The Munity On The Bounty Collections-Pameran koleksi Pembanjakan Kapal Bounty

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Showcase :The Original Munity on the Bounty Collections Koleksi pembajakan Kapal yang terkenal ,sudah diangkat kelayar putih “The munity of the Bounty”




1. The author of the book

2.original pictures collections



Mutiny on the Bounty

The mutineers turning Lt Bligh and some of the officers and crew adrift from His Majesty’s Ship Bounty, 29 April 1789. By Robert Dodd


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Showcase “the Ainu historic collections”

Pameran Koleksi Etnik  “Ainu”

 Frame One : Koleski Ainu Abad ke 19

The complete info look at dr iwan cybermuseum click hhtp://

The Ainu Collections in 19 th Century.

(based on Dr Iwan vintage books collection .witten by David Mac Ritchie,Edinburg,1892)







Ainu people-SUKU AINU

For the ethnic group of western China, see Äynu people.
Group of Ainu people, 1902 photograph.
Total population
The official Japanese government estimate is 25,000, though this number has been disputed with unofficial estimates of upwards of 200,000.[1]
Regions with significant populations
Historically Ainu and other Ainu languages; today, most Ainu speak Japanese or Russian.[2]
Animism, Russian Orthodox Christianity, Buddhism

The Ainu (アイヌ?, Aynu アィヌ) IPA: [ʔáinu] (also called Ezo in historical texts) are the indigenous people or groups in Japan and Russia. Historically they spoke the Ainu language and related varieties and lived in Hokkaidō, the Kuril Islands, and much of Sakhalin. Most of those who identify themselves as Ainu still live in this same region, though the exact number of living Ainu is unknown. This is due to ethnic issues in Japan resulting in those with Ainu backgrounds hiding their identities and confusion over mixed heritages. In Japan, because of intermarriage over many years with Japanese, the concept of a ‘pure Ainu’ ethnic group is no longer feasible.[3] Official estimates of the population are of around 25,000, while the unofficial number is upwards of 200,000 people.[1]



Ainu culture dates from around 1200 CE[4] and recent research suggests that it originated in a merger of the Okhotsk and Satsumon cultures.[5] Active contact between the Wajin (the ethnically Japanese) and the Ainu of Ezochi (now known as Hokkaido) began in the 13th century.[6] The Ainu were a society of hunter-gatherers, who lived mainly hunting and fishing, and the people followed a religion based on phenomena of nature.[7]

During the Tokugawa period (1600–1868) the Ainu became increasingly involved in trade with Japanese who controlled the southern portion of the island that is now called Hokkaido. The Bakufu government granted the Matsumae family exclusive rights to trade with the Ainu in the Northern part of the island. Later the Matsumae began to lease out trading rights to Japanese merchants, and contact between Japanese and Ainu became more extensive. Throughout this period Ainu became increasingly dependent on goods imported by Japanese, and suffered from epidemic diseases such as smallpox.[8]

The turning point for Ainu culture was the beginning of the Meiji Restoration in 1868. A variety of social, political and economic reforms were introduced by the Japanese government, in hope of modernising the country in the Western style, and included the annexation of Hokkaido. Sjöberg quotes Baba’s (1980) account of the Japanese government’s reasoning:[8]

‘ … The development of Japan’s large northern island had several objectives: First, it was seen as a means to defend Japan from a rapidly developing and expansionist Russia. Second … it offered a solution to the unemployment for the former samurai class … Finally, development promised to yield the needed natural resources for a growing capitalist economy.’[9]

In 1899 the Japanese government passed an act labeling the Ainu as former aborigines, with the idea they would assimilate – this resulted in the land the Ainu people lived on being taken by the Japanese government, and was from then on under Japanese control.[10] Also at this time, the Ainu were granted automatic Japanese citizenship, effectively denying them of being an indigenous group.

The Ainu were becoming increasingly marginalised on their own land – over a period of only 36 years, the Ainu went from being a relatively isolated group of people to having their land, language, religion and customs assimilated into those of the Japanese.[11] In addition to this, the land the Ainu lived on was distributed to the Wajin who had decided to move to Hokkaido, who had been encouraged by the Japanese government of the Meiji era to take advantage of the island’s abundance of natural resources, and to create and maintain farms in the model of western industrial agriculture. This development was termed Kaitakushi.[12] As well as this, factories such as flour mills and beer breweries and mining practices resulted in the creation of infrastructure such as roads and railway lines, during a development period that lasted until 1904.[13] During this time the Ainu were forced to learn Japanese, required to adopt Japanese names and ordered to cease religious practices such as animal sacrifice and the custom of tattooing.[14the end@copyright Dr iwan suwandy 2010

The Eastren Euro Historic collections Exhibtion In Dr Iwan Cybermuseum

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Czech Republic Historic Collections Exhibition

This article is about the country in Europe. For other uses, see Czech Republic (disambiguation).
Czech Republic

Česká republika
Flag Coat of arms
Motto“Pravda vítězí” (Czech)
“Truth prevails”
Anthem File:Kde domov muj inst.oggKde domov můj? (Czech)
“Where is my home?”
Location of  Czech Republic  (dark green)– on the European continent  (green & dark grey)– in the European Union  (green)  —  [Legend]
Location of  Czech Republic  (dark green)– on the European continent  (green & dark grey)
– in the European Union  (green)  —  [Legend]
(and largest city)
Prague (Praha)
50°05′N 14°28′E / 50.083°N 14.467°E / 50.083; 14.467
Official language(s) Czech, Slovak[1]
Recognized minority languages: Polish, German, Romani[2]
Demonym Czech
Government Parliamentary republic
 –  President Václav Klaus
 –  Prime Minister Petr Nečas
 –  Principality of Bohemia c. 870 
 –  Czechoslovakia 28 October 1918 
 –  Czech Republic 1 January 1993 
EU accession 1 May 2004
 –  Total 78,866 km2 (116th)
30,450 sq mi 
 –  Water (%) 2
 –  20101 estimate 10,515,818 (78th)
 –  2001 census 10,230,060 
 –  Density 133/km2 (77th)
341/sq mi
GDP (PPP) 2010 estimate
 –  Total $258.959 billion[3] 
 –  Per capita $24.832.[3] 
GDP (nominal) 2010 estimate
 –  Total $199.012 billion[3] 
 –  Per capita $19.084[3] 
Gini (2008) 26 (low) (4th)
HDI (2007) ▲0.903 (very high) (36th)
Currency Czech koruna (CZK)
Time zone CET (UTC+1)
 –  Summer (DST) CEST (UTC+2)
Drives on the right
ISO 3166 code CZ
Internet TLD .cz³
Calling code +4204
1 30 June 2010 (See Population changes).
2 Rank based on 2009 IMF data.
3 Also .eu, shared with other European Union member states.
4 Shared code 42 with Slovakia until 1997.

The Czech Republic (pronounced /ˈtʃɛk/ ( listen)[4] chek; Czech: Česká republika, pronounced [ˈtʃɛskaː ˈrɛpuˌblɪka]  ( listen), short form Česko [ˈtʃɛskɔ]) is a landlocked country in Central Europe.[5] The country borders Poland to the northeast, Germany to the west and northwest, Austria to the south and Slovakia to the east. The Czech Republic has been a member of NATO since 1999 and of the European Union since 2004. The Czech Republic is also a member of the Organization for Security and Cooperation in Europe (OSCE). As an OSCE participating State, the Czech Republic’s international commitments are subject to monitoring under the mandate of the U.S. Helsinki Commission. From 1 January 2009 to 30 June 2009, the Czech Republic held the Presidency of the Council of the European Union.

The Czech state or Bohemia (Lands of the Bohemian Crown) as it was known until 1918 was formed in the late 9th century. The country reached its greatest territorial extent during the 13th and 14th century under the rule of the Přemyslid and Luxembourg dynasties. Following the Battle of Mohács in 1526, the Kingdom of Bohemia was integrated into the Habsburg monarchy as one of its three principal parts alongside Austria and Hungary. The independent Republic of Czechoslovakia was formed in 1918, following the collapse of the Austro-Hungarian empire after World War I. After the Munich Agreement, Polish and German occupation of Czechoslovakia and the consequent disillusion with the Western response and gratitude for the liberation of the major portion of Czechoslovakia by the Red Army, the Communist party won plurality (38%)[6] in the 1946 elections.

In a 1948 coup d’état, Czechoslovakia became a communist-ruled state. In 1968, the increasing dissatisfaction culminated in attempts to reform the communist regime. The events, known as the Prague Spring of 1968, ended with an invasion by the armies of the Warsaw Pact countries (with the exception of Romania); the troops remained in the country until the 1989 Velvet Revolution, when the communist regime collapsed. On 1 January 1993, Czechoslovakia peacefully dissolved into its constituent states, the Czech Republic and Slovakia.

The Czech Republic is a pluralist multi-party parliamentary representative democracy. President Václav Klaus is the current head of state. The Prime Minister is the head of government (currently Petr Nečas). The Parliament has two chambers: the Chamber of Deputies and the Senate. It is also a member of the Organisation for Economic Co-operation and Development (OECD), the Council of Europe and the Visegrád Group.



The end@copyright Dr Iwan suwandy 2010

Pameran Koleksi Pulau Pagai di Dr Iwan Cybermuseum


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1. Kisah pertualangan Dr Iwan Ke Pagai UtaraDi kepulauan Mentawai 1971(Dr IWAN ADVENTURE AT PAGAI ISLAND 1971).

1) english version

Dr Iwan adventure to Pagai Island with small boat “Semaganat” fromTeluk Bayoru,staring at afternoon but because the raining and bigger oceoan waves taht night the boat hide at the Cingkuk Island near painan,and one of the student vomining due to the motion sickness, in the next moening the weater more comfertable. Dr Iwan and friend haved “mancing” the bigger tuna fish, and at afternoon after eight hours from cinghkuk ilsand the team arrived at Sipora Island, and Kian the moving sickness student dro there, and Dr Iwan and three team dropped at Siakakap at the north pagai Island. After two days one team lead by Dr Iwan as the senior intership Doctor as the lead with two yunior student and one native Silabu north Pagai island cops wityh the semangat boat which have dropping another team to siberut Island, bring the Dr iwan team via pagai straight between the north and south pagai island, very beutiful journey until cam eto small dusun at South Pagai (now there were  biggere arthquacueke 7,2 skaca Richter and Tsunami,many people died and loss, President and vice presiden of Republic Indonesia this day visit that location by helicopter from Padang city,  also the POLRI and Indonesian Armed forced by ship get helping persons and foods), after that went to silabu the center village of nothern pagai island, more detail story read the Dr iwan Adventure in Pagai island at hhtp:// and hhtp:// search Dr Iwan Adventures at mentawai island.)

2) Indonesian version

Tahun 1971 satu tim mhasiswa Kedokteran bekerja sama dengan bagian parasitlogi berangkat ke Pulaua mentawai untuk survey plasmodium malaria pada pendudk asli disana. Dr iwan saat itu sedang pratek akhir di RS ,bersama satu mahasiswa tingkat III dan satu tingkat I, dikawal oleh seorang polisi suku asli Mentawai asla pagai utara, ,memperoleh tugas ke daerah pagai utara ke desa Silabu. Rombongan terdiri dari  enam tim (18 orang) dan satu rombongan admisnsitrasi berangkat dari Teluk bayurt dengan kapal kecil bernama “Semangat” . baru saja berbunyi tanda bernagkat dari kapal tersebut, seorang anggto tim langsung muntah-muntah bernama Kian (saat ini sudah pensiun dokter kanwil SUMBAR), rternyata malam itu hujan sangat lebat dan gelombang omak samudra  Indonesia sangat tinggi, sehingga terpaksa berlindung dipulau cingkuk didepan kota Painan di pesisir Selatan Sumbar. Keesokan harinya udara cerah dan banyak kesempatan mancing ikan tuna, tetapi Kian tetap muntah=muntah sehingga terpaksa dsiturunkan di Pulau Sipora, kemudian rombongan berangkat ke desa Sikakap di Pulau Pagai Utara, disana istirahat dua hari sambil makan duren dan ikan pangang,bertemu pastor italia yang sudah lama disana,gereja berada diatas bukit. Kemudian tim Dr Iwan dengan dua teman yang saru Sifudin,dan yang lainnya namanya sudah lupa disebut saja Kamil, dikawal oleh seorang sersan POLRI berasal dari pagai Utara Silabu,namanya juga sudah luap dsiebut saja Sinumbing. Sore hari berangkat dengan kapal semangat meliwati selat anatar pagai utara dan Pagai selatan, mlamnya ke Pagai selatan (saat ini sdedang ada gempa 7.3 skala richter dan tsunami-baca info selanjutnya). Sunggup sangat lucu,keesokan hari kami mendarat di sebuah desa dari tengah lautan, dengan naik perahu penduduk asli tanpa ada cadik -imbnagan ,sehingga snagat labil, hampir seluruh rakyat tertawa terbahak-bahak melihat Dr Iwan sangat takut jatuh terpkasa ambil posis  duduk selonjor kaki lurus agar tidak jatuh kelaut. Setelah memebrikan pengobatan gratis kepada beberapa masyarakat duisana, yang anntre karena belum pernah berobat kedokter.

