overview of relevant information can be obtained which has the potential to influence some of the less quantifiable aspects of care delivery.