Objectives: Training on organ donation and transplantation is relevant for transplantation improvement. This study aimed at investigating the perceived benefits of Transplant Procurement Management training programs on professional competence development and career evolutions of health care workers in organ donation and transplantation.

Materials and Methods: An online survey was developed in 5 languages (Spanish, English, Italian, French, and Portuguese) and its link was emailed to 6839 individuals. They were asked to forward it to other professionals in organ donation and trans-plantation. The link was also shared on Facebook and at relevant congresses. Two research questions on the perceived influence of specialized training programs were identified.

Results: A total of 1102 participants (16.1%) took the survey; 87% reported participating in Trans-plant Procurement Management training programs, of which 95% selected Transplant Procurement Management courses as the most influential training they had participated in. For research question one, 98% reported influence on knowledge (score 4.5 [out of 5]), 93% on technical (4.2) and communication skills (4.1), 89% on attitude toward organ donation and transplantation (4.1), 92% on motivation to work (4.2), 91% on desire to innovate (4.0), 87% and 79% on ability to change organ donation and trans­plantation practices (3.9) and policies (3.5). For research question 2, main and interaction effects for position at the time of training and type of training were reported.

Conclusions: Transplant Procurement Management training programs had positive perceived effects.

Key words : International, Education, Survey

Introduction

Organ and tissue donor shortages have been analyzed in the search for solutions to overcome the gap between demand and supply. Different approaches, focusing on specific factors (attitudes toward organ donation, presumed consent, financial incentives, and education)^1-6 or multilevel factors,⁷ and different campaigns, organizational models, and national initiatives have been assessed^8-13 to analyze organ, and tissue donor shortages, and propose potential solutions to optimize donation processes, and outcomes. Guidelines¹⁴ and resolutions¹⁵ adopted by the World Health Organization, as well as conventions, directives, and action plans issued by the Council of Europe and the European Union, have called for balanced and regulated donation and transplantation activities across the European Union¹⁶ and the world.

One pivotal element identified as a key to success is the training of health care professionals involved in the donation process to improve skills, competencies, and awareness.^7,17,18 The European Training Program on Organ Donation (ETPOD) achieved a significant increase in organ donation rates.⁶ The Council of Europe¹⁶ provided guidelines and recommendations to governments of member states about the role, functions, responsibilities, and training of transplant donor coordinators. Moreover, through its Action Plan on Organ Donation and Transplantation (2009-2015), the European Commission supported the implementation of effective training programs for transplant donor coordinators.¹⁹

Several educational programs have been designed to support the European Commission's action plan. Over the years, Transplant Procurement Management (TPM) was developed and grew to become one of the largest and most international training programs. Designed on a model of the continuous improvement program (CIP) method,²⁰ TPM was launched in 1991 under the auspices of the University of Barcelona in Barcelona, Spain, with the support of the Spanish National Transplant Organization. It gained the recognition of the European Committee on Organ Transplantation of the Council of Europe in 1994 and was awarded the TTS-Genzyme Award for Education and Training in Transplantation by The Transplantation Society in 2008. TPM is supported through the academic endorsement of the University of Barcelona and offers face-to-face and online courses as well as a master’s degree in organ, tissue, and cell donation for transplantation.

Face-to-face training programs are delivered at 5 levels following a progression of expertise, aims, and length: new vital cycle (awareness, 8 hours); introductory (motivation, 16 hours); intermediate (collaboration, 24 hours); advanced (specialization, 40 hours); master’s degree (experts, 300 hours). They build on participants’ knowledge based on their previous training and experience in the field with proactive involvement in the learning environment.²¹ As proven by Knowles,²² adult learning is most effective when information is presented in the context of a real-life situation. Thus, TPM uses the Kolb learning cycle to engage and immerse learners in the learning situation in a constructivist approach. Through Web-based learning programs, participants further fine-tune their skills and competencies, which optimize direct application of skills and knowledge in their own professional environment. To assess training needs and develop and refine the training programs according to the audience, TPM applies the ADDIE instructional design model. Since 1991, about 10 000 professionals from 101 countries throughout the world have been trained through the different educational models of TPM as following: 87.5% in face-to-face courses and 12.5% in online courses.²³

With such a large number of professionals participating in these courses, the effect of these TPM training programs must be evaluated. The effect of the TPM continuous improvement methodology on the donation process could underscore the importance of further development and fine-tuning of such training programs.