Selajuntnya perjalanan diteruskan menuju Silabu di Pagai Selatan.Gelombang lautan Hindia yang sangat tinggi lebih kurang lima meter, terasa seperti naik jet coster bergelombang dari bawak ketas,sungguh terasa mulai mau mabuk dan badan diikat ketiang kapal agar tidak jatuh. Para kelasi kapal semangat enak saja memancing ikan tengiri dengan ukuran sangat besar.

Sore hari tiba di sebuah pulau kecil di depan muara sungai menuju silabu, sangat banyak nyamuk kecil disana, namanya sinyitnyit. Tiba-tiba terdengar teriakan seperti dalam cerita indian saja, puluhan perahu traditionil menjemput Dr Iwan dengan Tim, rakyat silabu snagat gembira untuk pertamakali bertemu dengan seorang dokter. Menyurut cerita kepala desa silabu,seorang purnawirawan sersan TNI AL, dulu pernah terdampar kapal perang dari eropa, sehingga ada yang menikah disana dan saat ini ditemui beberapa turunannya yang cantik-cantik seperti noni bule, mungkin portugis.

Dr Iwan dan tim menginap dirumah kepala desa, malamnya memberikan ceramah tentang kesehatan Lingkungan yang diterjemahkan kedlama bahasa mentawai oleh kepala desa diringi dengan tepuk tangan penduduk.

Dr Iwan yang dianggap sebagai tamu terhormat,diberikan tempat tidur disebelah kamar putri kepala desa, Dr Iwan dapat menjaga diri sehingga tidak tergoda untuk melakukan hal yang melangar adat, sebab bila menganggu putri Pagai,hukumannya nikah adat atau ganti rugi sepuluh ekor babi. Pagi hari dilakukan pengobatan gratis dan pengambvilan sample darah untuk pemeriksaan kuman malaria. Hapir 80 % penduduk silabu sudah menderita malaria dengan pembesaran limpa .

Keseokan harinya akan kembali ke Sikakap naik kapal Semangat tetapi Dr Iwan keberatan karena takut kapal akan tengelam, maka perjalan dilakukan dengan jalan kaki didarat, menempuh beberapa desa kecil,kemudian naik perahu ke Sikakap. Pada perjalanan ini Dr iwan diberikan beberapa hadiah pusaka etnis pagai seperti busur dan anak panah , gendrang kayu dan  tempat menyimpang tembakau dengan disain monyet untuk merokok yang dalam bahasa pagai disebut ubek.

(kisah lengkap baca dalm web blog hhtp:// search Kisah Pertualangan Dr Iwan Kepulau mentawai.

Dr iwan tahun 1980 , pernah memiliki pasien seorang peneliti dari USA, ia ketagihan Luminal, ada surat keterangan dari Kedokteran USa. selama hampir enam bulan menjadi pasien laqnganan Dr iwan di Padang, Pasien tersebut melakukan penelitian untuk thesis S3 tentang monyet kepala putih yang hanya ada di Pulau mentawai.

Selain itu kakak Dr iwan (Dr Edhie) pernah dikirimkan sebuah buku tentang pulau mentawai oleh seorang pastor,mungkin saat ini masih ada, bila ada kesempatan beberapa illustrasi akan dicuplik. Selain itu dr iwan juga meiliki bukukisah perjalanan seornag Belanda ke Pulau mentawai akhir abad ke 19, bebrapa illustrasi lihat di koleski milik Dr Iwan.

2. Kisah Pulau Mentawai Versi Penulis Asing

(1) the Ducth writer justus van Maurik had published about his adventure   to Indonesia in 1896 , the name of the Book  “INDIE” ,and he visit mentawai island , some of the rare picture book illustrations look below.

a) book cover

b) Mentawai Chief

c) Husband and wife

d) The Villige house

The Mentawai Islands
The Mentawai Islands lie to the West of Sumatra in the Indian Ocean.
They are composed of over seventy different islands. The islands
straddle the equator, which explains the lush temperate climate that is
associated with Indonesia. The history of the Mentawai Islands begins
between 2000 and 500 BC. The islands where once a part of Sumatra
and during the Pleistocene Era the islands were separated. The culture
of the Mentawai people is distinctly different from their fellow
Indonesians because of how long they’ve been separated from each
other. The islands were have been influenced culturally by the British,
the Dutch, the Germans, and finally by Catholic Italian missionaries.
Currently the Mentawai’s are considered regency within the Suatera

There are over twenty different endemic species spread through
out the seventy islands. There are four endemic primate species on the
islands; the Kloss Gibbon, the Mentawai Macaque, Mentawai leaf-
monkey and the sub-nosed monkey. In total the Mentawai’s house at

least seventeen endemic mammal species. Other common animals (at
least in these islands) are sea turtles, dolphins, fruit pigeons, endemic
squirrels, tropical fish like parrotfish, sharks, snakes and many more.
The Mentawai’s are composed of lush tropical rainforests, mangroves,
coral reefs, and beautiful white sand beaches. Some of which are
protected by the government. The Siberut National Park is one of the
most famous protected areas. Not only can you see the beautiful
vegetation of the Siberut Island, but you can also experience the lives
of indigenous Mentawai tribes.

The islands lie over one of the most active earthquake zones in
the entire world; because of its location the Mentawai’s are very much
at risk for tsunamis and earthquakes.

The culture of the Mentawai people is becoming increasingly
difficult to preserve because of rapid globalization. Historically the
people were jungle inhabitants until the Indonesian government forced
people to live in villages, thus becoming more modernized. Before they
lived in the government-run villages, the people lived in umas, which
are traditional long houses where an entire clan would live in. Before
modernization, the people of the Mentawai have lived off of the
tropical rainforests and of the natural resources that were available.
Everyone, including women and children were treated as equals.
Sikeireis or shamans, who shared everything that they knew with their


people, led the clans. With modernization came modern life styles,
many people renounced their clans and became more concerned with
materialistic ideals and thoughts. The government does provide school
for the children of the islands, but they tend to ignore the indigenous
history and culture of the Mentawai people.

The traditional religion of the Mentawai Islands is a form of
animism called Jarayak. This form of religion isn’t allowed by the
Indonesian government, many people have converted to either Islam
or to Christianity, but at the same time many people still practice

The Mentawai’s have become an incredibly popular surf
destination, not only for professional surfers, but also for surfers of all
skill levels since the mid-1990’s. One of the most popular ways to
enjoy the Islands is to take boat trips that take visitors to surf
locations around all of the islands. Another option is to stay at one of
the many hotels and resorts that are on the islands. These places
accommodate all of a surfer’s needs by providing the best in food and
service with transportation to the best waves. The most popular
islands with the best surf are Suberut, Sipora, and North and South
Pagai Islands. The most well known surfing area is called Playgrounds.
It is one of the worlds greatest spots to surf bringing in top surfers like
Andy Irons, Kelly Slater, and my all time favorite Taj Burrow. Many of


Taj Burrow’s videos are filmed in the Mentawai Islands, especially at
Macaroni’s, North Pagai and Lance’s Left, South Pagai. Surfing became
huge during a period during 1995 and still continues to gain more
fame as surfers continue to go and explore all of the wonders that the
Mentawai’s offer. The surfing industry has greatly expanded the
economy of the islands.

Tourism is now a huge industry. Since the 1980’s luxury resorts
are springing up all around the islands to cater to all a visitor’s wants
and needs. Fishing, surfing, relaxation, snorkeling, canoeing, kayaking,
hiking, learning about the culture and people, and just enjoying the
hospitality of the friendly Indonesian people are some of the things
that attract visitors to the islands.

3.Kisah Tsunami di Pagai Selatan 2010


The disaster-prone expanse of Indonesia has suffered three powerful blows to the region that has left over one hundred people dead Tuesday –and all three disasters were within hours of each other.

The fault that caused one of the world’s largest natural disasters back in December 2004, when a powerful earthquake trembled undersea and sent raging water to 14 countries in Indonesia, killing over 230,000 people, unleashed a strong undersea earthquake late Monday registering 7.7 in magnitude. The quake triggered a 10-foot tsunami that struck Tuesday, killing over 100 people and leaving thousands homeless.


According to officials, the tsunami struck the Mentawai Islands, a chain of about seventy islands and islets off the western coast of Sumatra, Siberut being the largest, that has become a destination popular among foreign surfers. The death toll from the tsunami is currently 113 – but steadily rising. Mujiharto, head of the Health Ministry’s crisis center, expects the toll to rise significantly.

“We have 200 body bags on the way, just in case,” he said. Meanwhile, between 150 and 500 people have been reported missing.

In addition to the killer tsunami were the eruptions of ash from Indonesia’s Merapi Volcano, located on the island of Java, that left one dead and about a dozen injured. Thousands living on the wall of the volcano have evacuated the area due to the smoke.

Indonesia, the world’s largest archipelago that houses approximately 237 million people, is located on a string of fault lines stretching from the Western Hemisphere through Japan and Southeast Asia known as the ‘Pacific Ring of Fire’ – making it extremely vulnerable to earthquakes, tsunamis and volcanic activity.





Showcase : Pameran Koleksi Pulau Mentawai di Dr Iwan Cybermuseum

selesai @hak cipta Dr iwan suwandy 2010

The minangkabau Collections Exhibtion at The Dr Iwan Cybermuseum

Driwancybermuseum’s Blog

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(1) headside

(2) tailside

2.Perca island (sumatra) Singapore marchant token




*Selendang cristic  embroidery design buterflies(Kotogadang)


* handkerchief embroidery design butterfly(Padang)






Minangkabau woman dressed in traditional clothes
Minangkabau woman dressed in traditional clothes

PS. THE COMPLETE INFO AND SHOW LOOK AT DR IWAN CYBERMUSEUM. please click hhtp://www.Driwancybermuseum.

the end @copyright Dr Iwan Suwandy 2010.

Manual bagi Pelatih Latihan Praktisi Rekam Medis menurt IFHRO




based on IFHRO manual

Prepared by:  Linda Galocy (US), editor

Table of Contents


Introduction 3
Unit 1 – Effective Teaching and Learning 5
Unit 2 – Defining Learning Objectives 14
Unit 3 – Creating Conditions for Learning 41
Unit 4 – Learning Resources 57
Unit 5 – Evaluation of Teaching and Assessment of Learning 62
Appendix 69
  1. Feedback on Lecture Planning















The purpose of this manual is to offer health information practitioners who are currently teaching or plan to teach in a formal or an in-service training program the opportunity to develop effective teaching skills.

The overall objective of this manual is to provide practitioners from different countries the opportunity to study the application of modern methods in the teaching of medical/health record science and to subsequently apply these methods effectively to the education of health information personnel in their respective countries.



The specific objectives of this manual are to enable practitioners to:

  • Analyze the goals and objectives of a program of study.
  • Develop a detailed syllabus including educational objectives for a health information program.
  • Plan and deliver lessons to health information students.
  • Identify, prepare and use effective teaching materials and resources.
  • Measure the achievement of educational objectives by students.
  • Develop summative evaluations for students to complete.


This manual has two sections:

  • Section one covers the development of teaching skills, and
  • Section two covers a set of learning modules for basic health record practice.


Each section has been designed as a starting point and can be customized as needs develop and change.

Section one contains five units:

  1. Effective Teaching and Learning
  2. Defining learning objectives
  3. Creating Conditions for Learning
  4. Preparing Learning Resources
  5. Evaluation of Teaching and Assessment of Learning


Some units have exercises with answers supplied at the end of the section.

Section two, the Learning Modules, contain six modules:

  1. The Health Record
  2. Patient Identification, Registration and the Master Patient Index
  3. Record Identification Systems, Filing, and Retention of Health Records
  4. Healthcare Statistics
  5. Planning a Health Record Department
  6. Administration and Management of the  Health Record Department


Suggested readings are included in some units.

