Education and Training as Improvement Interventions

Book Title: Education and Training as Improvement Interventions

Authors: Lauren E. Benishek, Albert W. Wu, Michael A. Rosen

Publication Details: Cambridge University Press, 2025, 50 pp., $23.00 paperback

Years ago, while working on the literature review for my dissertation focused on evaluating an education and training program for health care professionals, I struggled to find textbooks dedicated to the field of worker training. I found myriad textbooks on occupational health, industrial psychology, and evaluation. However, textbooks or guidebooks on worker training research itself were limited.

Albert W. Wu, Michael A. Rosen, and the late Lauren E. Benishek have helped bring the literature together in Education and Training as Improvement Interventions. Dr Benishek was an organizational psychologist and assistant professor in the Johns Hopkins Armstrong Institute for Patient Safety and Quality. Dr Rosen and Dr Wu are both active professors at Johns Hopkins, where Wu is a physician and Rosen is a human factors psychologist. In this thin, concise, open-access book, the authors gather literature and provide pillars and principles to guide those learning about the field of worker training and education.

The book starts with a few paragraphs as an introduction, sparsely defining education and training. A brief history of training research is attempted in five pages. Then, the substantial portion of the book starts by defining the fundamental pillars of training: (1) ensure training is appropriate; (2) create a positive learning environment; (3) design and implement training to be accessible, useable, and effective; (4) evaluate training; (5) and transfer and sustain competencies. These pillars are then contextualized with principles. For example, evaluation principles are deciding what to measure, how, and the analyses of data. Then, two case studies are presented where education and training were used in health care improvement, exhibiting the importance, successes, and challenges. Lastly, some of the pitfalls of training and education are illustrated to provide thoughts on improvement.

The pillars and principles are expanded to give succinct and useful background for the reader. For the evaluate training pillar, for example, the authors use the space to describe the commonly utilized Kirkpatrick framework of reactions, learning, transfer, and results, and the Phillips return on investment. The principle on confirming that training is an appropriate solution lays out the National Institute for Occupational Safety and Health (NIOSH) hierarchy of controls, which rank in order of decreasing effectiveness ways to mitigate workplace hazards and exposures. Training and education fall within administrative controls or changing the way people work. Case studies, which follow the pillars and principles, range in trainings to address obstetric emergencies, cardiopulmonary resuscitation, and a resilience program from a stressful patient-related event.

In the effort to be concise, much is lost. For example, the hierarchy of controls is mentioned, but the authors never explain that NIOSH is the federal agency responsible for work-related health research.¹ Although similar in name, the Occupational Safety and Health Administration (OSHA) is not mentioned, even though it was signed into law in 1970 alongside NIOSH. OSHA is responsible for enforcing healthy working standards and providing training and education. Since OSHA was created, worker deaths in America have decreased on average from 38 per day in 1970 to 15 per day in 2023.² In the pursuit of brevity, many other federal agencies are likewise missed, though they are of substantial importance to the field of worker training and education. The National Institute of Environmental Health Sciences Worker Training Program, for example, provides resources on curricula development, delivery, and evaluation.³

To the family medicine students and researchers new to the field of worker training and education, this book can serve as a helpful launchpad in their literature search. The text, in 26 pages, covers a wide array of useful principles. However, those wanting to learn about training and education as an improvement intervention must read further. The authors recognize that training as applied to specific clinic tasks is generally low-quality and difficult to translate into actionable guidance. Readers can appreciate the ebook version being open access, providing literature searches with grounded breakdown of principles. The book, one I wish I had as a student new to the field, will undoubtedly be a useful tool to spark curiosity to seek out more on those given principles. For that reason, this slim book of a late professor may one day be a common citation for the field of worker training and education research.