The objective of this study was to investigate the perceived benefits of TPM specialized training programs on professional competence development and career evolutions of health care workers in organ donation and transplantation.

Materials and Methods

A Web-based questionnaire including 49 multiple-choice, open-ended, rating-scale, and agreement-scale questions was developed in 5 languages (English, Spanish, Italian, French and Portuguese). This study reports on a subset of questions from this survey dealing with the objective of the study (Figure 1). The time required to complete the survey was approximately 15 to 20 minutes. A pilot test was taken by 10 participants. No survey pitfalls were reported. The study was approved by the Ethical Committee institutional review boards at the University of Barcelona, Spain, and Purdue University, West Lafayette, Indiana, United States. All of the protocols conformed with the ethical guidelines of the 1975 Helsinki Declaration. The survey initiated with the research participant consent form. By continuing, participants indicated their consent to participate.

Participants were recruited in May 2012 from the TPM database and other methods. A cover letter and link to the online survey were e-mailed to 6839 people who had participated in TPM or related training courses. They were also asked to forward the link to other individuals active in organ donation and transplantation. Two reminder e-mails were sent during the following month. Additionally, links were posted on Facebook (www.facebook.com/ transplantationprocurementmanagement) and handed out at organ donation meetings and congresses.

Participation in the study was voluntary. Participants received no direct benefits or compensation. All data were collected by means of Qualtrics (Provo, UT, ISA) Web-based survey software and kept confidential through personal password control. Additionally, all responses were anonymous and no identifiable information was collected.

Two main research questions were identified for the current study. Research question 1 was “What is the perceived influence of specialized training programs on career, collaboration, and skills and ability in organ donation and transplantation?” Research question 2 was “Do the different types of training programs (online, face-to-face, local/ national/international, etc) and individual charac­teristics (sex, position at time of training) have different perceived influences on competences (career, collaboration, skills, and ability) in organ donation and transplantation?”

Participants were asked to select the training they believed was most influential in considering their responses to the remaining survey items. Participants who selected TPM were asked to specify which courses they had attended. The types of courses were grouped in terms of similarity and were ranked from 1 to 7 on the basis of how advanced and intensive the training was, with a ranking of 1 being the most advanced, as follows: the master’s course in donation was ranked as 1, the introductory face-to-face course was ranked as 2, the intermediate face-to-face course was ranked as 3, the advanced face-to-face course was ranked as 4, the essentials in donation course was ranked as 5, the blended [online and face-to-face] courses were ranked as 6, and online-only courses were ranked as 7. When a participant identified multiple courses, the more advanced training category was used in our analyses.

Respondents were asked to rate the influence of trainings on 12 different items (on a scale from 1 to 5: 1- no influence, 5-great deal of influence), including respect from peers, advantages in promotions, technical skills, knowledge, networking ability, motivation to work in transplantation, collaborative opportunities, ability to change policies, ability to change practices, desire to innovate, and communication skills related to organ donation and transplantation (Figure 1). For most questions, the analysis focused on professionals who are still active in the field.

Statistical analyses
Research question 1 was subject to descriptive data analysis, plotting frequencies, percentages, and means, and referred to all participants who answered the survey items, regardless of which training they selected as being most influential. For research question 2, a series of additional analyses were performed using general linear model univariate analysis run on types of TPM trainings, sex, and position at time of training on the dependent variables presented above. A value of P < .05 was considered to be statistically significant. Statistical analyses were performed with SPSS software (SPSS: An IBM Company, version 21.0, IBM Corporation, Armonk, NY, USA).

Results

Of the total of 6839 prospective participants contacted, 1102 participants (16.1%) agreed to take the survey. Of those who completed the survey, 890 respondents (80.8%) provided information about their participation in training processes, and 794 participants (72.1%) reported still being active in organ donation. Of the 607 participants who reported sex, 252 were male (42%), and 355 were female (58%). Of 1102 who took the survey, not all answered to all questions. A total of 751 participants (87%) reported their position at the time of training as follows: 306 physicians (40.7%), 318 nurses (42.3%), 23 non-medical PhDs (3.1%), 12 biologists (1.6%), 4 laboratory technicians (0.5%), 5 social workers (0.7%). Other positions reported (11.1%) were nonphysician or nurse transplant donor coordinators (n = 23), psychologists, hospital directors, para­medics, quality control professionals, and tissue bank professionals.