Each section of the manual can stand alone if required. They have been prepared as a guideline to offer educators and potential educators:

  • An opportunity to gain further skills in the preparation, presentation and evaluation of an educational program for health information students, and 
  • Assistance with the development of basic teaching material for such a program.



Before embarking into a teaching career or simply planning a lesson for a seminar it is necessary for one to obtain an understanding of education. This unit provides a focus and a discussion of education, defines the teaching and learning process and provides key points that are essential for any instructor to keep in mind before preparing a lecture, lesson, or an entire course.



At the conclusion of this chapter you should be able to:

  1. Obtain an understanding of the difficulty in defining education;
  2. Identify the differences between training, education, instruction, and learning;
  3. List the five (5) aims of education;
  4. List the steps necessary to ensure teaching is effective;
  5. Identify communication skills as discussed in this unit



If we believe that teaching and learning are part of the educational process then it is important to understand education and the educational process. One should understand the definition of education and the relationship between education and training and training and instruction.

From the time of Plato authors have defined “education” in many ways with words and phrases such as “moral emphasis”, “experience”, “systematic instruction”, “training indoctrination”, “development”, and “give intellectual and moral training to”. But what does all of this really mean?

A definition is a “statement of the meaning of a word or word group or a sign or symbol” (Definition, 2010). Once the name of an object is associated with a definition, the word can be used meaningfully. Another way of learning to distinguish between objects is by observing them regularly. Often, a certain shape, size and structure can be associated with a certain word which names the object in question. The task, however, is often difficult when attempting to explain the difference between objects to someone who has seen neither – we know exactly what each one looks like, but it is often difficult to put into words. To actually define education is difficult as it is something we cannot see and it has neither a shape nor size associated with it and no one definition provides a true image.

A good definition settles issues without raising others, but the definition of education always seems to raise at least as many issues as it settles. Many authors have also developed a definition of teaching, in association with education, but they also vary in some way. Peters proposes that in place of a definition of education the following 3 criteria be used:

  1. Education implies the transmission of what is worthwhile to those who become committed to it. It ­requires something to be transmitted or passed on.
  2. Education must involve knowledge and understanding and some sort of “cognitive perspective” which is not inert.
  3. Education at least rules out some procedures of transmission on the grounds that they lack wittingness and voluntariness on the part of the learner.


Criteria are simply standards, not exact measures and therefore also leave questions to be asked. For example, Criterion 1 raises the question: Who decides what is worthwhile, and using the word “implies” suggests one characteristic of education, but leaves room for others to be included.

The second criterion is worded more definitively and categorically – the term must indicate that, unless the process involves knowledge and understanding and an overall view, it cannot qualify for the title “education”.

The third criterion provides a standard of comparison for methods of transmission. It does not dogmatically state that there is any one method of passing on knowledge and values. Nor does it state that indoctrination shall not be an educational method of passing on knowledge.

So far, this has not answered the question of “What is education”? Perhaps the best answer is that education is a process which must have both content and a method. The content is “knowledge” and “what is worthwhile” (values) and the method must allow the learner to understand what is being taught. By establishing criteria we come to discover “essential” characteristics of education – something of what it is, and something of what it is not. Although it is essential for us to have clear ideas about what constitutes education, we do not automatically ensure that education will be equally beneficial to all those committed to it.

At this point it can be concluded that there is no one definition of education. The next question to ask is “what is training?” and “what is the difference between “training” and “education”?” Training is said to be a narrower and more specific idea than education and training may be educational, but it can never be education. The term training, however, implies “exercising” and “repetition”. “Training” is for something, that is, a definite end or purpose. We do not merely “train” but train for; it also implies the acquisition of a skill.

Training is also closely associated with instruction. When talking about the educational process it is natural to talk about teaching. When educators discuss instruction we think of training (e.g. Physical training instructor). A definition of training is “an act, process or method of one that trains, the skill, knowledge or experience acquired by one that trains, the state of being trained” (Training, 2010). Training involves repetition. By repeating the application of skills learned an educator can be assured of proper training of students.

There is a narrowing down process as one moves from education to training to instruction. A definition of instruction is “to give knowledge to, to provide with authoritative information or advice, or to give an order or command to” (Instruct, 2010).

What then is the relationship between education and training? Is teaching an art not a skill?

To train someone how to teach is not enough. Teacher training lies within teacher education just as training lies within education. Education will include training but training can never be equated with education, and it can never be the larger concept which contains education.

There is a close connection between the aims of education and the content of education. The content of education is the curriculum – what we say about aims will serve as a bridge between “education” and “curriculum”.

The following aims of education give direction and provide a framework for our thinking:

  • To provide men and women with the minimum of skills necessary for them to take their place in society and to seek further knowledge.
  • To provide men and women with vocational training that will enable them to be self-supporting.
  • To awaken an interest in and a taste for knowledge.
  • To encourage people to think critically.
  • To put people in touch with and train them to appreciate the cultural and moral achievements of mankind.




We use the term effective teaching and learning but what does it really mean?

We know that teaching is a term used to describe a wide range of activities used to bring about learning, and learning is the acquisition of knowledge and skills or changes in behaviour patterns of a learner.

Effective teaching brings about a change or changes in a student’s knowledge, skills and attitudes as desired by the educator. That is, the teaching has effectively achieved the stated objective. Learning is effective when the students have understood and absorbed the knowledge, skills and attitudes imparted by the educator and are able to recall them when needed.

For teaching and learning to be effective, clear and measurable objectives need to written. Teaching must be suited to the knowledge, skills and attitudes possessed by the students at the start of the teaching/ learning process. That is, prior to teaching a group of students, their existing knowledge, skills and attitudes must be determined.  The methods and rate of teaching must also be suited to the students’ learning abilities.

Steps to be taken to ensure that teaching and learning are as effective as possible include:

  1. Setting learning objectives. 
    1. It is essential that each learning objective is unambiguous and clearly worded. It should state exactly what is to be learned. The formulation of such objectives will enable the educator to select exactly what the students need to be taught and the students to know exactly what they are required to know.
    2. Sequencing of learning. 
      1. The precise learning objectives needing to be achieved by the students are defined, and the knowledge/ skills/attitudes possessed by the students at the outset of the teaching process are assessed. It is then necessary for the educator to design the learning process in a series of logical steps or stages, geared to the students’ learning abilities. Each step or stage should lead to the achievement by the student of the next enabling objective, and ultimately to the successful achievement of the overall objective.
      2. Creating conditions for learning.
        1. Once the learning objectives have been developed, the next step is to create the conditions of learning to ensure students learn what they need to know. That is, the type of teaching methods best suited to achieve the learning objectives.
        2. Preparing learning resources.
          1. This step involves assessing the available resources and choosing the appropriate teaching materials and resources which will assist with the achievement of the learning objectives.
        3. Evaluation of teaching and assessment of learning. 
          1. The final step is to plan a course evaluation and develop reliable and valid assessments to measure student learning. That is, assess whether the teaching/learning processes have succeeded and if course objectives have been met.


For teaching and learning to be effective it is necessary that what is to be taught is precisely defined for both educator and student, that the teaching is structured in steps to suit the learners, and feedback is obtained to ensure teaching/learning processes have succeeded and course objectives have been met.




As discussed previously, the educator’s task is to bring about learning. This can be    achieved in many ways, for example, by the use of lectures, lessons, seminars, tutorials, or discussion groups. All such methods involve educator to student interaction or student to student interaction. This communication can take place in a classroom with a group of students or online through use of communication tools on the computer. Regardless of the method of communication the educator must have an understanding of the processes of communication and be able to control communication in the classroom or online. How then should we communicate?

  1. A.   Means of Communication


It is important that the educator be aware of, and use, the five channels of communication. These are sight, sound, smell, touch and taste. The most appropriate should be selected when planning to teach. The use of more than one method such as using a Power Point presentation or writing on a chalkboard as well as oral instruction will help the learning process.

It is also essential to understand non-verbal communication. Signs made, consciously or not, are of enormous importance. Signs such as body movements, smiles and gestures, are all means of communication. The educator must collect information from his pupils’ non-verbal communication, and be aware of his own use of this medium. The eyes are extremely useful in this connection; good eye contact with a class will help communication considerably.

The educator should have an understanding of the principles and processes of communication and learning. As many barriers to communication should be removed as possible to allow for a constructive and a productive classroom environment.

When teaching online it is essential for the educator to set rules of behavior and communication up front. The minimal amount of interaction required should be stated, rules of internet etiquette should be shared with the students, and deadlines for communication to occur should also be set. The online environment promotes student to student as well as student to educator interaction but it should be up to the educator to set the tone and minimum requirements for communication for students to follow.

  1. B.   Barriers to Communication


There are several factors which can inhibit the educator’s communication.  These include:

  1. Nervousness. Many educators, even experienced ones, are apprehensive, and this gives rise to behaviour which can distract, or annoy students. This behaviour may include looking at and/or talking to the top corner of the room, watching the chalkboard, juggling with chalk, nervous walking, looking out of the window. Such mannerisms should be identified and eliminated.
  2. Vocabulary. The educator must be careful to use words which can be understood by the student. New words must be explained immediately, and frequent checks made on comprehension.
  3. Voice. Speed of speech must be appropriate for the class and subject matter being taught. Speech should be neither too fast nor too slow. The articulation of words should be clear, pronunciation should not be idiosyncratic, and the voice should rise and fall appropriately.
  4. Presentation. A confusing presentation by the educator can inhibit learning. The subject matter and the lesson must be thoroughly prepared, with appropriate aids to communication.
  5. Technology. In an online environment technology is often a factor inhibiting communication. Students who do not have high-speed internet access, microphones on computers, or who are unfamiliar with instant messaging will struggle within this environment. It is important that the educator supply technological specifications to ensure all students meet the minimum requirements before they enroll in a course.


  • Spoken Communication

Understanding spoken words is not a passive process. A student takes time to select the information they feel is important, analyze it, accept or reject it, and then act. It has been proven repeatedly that different people are likely to select and retain different aspects of the same information.  Each student in a class may, therefore, arrive at a different interpretation and understanding of the material presented.

  • Written Communication

Like the spoken word understanding written words is also not a passive process. It is important for the educator to provide very clear expectations on what is appropriate in the online environment as it is very easy for anyone to misinterpret a written statement. It is important for the educator to continually monitor student to student interaction to ensure appropriate and respectful communication. The educator should be prepared to moderate any potential disrespectful or inappropriate conversation between students so as to ensure a positive learning environment.

  • Visual Communication

Seeing is an active process. Information channeled through the eye is also prone to distortion, and optical illusions are common. Different people see different things when looking at the same scene.

  • Personal Characteristics

If all communication is prone to distortion because people select differing bits of information, it is useful to consider the kinds of personal factors which will influence a student’s perception. These include age; attitudes toward the educator; the subject being taught; peer group, family; training/educational organization; previous learning; life experiences, school and work; internal stress; his/her own and others’ expectations; and motivation.

  • Motivation

Broadly speaking, students cannot be made to learn against their will. They have to want to learn. The motives for learning vary and cover fear and punishment at one end of the scale, to delight in acquiring knowledge at the other. Whatever the motivation, it is a pre-condition for learning. The student who is strongly motivated will learn no matter how hard the subject content may be, or how great the difficulties to be surmounted. The challenge for the educator is to inspire motivation in the unmotivated student, or sustain the motivation of the poorly motivated student in the face of difficulties, bearing in mind that repeated failure can result in despondency and despair, which can choke any positive effort to learn.

The methods of motivating students are as various as the individual students. These methods include relating subject matter to the students’ practical interests, inspiring interest by the quality of the teaching, and by the enthusiasm of the educator, inspiring interest through challenge, achievement and desire to do well.

Being properly motivated means not only knowing what one wants to do, but also having a compelling desire to do it. Lesson objectives that clearly describe what the student will be able to do at the end of instruction arouse interest, and challenge the student. Additionally, when the objectives are achieved they produce in the student the stimulation which is engendered by success.  “Nothing succeeds like success” and nothing succeeds in motivating the student more than continuous and frequent success along the way. The use of the systems approach is a means to this end. It provides the enabling objectives which, when systematically and continuously presented, sustain the students’ interest throughout the lesson, and when achieved, provide the encouragement of success.

