Hitting the target and missing the point? A BEME systematic review of evidence regarding the efficacy of statutory and mandatory training in health and care: BEME Guide No. 87

Abstract

Background

Mandatory training is considered fundamental to establishing and maintaining high standards of professional practice. There is little evidence however, of the training either achieving its required learning outcomes, or delivering improvement in outcomes for patients. Whist organisations may be hitting their compliance target for mandatory training, is the purpose missing the point? This systematic review aims to synthesize and evaluate the efficacy of statutory and mandatory training.

Methods

PubMed, EMBASE, CNAHL, ERIC and Cochrane Central registers were searched on 23^rd May 2023. All research designs were included and reported training had to specify an organisational mandate within a healthcare setting. Data was coded using a modified Kirkpatrick (KP) rating system. Critical appraisal was undertaken using the Modified Medical Education Research Study Quality Instrument, Critical Appraisal Skills Programme Qualitative Studies checklist and Mixed Methods Assessment Tool.

Results

Twenty-five studies were included, featuring 9132 participants and 1348 patient cases audited. Studies described evaluation of mandatory training according to Kirkpatrick’s outcomes levels 1–4b, with the majority (68%) undertaken in the UK and within acute settings. Training duration varied from 5 min to 3 days. There is a lack of consensus regarding mandatory training rationale, core topics, duration, and optimum refresher training period. Currently, mandatory training does not consistently translate to widescale improvements in safe practice or improved patient outcomes.

Conclusions

Due to the lack of international consensus regarding the need for mandated training, most papers originated from countries with centrally administered national health care systems. The rationale for mandating training programmes remains undefined. The assumption that mandatory training is delivering safe practice outcomes is not supported by studies included in this review. The findings of this review offer a basis for further research to be undertaken to assist with the design, facilitation, and impact of mandatory training.

Keywords:

• Best evidence medical education
• methods
• mandatory training
• statutory training

SUSTAINABLE DEVELOPMENT GOALS:

• SDG 4: Quality education
• SDG 5: Gender equality
• SDG 10: Reduced inequalities
• SDG 16: Peace, justice and strong institutions

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Helen Ashley

Helen Ashley, MA, FCIPD, FHEA, Director of Organisational Development, University of Manchester.

Suzanne Gough

Dr Suzanne Gough, PhD, PFHEA, MA Ed (Research), PgCert Academic Practice, BSc (Hons) Physiotherapy (UK), Professor and Head of Physiotherapy, at Bond University, Australia.

Carol Darlington

Dr Carol Darlington, MBChB, MRCS(A&E) Ed, FRCEM, MA Clin Ed, Consultant in Emergency Medicine, Mid Cheshire Hospitals NHS Foundation Trust.

Justin Clark

Justin Clark, BA, Senior Research Information Specialist at the Institute for Evidence-Based Practice at Bond University, Australia.

Chiara Mosley

Dr Chiara Mosley, PhD, RN, CHSE. MSc Health Sciences, ENB Higher award, ENB 405, 997, A19 (Advanced Practice), Dip HE Midwifery, Dip HE, Nursing. PGCE Simulation Lead at Mid Cheshire Hospitals NHS Foundation Trust, and Associate Senior Lecturer, Faculty of Health and Education, Manchester Metropolitan University.