Respondents reported participating in 1498 training courses in 46 countries, with many respondents reporting participating in multiple courses. Participants were from 46 countries, with the most participants responding from Italy (n = 349), Spain (n = 173), France (n = 132), Portugal (n = 47), Brazil (n = 38), Turkey (n = 19), Lebanon (n = 10), and Panama (n = 10).

Eighty-seven percent of respondents (910/1102 = 87%) reported participating in a TPM course (472 [45%] reported attending TPM training programs only, whereas 438 [42%] reported participating in TPM and other training programs, and 102 [9%] reported attending non-TPM courses). Forty-seven respondents (4%) indicated they had not participated in any training courses and were not included in further analyses.

Eight hundred four participants answered this question, of which 669 (83%) selected TPM as most influential and 135 (17%) selected other training programs. Based on 87% having taken a TPM course, and 83% selecting TPM as best, we concluded that 95.4% (83/87) of TPM attendants found them as most influential.

The perceived influence of specialized training programs on career, collaboration, and skills and ability in organ donation and transplantation (research question 1) is shown in Table 1. Because of the small number of respondents who selected training programs other than TPM as being most influential, only TPM training programs were selected for analysis of research question 2.

Men reported greater influence of trainings than women on respect from peers (men: 3.4 ± 1.5; women: 3.0 ± 1.4; P = .025) and networking ability (men: 3.8 ± 1.2; women: 3.4 ± 1.1; P = .033) across all TPM training programs. No effect of sex was found in analyses of the other items.

Position at time of training had significant effects on technical skills for organ donation and transplantation (P = .001), knowledge of organ donation and transplantation (P = .029), attitude toward donation (P = .002), motivation to work in organ donation and transplantation (P ≤ .001), “collaborative opportunities” (P < .001), ability to change practice (P < .001), ability to change policy (P = .004), desire to innovate (P = .006), and communication skills (P = .001) (Table 2).

Physicians report the highest influence of training on most of the items listed, such as attitude toward donation, motivation to work in organ donation and transplantation, ability to change practice, and ability to change policy. Nurses and social workers perceived trainings to have the most influence on ability to change policy and motivation to work in organ donation and transplantation. Social workers reported the most collaborative opportunities. However, laboratory technicians and biologists reported the lowest levels of perceived influence of training on all of the items (Table 2).

Type of training showed a significant effect on advantages in promotions (P = .033), with online, blended, and TPM master courses offering the most perceived benefit and essentials in organ donation and introductory face-to-face offering the least perceived benefit (Table 3).

A significant interaction effect between position at time of training and type of training on respect from peers (P = .022) and advantages in promotions (P = .011) was reported (Table 4). Physicians perceived more effect on advantages in promotion from TPM masters/international courses than nurses did. Nevertheless, physicians and nurses found the advanced training less beneficial than respondents in the “other” category did.

A significant interaction effect between position at time of training and type of training was also reported on networking ability (P = .017). Physicians and nonmedical doctors (PhDs) reported higher levels of networking ability in TPM masters/international courses but slightly lower levels than nurses and social workers reported in the advanced courses.

Finally, significant interaction effects between position at time of training and type of training were further reported on collaborative opportunities (P = .033), with physicians reporting the most col­laborative opportunities in the TPM masters/ international courses, and nurses and social workers reporting the most collaborative opportunities in the advanced face-to-face training (Table 4).

Discussion

TPM specialized training programs in organ donation and transplantation had positive effects for a significant percentage of health care workers in the field on professional competence development and career evolution. This may be explained by the ongoing effort of TPM to improve its products and services in compliance with professional requirements and provide increased efficiency and quality over time. To achieve a continuous improvement program, TPM has been applying the plan-do-check-act cycle, which allows it to constantly evaluate, improve, and refine its training programs.TPM training programs have many advantages beyond the traditional measures of increasing knowledge of a specific practice. Well-designed programs provide certifications and prestige that are likely to result in increased respect from peers and advantages in promotions. These programs result in improvement in technical skills and knowledge, as well as the ability to communicate effectively about organ donation and transplantation. Additionally, they bring together people who have similar interests who are likely to become influential in their fields and thus increase networking ability and collaborative opportunities. Furthermore, having well-designed programs taught by passionate faculty using innovative approaches18 increases motivation to work in transplantation and the desire to innovate in organ donation and transplantation. Many participants act on these motivations and report that the training programs are influential on their ability to change policy and practice related to organ donation and transplantation, collaborative opportunities, desire to innovate, and com­munication skills related to organ donation and transplantation.