Desire for a qualification is often the prime motivation of students. However, it is only when this prime motivation is reinforced, or replaced, by the enjoyment of the learning process, and when the student has learned to develop his own standards against which he can compare his achievements as he develops that the educator will have succeeded in the teaching task.

The educator must at all times respect the student as a unique, worthwhile, human being and not just one of the groups. Each student must know that the educator’s ambition is to get him/her to learn and to succeed.

  • The Environment

Communication can also be influenced by the physical environment of the classroom. Learning will be hampered if the room is too hot or too cold, humid, badly ventilated, drafty, or noisy. All students should be seated comfortably, with a good view of the educator and visual aids, and adequate space in which to work. The traditional classroom layout with rows of desks will enforce certain patterns of communication. Such an arrangement would, for example, be inappropriate for a discussion group, and the educator must re­arrange the seating to fit with the learning objectives for each session.

  • Assimilation

Assimilation requires that interest be aroused, sustained, and the students motivated to learn, while at the same time avoiding saturation and fatigue.

The educator has to make the subject matter meaningful and relevant, giving each topic a recognizable and logical structure, which leads from the simple to the complex, and presents the material in suitably graded steps without overloading the student. The student can only assimilate what has been experienced. Mere verbalism is not sufficient for this purpose and the student must be allowed to exercise, as far as possible, the full range-of-senses. The educator must therefore, capture and hold the students’ senses so that the lesson becomes a real and memorable experience.

  • Retention

The ability to retain information is dependent upon the impact of an experience upon the recipient. The eyes are the most effective gateway to the brain and an educator can best aid retention by making use of this fact. That is, by using visual aids possessing vividness, color, layout or an element of surprise, and by providing stimulating classroom demonstrations and practical work to the maximum possible extent. Recall also aids retention, and oral questioning and written exercises which require the students to recall past work, should be frequently used.

  • Feedback

It is essential to monitor learning and to check how each student has received and interpreted the material presented. The educator must devise learning situations which provide continuous feedback to both educator and student. Failure to do this will result in ineffective communication and make it more difficult for the student to learn and impossible for the educator to assess the effectiveness of his or her teaching.

In summary, to be effective it is necessary that what is to be learned is precisely defined by both educator and student.  The teaching method to be used must be selected to enable all students to reach the required level to meet the stated objectives of the course.



Definition. (2010). Retrieved June 5, 2010, from Merriam-Webster online dictionary:

Instruct. (2010). Retrieved May 23, 2010, from Merriam-Webster online:

Training. (2010). Retrieved May 23, 2010, from Merriam-Webster online:

World Health Organization.  Notes prepared for Workshop for Teachers of Health and

Medical Record Science, New Delhi, March, 1979.

UNIT 2 – Defining Learning Objectives 

The first step in determining what to teach is to analyse the perceived requirements of the end product of the teaching/learning process. That is, one needs to discover:

  • the minimum knowledge, skills and attitudes to be achieved by all students who successfully complete the course, and
  • the minimum of knowledge, skills and attitudes required at the beginning of the course so that the students may successfully undertake the course.


In other words, analyse what students need to know to become efficient practitioners, and assess what they already know prior to undertaking the course (Ewan, 1984)



At the conclusion of this unit you should be able to:

  1. Determine course requirements by writing a detailed job description and completing a task analysis;
  2. Specify course objectives in terms of what the students should be able to do after completing the learning process;
  3. Determine course content required to enable the students to attain the stated objectives.


What to Teach

Many educators do not have to decide what to teach since they may already have a pre-existing syllabus. However, all educators should know why they are teaching a subject and at what level the subject should be taught. In addition, a syllabus usually only contains an outline of a subject and educators need to decide what topics to cover in more detail in each teaching session.

When determining what to teach the educator must be able to define the content of a lesson or an entire course. The educator must determine:

a)    The aim of the course, which should be stated in general terms, indicating what it is hoped will be achieved;

b)    Objectives of the course, which are statements indicating what students should be able to do as a result of the learning opportunities presented;

c)    Content of the course, which refers to the subject matter that will be covered to enable the students to attain the objectives;

d)    Assessment, describing how the educator will measure the outcome of the teaching/learning process. That is, how the student will be assessed to find out whether the teaching/learning process has been effective.


Some definitions we should look at before proceeding are:

a)    A course is usually taken to mean any program or series of planned units related to each other.

b)    A syllabus is a statement of the objectives to be covered by a course of study.

c)    A curriculum is a course of study or a plan of learning.

d)   A learning opportunity is a planned and controlled relationship between students, educators, materials, equipment and the environment in which it is hoped that learning will take place.

e)   Course aims are long term goals, usually expressed in fairly general terms.

f)    Course objectives are more detailed than the course aims and should indicate the measurable performance students must achieve to successfully complete the course.

g)   Lesson objectives are clear and precise statements of the performance, expressed in behavioural terms, which the students are required to achieve in order to attain the course aims.

h) Enabling objectives are the component knowledge, skills and attitudes that the student must acquire in order to achieve the lesson objectives.

Remember that learning should be relevant to the future needs of the students. That is, learning that will facilitate effective performance by the students in their subsequent professional roles.

When developing a course, educators need to:

  1. clearly establish what they are trying to achieve with their students, then
  2. decide how they hope to do it, and finally
  3. consider to what extent they have been successful in their attempts.



a)            Stages of Development

The planning of learning opportunities which are intended to bring about certain changes in the students, and the extent to which these changes have taken place, is what is meant by curriculum development. The four stages of development are:

  1. Careful examination of the objectives of teaching. This requires the drawing on of all available sources of knowledge and informed judgment.
  2. The development of methods and materials which are judged most likely to achieve the objectives agreed upon.
  3. The assessment of the extent to which the methods and materials selected will achieve the objectives.
  4. Feedback of the experience gained is necessary in order to provide a starting point for further study. For example:
  • Curriculum process
  • Objectives
  • Methods & materials
  • Feedback
  • Assessment


b)           Where to Start

You have been asked to develop a curriculum for a new course in Health Information Management and now you need to determine where you should you start?

We have already said that there are two main factors to be considered when deciding what to teach (Ewan, 1984). These factors are:

  • What students must know or be able to do at the completion of the course, and
  • What the students already know.


The first step is to determine what the students must learn. That is all the things a student must know to be a competent practitioner. In addition you may want to include other things which are “useful to learn” and perhaps “nice to learn”.

To find out what the student must learn the steps are to:

  • Write a detailed entry-level role job description for the Health Information practitioner.
  • Conduct a task analysis for the role of the Health Information practitioner.
  • Determine course objectives.
  • Write a statement of content that will enable students to understand what it is they will need to do in order to achieve the stated objectives.


c)            Writing a Job Description

A job description defines the standards for a job, aids in evaluating job worth, both internally and externally, clarifies the purpose and essential functions of a position and informs the creation of training and development plans. According to DePaul University (US) “A well written job description describes the main elements of a job and is not a detailed listing of specifications. It provides guidance on the general nature and level of the work being performed. It describes the duties as they currently exist” (2007).

A job description should include 3 main items:

  • General summary – this should be a brief paragraph describing the purpose of the position and the level of work to be performed.
  • Principal duties and responsibilities – this should be a list of 5-7 essential functions that would be the most important in order to be successful in the position.
  • Other applicable knowledge, skills, and abilities – This includes the education and experience preferred in order to perform the principal duties and responsibilities and required certifications.


A sample job description is as follows:

Job title:  Health Information Manager


General description: Administer the health record services of the health care facility, including the development, planning, implementation, evaluation and control of health record systems and services


Principal Duties and Responsibilities:

The primary function of the Health Information Manager is the organization and administration of patient information systems within the health care facility. Activities and responsibilities include administration of the health record services department, development, planning, implementing and controlling health record systems and services, administering other areas of patient information services, consulting and advising on patient health information systems, ensure achievement of accreditation standards, protect health information from unauthorised access and produce health information for authorized access, provide in-service training for staff and supervision of students, retrieve, collect, compile and analyse data for internal and external statistical and reporting purposes and for use in patient care, clinical and health service research, evaluation and education, represent the health information department on hospital committees, and performs other duties as assigned.


Minimal acceptable qualifications

Include credentials and education as desired in this section here. Also include any other experience desired such as typing/keyboarding skills, level of computer proficiency desired, etc.

d)           Conducting a Task Analysis

A task analysis is the process of gathering information on all aspects of a specific task. Each activity listed in the job description can be broken down into specific tasks which the health information manager must perform and therefore things that the student must learn. For example, the activity “administer the health record services of the healthcare facility” can be broken down into the following tasks:

  • select, direct and supervise staff
  • organize the workflow within the health information/health record department
  • responsible for all areas of the health information/medical record department
  • prepare a departmental budget
  • evaluate, select and order equipment
  • plan the work space and storage areas
  • document the activities of the department and
  • maintain a policy and procedure manual


Remember that by conducting a task analysis you are analyzing a job in order to decide on the appropriate content for an educational program. In some cases you may need to take each task and break them down further into more specific parts to enable you to identify the knowledge, skills and attitudes required to do the task.

When you have completed your task analysis you should be ready to determine and write detailed course objectives.

Determining Learning Objectives

As mentioned previously, teaching is directed towards outcome. The educator engages in certain activities in order to bring about changes/learning in his students, and must, therefore, know what changes he is trying to achieve. The specifications of what the student must be able to do after instruction, are usually expressed as objectives.

Objectives have three components:

  1. Performance: A definition of exactly what the student must be able to do to demonstrate that he has acquired the specific behaviour.
  2. Conditions: A statement prescribing the conditions under which the student must demonstrate the specified behaviour.
  3. Standards: A statement setting the performance standard against which student behaviour must be judged.


e)            Principles for Developing Instructional Objectives

In considering the use of instructional objectives, it is most helpful to note four principles related to the development of objectives. These are:

  1. a well-stated instructional objective has as its subject, the learner
  2. a well-stated instructional objective has a verb that describes behaviour or performance to be observed
  3. included in the objective is a statement describing the conditions under which the student will perform what is learned
  4. included is a statement concerned with the standard of performance required of the student who is said to have achieved the objective

Remember that the specification of course objectives is a precise statement of the knowledge, skills and attitudes which all students must attain by the end of the course.

Before proceeding it is important to define knowledge, skills, and attitudes.

      i.        Knowledge (cognitive learning) deals with thinking and can range from simple recall of facts to higher-order logical and scientific reasoning.

    ii.        Skills (psychomotor learning) deals with the ability to coordinate muscular movements and can range from skills involving a single movement such as pressing a control switch to higher-order skills such as high-speed keyboarding.

   iii.        Attitudes (affective learning) deal with feelings and can range from simple awareness of problems to a whole philosophy of life.

You do not have to divide everything into knowledge, skills and attitudes, but you should consider what knowledge, skills and attitudes are involved when analyzing a task.

Once you have analysed the tasks, you will be able to determine what content you will need to cover. Content is often written in terms of learning objectives. Learning objectives enable you to communicate to students and others what the students need to know.

It is important to remember that you should always write learning objectives as what the student should be able to do or TSSBAT. For example:

At the conclusion of this course the student should be able to:

Write learning objectives in terms of performance and conditions for lessons or topics listed in an existing syllabus.

Remember to preface all objectives with TSSBAT.

The following points summarize what we mean by learning objectives:

  • A learning objective describes an intended outcome of a lesson or part of a lesson. The topics listed in a syllabus usually do no more than provide a summary of its content.
  • A learning objective must state in performance or behavioural terms, exactly what the learner will be doing when demonstrating his achievement of the objective.
  • The objectives for a lesson may consist of several specific statements. The objectives for an entire course syllabus will consist of many specific statements.
  • The objective that is most usefully stated is the one that, without ambiguity, communicates the instructional intent of the educator.



Three types of learning

According to Benjamin Bloom there are three types of learning:

  • Cognitive: mental skills or knowledge
  • Affective: growth in feelings or emotional areas or attitude
  • Psychomotor: manual or physical skills


“These domains can be thought of as categories. Trainers or educators often refer to these three domains as KSA (Knowledge, Skills, and Attitude). This taxonomy of learning behaviors can be thought of as “the goals of the training process.” That is, after the training session, the learner should have acquired new skills, knowledge, and/or attitudes” (Clark, 2009).

Learning objectives should begin with an action verb that describes the behaviour or performance expected from the student. After the action verb comes the subject content that the student is expected to learn.

Consider the following three learning objectives.

The student should be able to:

  1. State the difference between ratio, rate and a proportion
  2. Draw a population pyramid
  3. Display receptiveness to ideas/opinions of others in a group situation.


