Assessing the Perceived Effectiveness and Identifying Challenges of In-Service Training for Staff in a Teaching Hospital: A Mixed-Method, Sequential Explanatory Study

Abstract

Background: In-service training of healthcare staff is one of the key components of professional development and improving the quality of services. However, previous evidence indicates that the extent of applying learned material in the workplace can be influenced by individual, organizational, and process factors. This study aimed to evaluate the perceived effectiveness of in-service training and identify its challenges and harms from the perspectives of staff and managers in a teaching hospital in Yazd.

Methods: This study was conducted using a sequential explanatory mixed-methods design in 2024–2025. In the quantitative phase, 309 employees were selected through stratified random sampling proportional to size and completed Esmaili’s 24-item In-Service Training Effectiveness Questionnaire. This instrument assesses employees’ perceptions of the effect of training on three dimensions: knowledge development, skill improvement, and attitude creation/change, using a 5-point Likert scale, with a total score range of 24–120. Quantitative data were analyzed using independent t-tests and one-way analysis of variance with SPSS ₂₆. In the qualitative phase, quantitative findings were used to gain a deeper understanding of employees’ perceptions of training effectiveness and to guide the interviews. At this stage, semi-structured interviews were conducted with 30 purposively selected managers and employees. Qualitative data were analyzed using directed thematic analysis based on the structural, process, and contextual dimensions of the three-pronged model using MaxQDA ₂₀₂₀ software.

Results: The mean total perceived effectiveness score was 87.57 ± 27.68 (out of 120; 73% of the maximum). The mean scores for knowledge development, skill improvement, and attitude creation/change were 21.86 ± 6.71 (out of 30), 25.79 ± 7.88 (out of 35), and 39.91 ± 13.43 (out of 55), respectively; after standardization for the number of items, the three dimensions were at a similar level (72.6 % to 73.7 % of the maximum). Scores on all three dimensions differed significantly by job group, educational level, employment status, and work experience (P < 0.001). By gender, skill improvement (P = 0.045) and attitude change (P = 0.019) differed significantly, and by age, only skill improvement did (P = 0.017). Qualitative analysis revealed the challenges of the staff training system in three main themes: structural challenges (time constraints and work pressure, poor needs assessment and educational planning, limited resources and educational infrastructure, and inadequate managerial support and motivational system); process challenges (mismatch of course content with job needs, challenges related to instructors, dominance of passive teaching methods, and poor evaluation and feedback); and contextual challenges (insufficient continuous learning culture, inadequate motivation for participation, participants' perception of limited training transfer, and reduced perceived value of training).

Conclusion: The findings of this study indicate that although employees and managers have a positive attitude and relative acceptance toward in-service training, this process faces serious challenges in needs assessment, design, implementation, evaluation, and post-training support. These limitations play a key role, particularly in the application of learning in the workplace. To improve perceived effectiveness and facilitate the transfer of learning to the operational environment, revising training policies is essential. This revision should focus on accurate needs assessment based on job descriptions, designing practical content with active learning methods, empowering instructors, and especially strengthening managerial support and continuous evaluation systems.