Literature research reveals that similar studies have been conducted in different medical fields. In Toronto, Ontario, Canada, a study was performed to examine how interprofessional education clinical placement influences health care students' perceptions of interprofessional collaboration. Findings suggest that structured interprofessional education clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of interprofessional collaboration in health care delivery.²⁴ The results of another study, conducted by the American Medical Association to evaluate changes in practice behaviors, suggest that a well-designed education intervention can enhance health professionals’ confidence and clinical practice.²⁵

However, not all types of trainings have the same outcomes for all participants, although most training still received high evaluations. These differences are important to note in terms of evaluating overall success and for consideration of who is likely to benefit most from a certain type of training. It appears that overall, organ donation and trans­plantation is still a male-dominated field,²⁶ and female participants were less likely to feel the same influence of training programs on respect from peers. Additionally, it is a bit surprising that blended and online training programs were reported to have more of an influence on promotions than face-to-face courses. There are a couple of possible explanations for this. First, the overall numbers of participants in these categories was significantly lower than for the TPM masters/international and the advanced face-to-face courses. Moreover, in the masters and advanced courses, the majority of respondents were nurses and physicians. Thus, it may be less common for a physician or a nurse to report a specific type of promotion.

Overall, this report provides a new type of evaluation of training programs that goes beyond rating the quality of the course or instructors and focuses specifically on how different groups perceive the benefits of training programs in their ongoing work life. Generally, physicians reported the greatest influence of the trainings on improving their attitudes toward organ donation and transplantation. Physicians also reported more influence of the trainings on their ability to change policies and practices related to organ donation and trans­plantation. However, in many categories, nurses and social workers also reported high levels of influence of the trainings on their ability to change policy and practice as well. Laboratory technicians and biologists seemed to perceive less benefit from the training than did medical professionals, social workers, and other professionals.

The survey was developed together with experts from University of Barcelona and the Brian Lamb School of Communication, Purdue University, who helped to ensure the accuracy and consistency of our measurements. It was further revised, readjusted, translated, and validated by experts in organ donation and transplantation. Piloting and pretesting was also performed to increase both validity and reliability of the survey, and finally, the survey was approved by the institutional review boards of the University of Barcelona and Purdue University, which conferred validity and reliability to the survey results.

However, we also should consider some limitations of the study. One of the identified limitations is that only 16.1% of the total potential participants contacted agreed to take the survey. While the response rate is not as high as we would like, it is in line with response rates for online and mail surveys,²⁷ especially because no incentives to participate were provided. While we have no direct knowledge of the reasons the rest of those contacted did not complete the survey, there are several possible explanations. Some contact details could have been erroneous, contacted individuals may not have been interested in taking the survey, or they did not find training programs beneficial. So, we cannot rule out that participants most influenced by training had the greatest motivation to take the survey. As such, the results may be positively skewed. However, given the success of training programs in increasing rates of transplantation, we think the results are likely to be fairly representative.

Additionally, a degree of caution should be taken in interpreting the data for biologists, laboratory technicians, and social workers, especially when broken out by type of training, as the number of participants in a given course for each category might be very low. Moreover, while online courses seem to be more influential to physicians and nurses, there is a low sample size for these categories, making interpretation more difficult.

Last, the study focuses on the perceived benefits from the trainings on career, collaboration, and skills and ability in organ donation and transplantation and not on the actual impact of the trainings on the different items. However, previous findings6 show that the educational initiatives undertaken by TPM along with the consortium partners and the support of the European Commission within ETPOD project­­(DGSANCO–EAHC2005205) were successful and achieved significant increase in organ donation figures.

In conclusion, TPM specialized training programs in organ donation and transplantation are influential and have positive effects for a significant percentage of health care workers in the field on professional competence development and career evolutions.

This study lends support to the importance of TPM specialized training programs, not just for development of technical skills but also development of career conditions that will keep health professionals active in organ donation and transplantation. This, combined with an increase in knowledge, skills and abilities to communicate should help to improve organ donation and transplantation around the world. The data collected allow future evaluations focusing on issues such as networks and collaboration, success in changing policy and practice, and career advancement and committees.

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