The three action verbs “state”, “draw”, and “display” correspond to the three types of learning: knowledge, skills and attitudes.

Many verbs are imprecise and open to a range of interpretations. Others are more precise, less open to misinterpretation, and therefore more suitable for stating learning objectives. For example, although it is not wrong to use words such as “understand” or “recognise” when you are writing objectives, these verbs are not sufficiently explicit to be useful until you indicate how you intend to sample or test what the student understands and what he/she should be able to recognise. That is, what the student will be doing when he is demonstrating that he “understands” or “recognises”.

Words associated with the three types of learning domains as suggested in Bloom’s Taxonomy [1956] include:

1. Words associated with the Cognitive Domain include:

Knowledge Comprehension Application
defines, describes, identifies, knows, labels, lists, matches, names, outlines, recalls, recognizes, reproduces, selects, states comprehends, converts, defends, distinguishes, estimates, explains, extends, generalizes, gives Examples, infers, interprets, paraphrases, predicts, rewrites, summarizes, translates applies, changes, computes, constructs, demonstrates, discovers, manipulates, modifies, operates, predicts, prepares, produces, relates, shows, solves, uses


Analysis Synthesis Evaluation
analyzes, breaks down, compares, contrasts, diagrams, deconstructs, differentiates, discriminates, distinguishes, identifies, illustrates, infers, outlines, relates, selects, separates categorizes, combines, compiles, composes, creates, devises, designs, explains, generates, modifies, organizes, plans, rearranges, reconstructs, relates, reorganizes, revises, rewrites, summarizes, tells, writes appraises, compares, concludes, contrasts, criticizes, critiques, defends, describes, discriminates, evaluates, explains, interprets, justifies, relates, summarizes, supports

This domain involves the knowledge and development of intellectual skills. This includes the recall or recognition of specific facts, procedural patterns, and concepts that serve in the development of intellectual abilities and skills. Each of these categories is listed starting from the simplest behavior to the most complex. The categories can be thought of as degrees of difficulties. That is, the first one must be mastered before the next one can take place. (Clark, 2009)

2. Words associated with the affective domain include:

Receiving phenomena Responding to phenomena Valuing Organization Internalizing values
asks, chooses, describes, follows, gives, holds, identifies, locates, names, points to, selects, sits, erects, replies, uses answers, assists, aids, complies, conforms, discusses, greets, helps, labels, performs, practices, presents, reads, recites, reports, selects, tells, writes completes, demonstrates, differentiates, explains, follows, forms, initiates, invites, joins, justifies, proposes, reads, reports, selects, shares, studies, works adheres, alters, arranges, combines, compares, completes, defends, explains, formulates, generalizes, identifies, integrates, modifies, orders, organizes, prepares, relates, synthesizes acts, discriminates, displays, influences, listens, modifies, performs, practices, proposes, qualifies, questions, revises, serves, solves, verifies

“The affective domain (Krathwohl, Bloom, Masia, 1973) includes the manner in which we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes. The five major categories are listed from the simplest behavior to the most complex” (Clark, 2009)

3. Words associated with the Psychomotor Domain include:

Perception Set Guided response Mechanism Complex overt response Adaptation Origination
chooses, describes, detects, differentiates, distinguishes, identifies, isolates, relates, selects begins, displays, explains, moves, proceeds, reacts, shows, states, volunteers copies, traces, follows, react, reproduce, responds assembles, calibrates, constructs, dismantles, displays, fastens, fixes, grinds, heats, manipulates, measures, mends, mixes, organizes, sketches assembles, builds, calibrates, constructs, dismantles, displays, fastens, fixes, grinds, heats, manipulates, measures, mends, mixes, organizes, sketches NOTE: The Key Words are the same as Mechanism, but will have adverbs or adjectives that indicate that the performance is quicker, better, more accurate, etc adapts, alters, changes, rearranges, reorganizes, revises, varies arranges, builds, combines, composes, constructs, creates, designs, initiate, makes, originates

“The psychomotor domain (Simpson, 1972) includes physical movement, coordination, and use of the motor-skill areas. Development of these skills requires practice and is measured in terms of speed, precision, distance, procedures, or techniques in execution. The seven major categories are listed from the simplest behavior to the most complex” (Clark, 2009).

f)             Subject outline

Finally, when developing a curriculum you should prepare a subject outline along the following lines:

Subject title; Hours; Pre-requisite (prior knowledge of student); Co-requisite (what should be taught at the same time); General aim of the subject; Specific objectives; Content; presentation;. Assessment; Textbooks to be used; References to be used

A subject outline could look like this:

SUBJECT:  HEALTH RECORD MANAGEMENT HOURS: 60 hours; 2 hours per week for Semester I; 2 hours per week for Semester II; PRE-REQUISISTE: Nil CO-REQUISITES: Nil GENERAL AIM: This subject introduces the student to the concepts of a health information system by means of an integrated study of the nature of information and health record management. The theory of information systems is complemented by practical implementation in both manual and computerized environments.

SPECIFIC OBJECTIVES: At the conclusion of this subject the student should be able to:

  1. explain the basic concepts of an information system and the nature of medical information;
  2. determine the roles and responsibilities of medical record departments and hospital committees in maintaining the quality of medical records;
  3. analyze privacy and confidentiality issues relating to health care delivery in a hospital;
  4. perform the technical functions of medical record procedures and describe how they relate to serving the needs of the health care facility and the patient;
  5. determine the value and uses of the medical record and the requirements for a complete medical record;
  6. compute hospital statistics from daily bed census figures, using the appropriate formula
  7. discriminate between a structured and unstructured medical record



  1. Introduction to information systems concepts and components of an information system;
  2. distinction between data capture and collection;
  3. development of the health record during the medical care process;
  4. quality in health recording/documentation; record structures including source oriented, problem oriented documentation;
  5. the health record as an information system; electronic health record systems;
  6. patient identification and master patient index;
  7. record numbering and filing systems; record control;
  8. record retention and storage;
  9. discharge analysis;

10. hospital census and hospital statistics;

11. privacy, security, confidentiality and release of information

PRESENTATION: Lectures and small group tutorials


One 1500 word essay assignment           20%

One x 2 hour exam each semester           80%


Burch, John G., Strater, Felix R., and Grudnitski, Information systems: Theory and practice (2nd Ed.), New York: John Wiley & Sons.

Huffman, Edna K. (1981). Medical Record Management (7th Ed). Berwyn, IL: Physicians Record Company.


Place, Irene, Hyslop, David J. (1982). Records Management: Controlling Business Information. Virginia: Preston Publishing Co. Inc.

Waters, K.A., Murphy, G.K. (1979). Medical Records in Health Information. Germantown: Aspen Systems Corporation.



Remember, the process for defining the content of a course for health information practitioners is as follows (Ewan, 1984):

  1. Analyse the work situation and determine the needs
  2. Define the general functions of the health information practitioner
  3. Write a job description for the health information manager
  4. Break down the activities relating to the job description into specific tasks
  5. Determine the knowledge, skills and attitudes necessary to perform the tasks
  6. Write learning objectives based on the determined knowledge, skills and attitudes, and
  7. Determine the content needed to achieve the stated learning objectives






Bloom, B.S. et al. (1956). Taxonomy of Educational Objectives:  The Classification of

Education Goals.  New York: Longmans Green.

Clark, D. (2009, May 26). Bloom’s taxonomy of learning domains. Retrieved June 1,

2010, from Big Dog & Little Dog Performance Juxtaposition:

DePaul University. (2007). Writing job descriptions. Retrieved May 31, 2010, from Office

of Human Resources:


Ewan, C.E. (1984). Teaching Skills Development Manual: A Guide for Teachers of

Health Workers. Sydney: University of NSW, School of Medical Education.




  1. Work at your own pace.


  1. Put a checkmark by your choice of answers or write your answers in the spaces provided.


  1. Always give your own answer before looking up answers


  1. Correct any mistakes after checking your answers





At present, the contents of our courses are usually controlled by means of a syllabus which is issued in a traditional format, i.e. a list of the topics to be “covered” during the course. It is important, therefore, if that primary aim is to be met, that when writing the syllabus and subsequently the lesson plans care should be exercised to ensure that they are written in such a way that the effectiveness of the course is guaranteed for every student.

Look at the example shown below of a traditional syllabus:

Lecture/ Practice – Electrical units and trade, electrical measurement, and technology

This lecture will discuss the units of current EMF resistance and power and their relationship to one another, calculation of circuit resistance and symbol representation, and the use of instruments for the measurement of current voltage and resistance.

This is supposed to indicate the performance of a student. Many questions arise here:

a)    Which units and relationships are concerned, and is the trainee to define them, list them, and state their derivation or what?

b)    What calculations must the trainee be able to make, given what information and, if appropriate, what equipment; how many must he make, in what period of time, and how many must he get correct?

c)    Which instruments must the trained man be able to use, to what accuracy, and under what conditions?

If the student is to be able to perform effectively the tasks for which he is being taught, the instructor must have available a clear statement of what the student must be able to do, the conditions under which he will be expected to do it and the standard to which he must do it. The traditional syllabus provided in this example does not provide this information and the questions posed in sub paragraphs a) to c) above are indicative of the difficulties involved in attempting to interpret statements of course content contained in traditional syllabi.

Reference for this section:

From notes prepared by WHO for a Workshop for Teachers of Health and Medical Record Science, New Delhi, 1979.



Only by writing syllabi as objectives will the difficulties be resolved.  With this in mind, this exercise has the following:

  1. Given a number of statements of training objectives and the labels “Performance”, “Conditions” and “Standards”, the reader should be able to label the main parts of all the statements and identify which parts are missing in any statement which is not complete.
  2. The reader should be able to state without error the two requirements of the performance words in a good objective and identify acceptable words from a given list.
  3. Given extracts from attempts at objectively written syllabi the reader should be able to identify those with acceptable performance elements.
  4. Given extracts from existing syllabi the reader should be able to write lesson objectives stated in performance terms.


Here is an example of a lesson objective:

The student must be able to list all the steps required to prepare a discharge list for distribution to service departments.

This is a statement of what a student must do (the performance required to show that he has learned, i.e. he has to draw up a list). Thus a lesson objective must contain a performance element. In the previous example where the student must list the steps, as an educator you would probably ask some questions as follows:

a)    In what environment will the performance take place?

b)    Are reference documents to be used?

c)    Can the student receive any assistance from other personnel?


In answering the above questions it is seen that the lesson objective is not as precise as it could be, since we have not stipulated under what conditions he has to do it.

Question 1) A lesson objective must state ________________________as well as performance.

We can also ask further questions as follows:

a)    How long is he given to draw up his list? i.e. standards of time

b)    Are errors acceptable? i.e. standards of accuracy

c)    Must the steps be in a particular sequence? i.e. standards specified in reference documents

Question 2) These further statements are standards of performance required by the job. Hence to make an objective complete we must also include: ________________

Question 3) State the three essential elements of a good learning objective:

a) ___________________

b) ___________________

c) ___________________

Because of the importance of the three elements and to make it easier to write we prefer to put the objectives into three columns.

List all the steps required to prepare a discharge list for distribution to service departments Without reference to notes or any other source of material In the correct sequence as described in the procedure manual without error


Question 4) Let us now consider another lesson objective:

Given a dinner menu select and set out correctly the cutlery and glasses for 40 places within 40 minutes.

Sort this objective it into its 3 elements, placing them in the columns below.

PERFORMANCE                CONDITIONS                      STANDARDS

______________                 ____________                     ____________

______________                 ____________                     ____________

______________                 ____________                     ____________

______________                 ____________                     ____________

Question 5) now you should have attained the performance specified in the first objective of this exercise, i.e. label the parts of a lesson objective. See if you can identify the elements present in the two incomplete objectives below.

Read them through, and then write out the parts of the objective on the table below.

  1. Given 10 different quadratic equations, with no reference for aid, the student should calculate the value of the unknowns.
  2. The student should measure voltages to an accuracy of within + 2%


PERFORMANCE                CONDITIONS                      STANDARDS

______________                 ____________                     ____________

______________                 ____________                     ____________

Let’s see how we can apply this objective approach to an extract from a traditional syllabus shown below: ­

The overhead           visual aids     tutorial projector

This can be re-written as a lesson objective to read as:

PERFORMANCE                CONDITIONS                      STANDARDS

He must operate the            in a classroom with              correctly

Overhead projector              students present

Question 6) you have just seen in the previous frame how an extract of an existing syllabus has been expanded into a complete lesson objective with the three elements of __________, conditions and standards.

Question 7) we will focus our attention during the rest of this exercise to this performance element which describes what the student must be able to ________________to show that he has learned.

Question 8) Look at the performance element of these 2 objectives:

a) He must operate the instructional media

            b) He must state the uses of the instructional media

The words “operate” and “state” tell us what the student must do, not just “to understand” or “have knowledge” of the operation and characteristics. The point is the student must carry out the action of operating and stating. Thus the verb, “operate”, describes what is expected of the students’ performance.

Look at the following two groups of verbs and notice the difference. One of the groups might be used in the specification of performance. Suppose you specify that the learner will be able:

A         to know                                  to perceive

to understand                       to have knowledge of

to appreciate                         to be aware of

to recognize                          to realize

to remember                          to comprehend

to be acquainted with          to sympathize with

to be familiar with                 to be conscious of

B         to write                                   to list

to recite                                  to conduct

to identify                               to select

to build                                   to raise

to find                                     to solve

to file                                      to construct

to weigh

Question 9) which of these two groups ought to be used in writing an objective?

 A _______or B _______

Consider the description “to understand” in group A. It in fact means very little. This does not mean that understanding is unimportant. What you as a writer of objectives must do, is decide what you want to observe the student doing as evidence that he “understands”.

Question 10) put a checkmark in the box marked YES if you think the given verb could be used in an objective, and in the box marked NO if you think that it could not, that is if it indicates a thought process.

                                                                                    YES                                        NO

a)            Appreciate                                                     _______                                ______

b)            Identify                                                           _______                                ______

c)            Fit                                                                    _______                                ______

d)            Remember                                                    _______                                ______

e)            Lift                                                                   _______                                ______

f)             Select                                                             _______                                ______

g)            Comprehend                                                            _______                                ______

Question 11) It has already been pointed out that an objective will need to include a statement of the standard a student must achieve. It is important for the instructor to be able to measure whether or not the student has reached that standard.

The problem of ensuring that the action described is one that is measurable is a particularly difficult one. For example, let’s look at the performance “to describe”. This action is observable but is it measurable? _________________ (yes/no)

Question 12) Consider the case of one particular syllabus where the student is required to “know, understand, appreciate, or be conversant with”. None of these performance words illustrates an action which is at all observable. Thus we must at least find a word which illustrates an observable performance, which is as near as possible to the required performance. Would the words “explain”, “discuss”, and “describe” be better choices? __________ (yes/no)

For some knowledge and, almost certainly, all attitudinal training (e.g. liberal studies, leadership and management) it is difficult to write objectives containing performance words, illustrating action which is both measurable and observable. Here we should at least seek observable performance for the lesson objectives.

Remember in education we are aiming for the students’ acquisition of knowledge, skills and attitudes. It may help to think of these as three separate categories and choose verbs which would fit them. The knowledge verbs will not be too difficult to find providing that you avoid the trap of describing a thought process.

Question 13) Consider the words “list”, “identify” and “state” These are acceptable in objectives because they are both __________________ and___________________.

The Skills area is more difficult and may require some definition of the verb used, e.g. “operate” means “to control physically”.

In the knowledge and skills categories there are many verbs which describe actions which are both observable and measurable.

It is the attitude category which creates most difficulty.  The guiding rule must be if you use a verb that is observable but not measurable be certain that you are describing an activity in the attitude category; if you are not, change the verb.

Here are a few points relating to writing attitudinal objectives:

When teaching medical statistics to health information students you will be concerned with increasing their knowledge – knowledge ranging from recall of facts to ability to solve problems. On the other hand, the skills you will expect them to acquire will be few: these may include ability to assemble data in tables, draw graphs and bar diagrams, use a simple electronic calculating machine and fill in forms, such as the standard death certificate, neatly and accurately. You will not find it difficult to write performance objectives for most of the knowledge and skills you expect your students to display by the end of your course. What you will have difficulty with is the writing of objectives to describe the observable and measurable actions you expect them to display in relation to the changes in attitudes you hope to bring about. Yet the changing of students’ attitudes towards the relevance of statistics to health care, and towards the interpretation of medical and particularly clinical evidence in the light of statistical concepts, is an important, and some would say the most important task facing the educator of medical statistics.

How difficult it is to write explicit attitudinal objectives is well illustrated by the following example, taken from a course on medical statistics:

The student should be able to appreciate the role of biological variability in medicine.

This may be a worthy attitudinal objective, but it fails to communicate. No one, least of all the student, will have any clear idea about what the person who formulated it intended to teach or what change in attitudes his students would be expected to demonstrate as the result of his teaching. This would be made a little clearer if it read:

The student should be able to state what is meant by biological, instrumental and observer variability in clinical medicine and give two examples of each taken from among the biochemical laboratory measurements commonly requested by hospital physicians.

“To appreciate the role of” describes nothing that is observable, let alone measurable; “to explain” (or “discuss” or “describe”) is more explicit – the expected behaviour can at least be observed, although it may be difficult to measure. To ask the student to state what is meant by the different types of variability and to give two examples of each from a defined area of medicine makes the objective much more explicit and at least in part measurable.

The following questions are statements from attempts at objectively written syllabi. Indicate by a tick in the YES/NO boxes, those with acceptable performance elements.

Question 14) in each case “the students should” statement should be understood to precede the performance elements.

  Yes NO
a)    Be able to classify a disease process _______ _______
b)    Be able to compute the gross death rate _______ _______
c)    Know the correct formula for the calculation of an infection rate _______ _______
d)    Be able to state the five uses of hospital statistics _______ _______
e)    Understand the meaning of informed consent _______ _______
f)     Be aware of the safety procedure to be adopted during fire exercise _______ _______
g)    List the three components of a learning objective _______ _______
h)   Differentiate between correctly and incorrectly expressed objectives _______ _______


 How well did you do?

If you had less than 1 error proceed to the next question.

If you had more than 1 error go back to question 13.

Question 15) Which of the following learning objectives, are stated in performance or behavioural terms? Put a tick in the Yes or No column against each example.

  Yes NO
a)    to know how to compute the standard deviation _______ _______
b)    to understand and describe the concept of biological variability _______ _______
c)    to apply the chi-square test to a given set of data _______ _______
d)    to write down the formula for the standard deviation _______ _______
e)    to recognize the misapplication of statistical principles or methods in medical publications _______ _______
f)     to list in logical order the steps to be taken in the computation of the standard error of the difference between two proportions _______ _______
g)    to explain the uses of the t test _______ _______


Question 16) As mentioned previously, some verbs are much more suitable than others in the formulation of learning objectives. Which of the following are suitable and which less suitable?

  Suitable Less Suitable
a)    to know ________ _______
b)    to compute ________ _______
c)    to list ________ _______
d)    to understand ________ _______
e)    to appreciate ________ _______
f)     to identify ________ _______
g)    to realize ________ _______
h)   to construct ________ _______
i)     to assemble ________ _______
j)      to be aware of ________ _______
k)    to calculate ________ _______
l)     to specify ________ _______
m)  to tabulate ________ _______
n)   to discuss ________ _______
  • o)    to use
________ _______
p)    to describe ________ _______
q)    to name ________ _______
r)     to make ________ _______
s)    to operate ________ _______
t)     to be familiar with ________ _______


Check your answers against the answers given on page 36.

Question 17) Now see if you can categorize correctly the following verbs all commonly used in learning objectives, according to whether they are concerned with measuring knowledge, skills, or attitudes. Place a checkmark in the correct column for each verb. Some will have more than one answer.

  Knowledge Skills Attitudes
a)    assemble _______ _______ _______
b)    compute _______ _______ _______
c)    categorize _______ _______ _______
d)    construct _______ _______ _______
e)    calculate _______ _______ _______
f)     define _______ _______ _______
g)    discuss _______ _______ _______
h)   draw _______ _______ _______
i)     describe _______ _______ _______
j)      explain _______ _______ _______
k)    identify _______ _______ _______
l)     list _______ _______ _______
m)  make _______ _______ _______
n)   recognize _______ _______ _______
  • o)    state
_______ _______ _______
p)    specify _______ _______ _______


Check your answers against the answers given on page 37.


Question 1) CONDITIONS

Question 2) STANDARDS


Question 4)

PERFORMANCE                CONDITIONS                      STANDARDS

Select and set                       given a menu                       correctly

out the cutlery and               minutes                                  40 places

Glasses                                  ____________                     40 minutes

Question 5)

PERFORMANCE                CONDITIONS                      STANDARDS

given 10 different                 with no reference to aid      calculate the value of unknowns

Measure voltages                ______________                 accuracy within +2%


 Questions 7) DO

 Question 8) ACTION

 Question 9) Group A describes thought processes which no one can see. Group B describes actions. These are performances that are observable.

Question 10) Yes examples, b, c, e and f are “observable”.

Question 11) we think you will agree that it is difficult to measure a description, because there is no valid or reliable means of doing it.

Question 12) Yes they would be, even if they are difficult to measure. If your answer was NO, please return to Q.11 and read again.


Question 14.

                                                                                                                        Yes                 No

a)    Be able to classify a disease process x _______
b)    Be able to compute the gross death rate x _______
c)    Know the correct formula for the calculation of an infection rate x _______
d)    Be able to state the five uses of hospital statistics x _______
e)    Understand the meaning of informed consent _______ x
f)     Be aware of the safety procedure to be adopted during fire exercise _______ x
g)    List the three components of a learning objective x _______
h)   Differentiate between correctly and incorrectly expressed objectives x _______


Question 15

  Yes NO
a)    to know how to compute the standard deviation x _______
b)    to understand and describe the concept of biological variability x _______
c)    to apply the chi-square test to a given set of data x _______
d)    to write down the formula for the standard deviation x _______
e)    to recognize the misapplication of statistical principles or methods in medical publications x _______
f)     to list in logical order the steps to be taken in the computation of the standard error of the difference between two proportions x _______
g)    to explain the uses of the t test x _______


Question 16

  Suitable Less Suitable
a)    to know x _______
b)    to compute x _______
c)    to list x _______
d)    to understand ________ x
e)    to appreciate ________ x
f)     to identify x _______
g)    to realize ________ x
h)   to construct x _______
i)     to assemble x _______
j)      to be aware of ________ x
k)    to calculate x _______
l)     to specify x _______
m)  to tabulate x _______
n)   to discuss x _______
  • o)    to use
x _______
p)    to describe x _______
q)    to name x _______
r)     to make x _______
s)    to operate x _______
t)     to be familiar with ________ X


Question 17

  Knowledge Skills Attitudes
a)    assemble _______ x _______
b)    compute x _______ _______
c)    categorize x _______ _______
d)    construct x x _______
e)    calculate x _______ _______
f)     define x _______ _______
g)    discuss _______ _______ x
h)   draw x x x
i)     describe x _______ _______
j)      explain x x x
k)    identify x x x
l)     list x _______ x
m)  make x x x
n)   recognize x _______ _______
  • o)    state
x x x
p)    specify x x x



Write at least 3 learning objectives using the following guide.

SUBJECT:    Master Patient Index

Content Limits: (Knowledge, skill, attitude, and specific subject matter limits)

Given (what conditions will student work with, or respond to?)

The student should (observable performance or product showing his performance, i.e. state, write, construct, etc.)

Performance standards (How well?  Quantitative and/or qualitative minimum standards for acceptable performance)


This exercise should be undertaken in a group situation.


The objectives of this group exercise are to:

  1. provide practice in stating a course aim clearly and precisely,
  2. analyze an existing course syllabus and restate a section of it in the form of a list of course objectives,
  3. arrange the objectives into a logical teaching sequence,
  4. define the lesson objectives required for the attainment of the course objectives (including standards to be attained and the conditions of attainment of each objective),
  5. allot lesson objectives to the necessary number of lessons required for their attainment and arranging the lessons in an appropriate sequence.



The group is to analyse an existing course syllabus and all related examination papers. In light of the subject knowledge and teaching experience of group members, they should then be able to:

a) Define the aim of the course syllabus

b) Re-write a section of the syllabus in the form of a list of course objectives

c) Arrange the course objectives in logical teaching order

d) Derive lesson objectives, with conditions and standards, from the course objectives

e) Allot the lesson objectives to the number of lessons needed to cover the selected section of the syllabus.


 1. Each group will elect a chairman who will be responsible for chairing meetings, allotting tasks to group members and submitting the group’s solutions at the end of the session. At the first meeting each group will agree on the division of work between members, the way it will be carried out, and the procedure for presenting it. As quickly as possible thereafter group members will produce a list of course objectives for which they are responsible. These objectives should be discussed at a group meeting and agreed upon or revised as necessary. When the group has agreed on the completely rewritten section of the syllabus as a comprehensive list of course objectives, work on the formulation of objectives for each lesson may proceed.

2. To prepare the lesson objectives, the course objectives should first be arranged in a logically sequenced learning order. Having agreed on the length and number of lessons for the course, each objective may then be allotted to one or more lessons, because it is from the course objectives that the objectives for each lesson (the lesson objectives) are derived. In some cases the course objectives, as written, may be acceptable as the lesson objectives, but usually it will be found that the lesson objectives will be amended and become expanded versions of the course objectives.

 3. The group chairmen will meet to consider how the results of the exercise might be consolidated to produce one basic syllabus.

UNIT 3 – Creating Conditions for Learning


Once you have decided on the material that the students must know and which parts represents knowledge, skills and attitudes, the next step is to decide how to create conditions which will help the students learn what they must know. Every student learns best when taught at their own level of working competence, with tasks that are challenging and with procedures and materials that are of the highest interest. In other words, there are differences among students which affect their learning. Some students learn best by reading and others by doing. Therefore, when planning teaching sessions, it is important to keep in mind the variations in personality, level of education, preferences, and background knowledge of students.


At the conclusion of this unit you should be able to:

  1. Create the appropriate conditions in your classes to enable your students to effectively learn the knowledge, skills and attitudes required to achieve their learning objectives.


Conditions of learning

Two categories of conditions for learning have been identified, (Ewan, 1984). These are:

a) Environmental, and

b) Personal

  1. Environmental conditions include physical facilities, educator style, resources available, attitudes of the class to the subject and to the learning itself.


Physical factors include the physical environment such as adequate lighting, ventilation, seating, temperature, and external noise control. Teaching materials and resources such as handouts, pictures, models, chalkboards, whiteboards and overhead projectors often enhance the presentation of an effective teaching session.

Behavioral factors include such things as the educator’s personality. If the students find their teacher unapproachable or distant, they will be hesitant to participate in class. If they feel uncomfortable with the teacher, students tend to withdraw from any interaction.

There is always room for relaxation in a classroom while at the same time maintaining a good working atmosphere. Such relaxation will allow for questions, discussions and minor diversions from the topic to explore unexpected comments or suggestions.

It is important to treat students as individuals whenever class sizes permit. Being positive about a student’s response, even if it is incorrect, is important. If an incorrect answer is given the educator should take time to assist the student in reaching the correct answer. Praise should also be given for work well done. Harsh criticism should be avoided as students will be more inclined to offer comments if they know the educator will listen and not criticize if they are wrong. Students, however, must be told when they are wrong, but such criticism should be constructive, not destructive. A quiet explanation of where he/she went wrong and how the mistake can be corrected gives the student the opportunity to learn from the mistake. Personal insults should be avoided.

  1. Personal conditions include motivation which is often considered to be the most important condition for learning. We all know that students must want to learn. We have all been students at some time or another and we should be aware of the many contributing factors relating to lack of motivation and disinterest.

In many cases students are motivated to pass examinations and are not motivated to learn anything which is may not appear on an exam. It is important, therefore, for the educator to help students see the relevance of what they are learning. They should be sufficiently motivated by a desire to learn in order to become a competent practitioner. This motivation should be encouraged by the educator. Ewan (1984) describes two kinds of motivation:

  1. External motivation which is achieved in the form of exams, assignments and other forms of formal assessment, and
  2. Internal motivation which occurs when students have an interest in learning and have personal goals to achieve.

The educators’ task is to create conditions of learning in which students’ internal motivation is recognized and encouraged to develop. Educators should also see that sources of external motivation are kept in their right perspective.

Conditions of learning knowledge

An educator’s job has three (3) main purposes (Ewan, 1984):

  1. presenting information in such a way that it is easy for students to retain information,
  2. presenting information in such a way that students are able to store it for future use,
  3. providing opportunities for students to strengthen their learning by using it to perform tasks or ­information out

The conditions of learning for knowledge, skills, and attitudes are slightly different but their basic principles are the same.

a)    Input

It is important to present information in a way that students can understand. Facts should be presented in a way that students can easily understand and must be relevant to the students’ learning needs.

b)    Process and Storage

Information should be readily recalled. That is, the student must be able to store the information in such a way that facts can be retrieved when needed. When new material is being presented the use of examples or reminding students of previous learning will assist the student with storing the new information for easy recall.

c)    Output/performance

Information learned and stored must be used to perform tasks or solve problems. Students should be given practice in applying knowledge to situations similar to those they will meet when they join the workforce. They should also be given the opportunity to apply their knowledge to situations which are not familiar or typical. The introduction of new and unusual problems enables students to work beyond simple recall. They need to analyse a problem and think through a range of possible solutions until they come to one which will effectively solve the given problems.


Conditions of learning skills

Skills are tasks which students learn to do by practice. The same three areas, input, process/storage and output/performance apply here (Ewan, 1984).

a)    Input

Students must know what they are expected to do. This can be achieved by demonstration, films, videos or role play. If a skill has several components, the students must be taught each component step by step. They should master each step before moving on to the next one.

b)    Process and Storage

Students must be given the opportunity to practice the skill being taught. It is important to provide students with the opportunity to practice professional skills in a real-life situation or in a simulation exercise. For example, if you are teaching terminal digit filing you should have a “practice filing area”. The students could practice filing in this simulated file before being sent to a real life situation in a hospital.

c)    Output/performance

Students must be told how well they are performing, that is, given feedback. Remember our discussion in Unit 1. Students must be told if they are performing a task incorrectly to enable them to correct their mistake before proceeding to other tasks.

Conditions of learning attitudes

“Attitudes are usually defined as a disposition or tendency to respond positively or negatively towards a certain thing (idea, object, person, and situation). They encompass, or are closely related to, our opinions and beliefs and are based upon our experiences. As far as instruction is concerned, a great deal of learning involves acquiring or changing attitudes” (Kearsley, 2010).

It is important to expose students to good role models of desired behaviour during their training. They should also be given an opportunity to try out their new attitudes and judge their effectiveness. This can be achieved by providing a practical placement in a hospital or other health care facility.


Conditions of learning are only part of the answer on how to teach a particular subject. The other part lies in the selection of teaching methods. Some common teaching methods are listed below:

  • Lecture
  • Seminar
  • Group discussion
  • Buzz groups – Groups of 2-6 members who discuss issues or problems for a short period
  • Demonstrations – The educator performs some operation
  • Role Play
  • Tutorial
  • Simulation and Games


The Lecture

The lecture is probably the quickest and most economical method of presenting information to a large number of people at one time and is a widely used teaching method in higher education establishments. Although an economical teaching method, the lecture is an inefficient one because there is usually no feedback from the students during the lecture, and the lecturer cannot tell whether the students are and retaining any information. If, therefore, the maximum teaching value is to be gained from lecturing, it is essential that each lecture should be very carefully prepared and presented.

Lecture Preparation

Thomas H. Staton in his book “How to Instruct Successfully” suggests that when preparing a lecture the educator should remember that he is dealing with people and use the letters of the word “PEOPLE” as a prompt for the steps in preparing a lecture, in the following manner:­

  • P – PINPOINT the exact purpose of the lecture by defining the overall objective and the precise enabling objectives.
  • E – EXAMINE the backgrounds, existing knowledge, and needs of the students who will attend the lecture, so that the information to be presented to them is at their level, is not too complicated for their understanding, does not cover the ground already covered by someone else, and will be presented to them in words which they will all understand, i.e. technical jargon and technical terms must be explained if they will be unfamiliar to the students.
  • O – ORIENTATE the talk to match the knowledge and interests of the students. Plan to present accurate, up-to-date and relevant information in an interesting manner. Decide what equipment will be necessary to deliver the lecture and make sure that it will be available in working order.
  • P – PARTITION the lecture material into convenient sections so that the students’ learning will be facilitated.
  • L -LIMIT the lecture material to that which can be readily absorbed by the students in the time available.  Decide how much time to spend on each objective and the important points to include in a hand-out to obviate or minimize the need for note-taking during the lecture.
  • E – EXAMPLES should be used when appropriate to make the subject matter vivid and to stimulate the students’ interest.


Structure of the Lecture

A lecture should have an introduction, a development section and a conclusion.

The introduction should briefly review previous work or refer to previous lectures. The introduction should arouse the students’ interest and get them motivated them to learn while stating the objective(s) of the lecture.

The development section is the main part of the lecture, and describes how the objectives can be attained. The subject matter should be presented in a logical order using any appropriate audio­visual aids both to enhance the students’ understanding and to maintain their interest. The objectives should each be stated at the appropriate stage of the development section so that students are aware of what the lecturer is trying to teach.

The conclusion should consist of a re-capitulation of the main points of the lecture, the answering of questions and a short description of the subject of the next lecture in the series.



Suggested Lecture Plan

It is most important that a lecture be carefully timed to ensure that the subject matter can be taught in the time available. If in doubt, rehearse beforehand to make certain that it can. Such a plan will provide an instructor with time signals which will help adhere to the planned delivery programme. The following table is an example of a lecture plan for a one-hour lecture.

Timing Teaching points Aids
5 minutes Introduction section PowerPoint slide
15 minutes Objective 1 PowerPoint slide, diagram, chart
15 minutes Objective 2 PowerPoint slide, table
15 minutes Objective 3 PowerPoint slide, math problem
10 minutes Conclusion section/questions Power Point slide


Final Preparations

Before the start of the lecture the lecturer should: ­

  1. Check that the seating arrangements in the lecture room will enable all students to see and hear the lecturer.
  2. Check that all the students will be able to see clearly all visual aids that will be used in the lecture.
  3. Check that all teaching aids, demonstration equipment, etc. are available in the lecture room and are working properly.
  4. Check that any hand-outs to be given to students are available before the start of the lecture.
  5. Read through the lecture material to ensure that it will be fresh in memory at the start of the lecture.


Delivery of the Lecture

  1. Voice and manner.  The lecturer should:
  • Make sure that they can be easily heard by everyone in the lecture room. If in doubt, ask those at the back.
  • Speak confidently and enthusiastically.
  • Speak slowly and clearly.
  • Avoid sounding monotonous by making frequent changes of pitch and volume.
  1. Mannerisms. The lecturer should avoid distracting mannerisms such as addressing the lecture to the ceiling, constantly looking out a window, fiddling with money or keys in pockets, juggling with a piece of chalk, swaying from side to side, or any other distracting mannerism.


  1. Vocabulary. The lecturer should use the simplest possible vocabulary and certainly one that is sure to be understood by all of the audience. When it is necessary to use technical terms or jargon which are new to the audience, their meaning should be carefully explained.
  2. Timing. It is important that the lecturer adhere to planned timings. The effectiveness of a lecture is often nullified if the lecturer has to rush through later parts of it because he has overstepped the time allotted to earlier parts. Timings should be marked on the lesson plan or, if using a script, at the top of each page of the script and should keep a close eye on the time throughout the lecture.



After the lecture the lecturer should try to obtain opinions of members of the audience about the effectiveness and/or strengths and weaknesses of the lecture, so that necessary improvements can be made before delivering the lecture again. A critical self-appraisal can be done to make note of the points which can be improved the next time the same lecture is delivered or for future lectures that will be presented.

The Lesson

The lesson consists of:

  • Statement of lesson objective/s
  • Assessment of knowledge, skills and attitudes of students
  • Design of lesson plan
  • Implementation of lesson
  • Evaluation of achievement of lesson objective/s by students


Lesson preparation

Before giving a lesson, the educator must have adequate knowledge of the subject to be taught and must decide on the form and content of the lesson, taking into account the abilities and background of the students and the time available for the lesson. Consideration should be given to the following:

  • The overall objective/s of the lesson must be correlated with other subjects in the course syllabus
  • must be precisely and clearly defined in simple language
  • must, when appropriate, state the standard to be achieved and the conditions
  • must be attainable within the time allotted to the lesson


The enabling objective

An overall objective may be achieved in a series of steps, which are referred to as the enabling objectives. The attainment of the enabling objectives leads logically to the attainment of the overall lesson objective.

Selection of teaching material

The material to be used during the lesson:

  • Should not be excessive
  • Should be relevant to the objective/s of the lesson
  • Should be suitable for the type of student being taught.


Arrangement of teaching material

The teaching material should be arranged in a logical sequence and should proceed from the known to the unknown and from the simple to the complex.

Design of a teaching plan

Having decided what to teach, a suitable plan for the teaching of each unit of the subject matter must be prepared. This should be designed by the educator to suit their own manner of teaching and is always amended as the result of experience and of feedback from students. There are a variety of ways of designing a teaching plan. One of the clearest ways is the columnar plan in which the plan is set out under column headings such as: Lesson number, Lesson length, Objectives, Audio-visual aids, in- class work, tests and homework. Having a plan is important to ensure proper attention has been paid to facilitate learning by the students. These include:

  • a logical sequence
  • efficient allocation of teaching time
  • precise teaching objectives
  • the choice of the best teaching methods
  • appropriate questions and testing


Structure of the lesson

Similar to the structure of a lecture a lesson consists of an introduction, the development of the subject to be taught or the body of the lesson and the conclusion.

The introduction

The purpose of the introduction to a lesson is to lead the students into the new subject matter, arouse their interest, win their attention, and motivate them to learn. The introduction should be short and relevant and should inform the students of what they are to be taught in the lesson; it should recall previous work on the subject and lead naturally to the statement of the objective/s of the lesson. It should provide an explanation of why the students need to learn the subject matter, and if this is possible, describe the practical applications of the subject matter or its relevance to current or historical events. There should be time to allow questioning of the students to enable the educator to determine their readiness for the new work.

The body of the lesson

The body of the lesson is broken down into a series of steps or the enabling objectives, which lead logically to the attainment of the overall lesson objective or objectives. These objectives must be given to the students at the outset so that they know what they are required to learn, and what the educator is trying to teach. The number of enabling objectives will depend on the complexity of the subject to be taught and the abilities of the students.  Short steps command the students’ attention, assist student participation, maintain students’ interest, and enable the educator to ensure that nobody is being left behind.

Throughout the lesson, and at the end of each step in the lesson, the educator should question the students on the content to ensure they are learning. After the educator is satisfied that the students are comfortable with the content then you can move on to the next objective. Keep in mind that students learn through the eyes as well as the ears and that variety stimulates interest. Visual aids, models, actual pieces of equipment and practical demonstrations should be used whenever possible to reinforce teaching and learning. It is always a good idea to test visual aids before the lesson to make sure that they will work.

The conclusion

The conclusion of a lesson consists of recapitulation of its subject matter and testing to: ­

  • Reinforce the subject matter taught in the lesson
  • Discover whether all the students have learned what has been taught and,
  • Measure the teacher’s effectiveness.


During the conclusion, each enabling objective should be restated and followed by questioning; orally, rather than in writing, because written tests are extravagant of class time and, to be of real value, have to be marked individually. The students can then be told what will be in the next lessons in the series and the preparations they should complete prior to the next lesson.

After the lesson is over the educator should review his/her teaching critically to determine whether it was effective or if what can be improved. It is always a good idea to document specific thoughts or feedback as soon as possible after the lecture. It may be difficult to remember specific thoughts or ideas especially if there is a large amount of time before presenting the same material again.

Achievement of the lesson objective/objectives

It should never be forgotten that the educator is employed to teach all and not just the more able students, and that teaching ability is judged by an educator’s ability to teach the less able rather than the bright. It may be found that by applying this principle, an educator does not complete a lesson planned in the time available, but it is far more important that all the students learn what has been taught rather than a portion of a class learned a lot and the remainder learned very little.

If it is not possible to complete a planned lesson in the time available, the educator should analyse the reasons for the failure. Perhaps some or all of the students lack the ability to undertake the course of study, in which case the initial selection of students should be improved; or the syllabus is too ambitious to be completed in the time available and should be amended or additional time allowed for its completion. Maybe the method of teaching needs to be improved. A good teacher is one willing to consider the possibility of improving his or her own teaching before considering other remedies.

Questions and questioning

Before completing this section on the lesson we should take a brief look at questions and questioning.

The purpose of questions during the introduction to a lesson is to: ­

  • Discover how much the students know of the subject before introducing new material
  • Revise/review what has been taught in a previous lesson so as to refresh the students’ memories
  • Arouse the interest of the students and hold their attention


The purpose of questions during the body of a lesson is to:

  • Discover at each stage of a lesson whether all students are learning what is being taught, so that, if necessary, the stage of the lesson can be re-taught before proceeding to the next.
  • Discover whether the subject is being taught at an appropriate rate.
  • Discover whether the method of teaching is the right one for the particular class or whether the subject needs to be developed in a different way.
  • Give the opportunity to the students to contribute information on the subject or to learn by themselves by observation and deduction rather than from listening.


The following DOs and DON’Ts in questioning will help in the development of questioning technique: ­

  1. Do not allow mass answers or a student to answer who has not been asked to do so. Insist that only the student to whom the question is addressed is to answer it. If the answer is incorrect, praise the student for trying and address it to another student.
  2. Do not be tempted to address the majority of questions to the brightest students. The test of your teaching is whether you can teach the slower ones. At each stage of a lesson a cross-section of the class, from slowest to brightest, should be questioned.
  3. Do not automatically repeat every answer given by a student.  Do so only if the answer may not have been heard by all the other students, if it is correct but badly expressed, or when the answer needs to be emphasized.
  4. Do not ask questions which enable the students to guess the answers.  If you think a student has guessed the correct answer, ask for reasons why it was given.
  5. Do avoid asking questions to which the answer is obvious.
  6. Do address questions to the whole class and then, after a short pause during which all students will have to think of the answer, name the student who is to answer.
  7. Do ensure that all members of the class are questioned at some stage but avoid questioning in rotation so that no student knows whether or not he or she is going to be asked the question – this will keep them on their toes.
  8. Do encourage the slowest students to answer questions by praise and a sympathetic manner.
  9. Do give the brightest students the occasional difficult question to keep their interest and sharpen their intellects.

10. Do make sure that each question is phrased, without ambiguity, to elicit the answer required.

11. Do ensure that each question is fully answered by the concerned student; if the answer is incomplete, the teacher should probe or break up the question into parts to obtain the answer required, but must not complete the answer for the student.

12. Do teach on the assumption that if a student has not learned what has been taught, it is the educator who has failed.  Snubbing, bullying and, worst of all, sarcasm, are the refuges of the bad teacher. If a student has not been able to give a correct answer to a question it is because he or she has not learned. It is the job of the teacher to discover the reason and to put it right.

13. Do try to pose questions which require the students to exercise their reasoning power ­and answer “Why, What, When, Who, Where and How”.

Questions from students

From the point of view of the educator, questions from students demonstrate that their interest has been aroused and that they are ready to learn. It fosters communication between the educator and students and makes teaching a more exciting and enjoyable experience. In an ideal situation, it would not be necessary for the educator to question the students because any student who did not understand nor had a query would interrupt the teacher to ask a question. Unfortunately this is an unlikely situation. Ideally the educator should give the students every encouragement to ask questions. Educators must be on their guard against the danger of artfully posed questions which are designed to lead them away from the subject they are teaching, in these circumstances, they should either: ­

  • manipulate the questions so as to make them relevant, or
  • dismiss them as irrelevant, while at the same time appreciating that such questions originate from lack of interest in the subject of the lesson and that a greater effort must be made to inspire interest in it.


Remember that questions can serve a number of important functions:

  • They can stimulate thought by raising the level of attention.
  • They can motivate students by arousing their interest and curiosity.
  • They can enable the lecturer to discover what the students know.
  • They can enable the lecturer to check on the clarity of his/her presentation.


The essential part of planning a teaching session is to plan the questions to be asked along with planning the content.

The Seminar

A seminar may be defined as a discussion group in which each student can actively participate within the allotted time. The seminar is subject-oriented and sometimes requires the presentation of a short paper by one or more of the group at the beginning of the session which then forms the subject of the seminar discussion. The leader leads the group through the discussion and essentially helps to keep the group focused on the topic of discussion. The students are generally the group who asks questions of each other, provides examples when necessary, and controls the discussion topics.

Types of seminars

A seminar may be either student-centered or instructor-led.

In the student-centered seminar the educator or leader arranges beforehand for a member or members of the group to prepare a specified topic and make a short presentation that will then allow discussion to follow.

In the instructor-led seminar the instructor introduces the topic or topics and leads the subsequent discussion.

Suggestions for effective groups

According to McKeachie (2002) the following are suggestions to ensure effective groups:

  1. Be sure everyone contributes to discussion and to tasks.
  2. Don’t jump to conclusions too quickly. Be sure that minority ideas are considered.
  3. Don’t assume consensus because no one has opposed an idea or offered an alternative. Check agreement with each group member verbally, not just by a note.
  4. Set goals – immediate, intermediate, and long-term – but don’t be afraid to change them as you progress.
  5. Allocate tasks to be done. Be sure that each person knows what he or she is to do and what the deadline is. Check this before adjourning.
  6. Be sure there is agreement on the time and place of the next meeting and on what you hope to accomplish.
  7. Before ending a meeting, evaluate your group process. What might you try to do differently next time?


Keeping the above points in mind will help students and instructors stay on task, ensure everyone has a voice in the discussion, and allows for some evaluation which is very important in improving the seminar process.

The Leader

A good leader of a seminar is one who can both control the discussion and encourage participation by all members without appearing to take a major part in the discussion. The leader should be:

  • a clear and quick thinker
  • a good listener
  • able to express himself clearly and succinctly
  • able to summarize a discussion point or a point of view
  • be unbiased in the discussion
  • be patient, tolerant and able to encourage the participation of all without offending
  • be able to control the discussion and prevent it from going of course.


The leader should not be interested only in his own point of view or profess to know all the answers or expect everyone to agree with his opinions.

Planning and preparing a seminar

Before the start of the seminar the leader should:

  1. Be knowledgeable of the subject matter.
  2. Announce the topic for discussion sufficiently in advance of the time of the seminar to ensure that all its members have sufficient time to acquire the necessary knowledge of the subject.
  3. Decide on the objective/s of the seminar.
  4. Prepare his introduction to the discussion.
  5. List headings to enable him to guide the discussion.
  6. Arrange provision of any necessary equipment, prepare hand-outs, and arrange seating in such a way to allow a productive discussion.


Conducting a seminar

A suggested method of conducting a seminar is as follows: ­

  1. The leader should introduce the topic to be discussed and state the objectives to be achieved; if applicable he should detail the headings under which the topic might conveniently be discussed.
  2. After the introduction the topic can be presented by a group member or members reading a short paper or speaking on the subject for a few minutes followed by the discussion, or, if no paper is to be presented, the leader can start the discussion by posing a question to the group.
  3. The leader should encourage the less forthcoming members of the seminar to contribute their opinions, disagreements, or ideas while at the same time making sure that no one is allowed to monopolize the discussion so that everyone in the group participates in the discussion.
  4. The leader should lead the discussion when necessary to prevent it from bogging down or digressing from the subject, but should do so as unobtrusively as possible. He should also avoid lecturing to members of the group. When necessary, it is important to intervene in the discussion to ask individuals to clarify or summarize what they are trying to express. Finally, summarize the discussion at the end of each stage and at the end of the seminar, giving credit for any specially noteworthy contribution to the discussion


The types of questions which can assist in a productive discussion/seminar:

  1. Leading questions put in such a way as to suggest specific answers will help to carry the discussion forward.
  2. Factual questions designed to elicit facts necessary for the discussion.
  3. Direct questions seeking a contribution from a particular individual.
  4. Overhead questions directed to the whole group to move the discussion along.
  5. Controversial questions designed to produce argument from a sharp division of views.
  6. Provocative questions likely to provoke a strong reaction from most of the seminar participants.
  7. Re-directed questions asked of the leader redirected to another member of the seminar.


Constraints on a Seminar

Constraints which can restrict the value of a seminar are:

  1. Too many or too few members; insufficient members to allow a wide variety of views or too many members to enable all to contribute effectively.
  2. Members of the seminar having insufficient knowledge of the subject under discussion to be able to make worthwhile contributions.
  3. Inability of seminar members to express themselves adequately in speech.
  4. Inability of seminar members to argue and/or discuss a subject rationally.
  5. Inability of a seminar member or members to accept criticism or contradiction of their views without taking offence.
  6. Poor leadership is the biggest constraint of all.



Ewan, C.E. (1984).  Teaching Skills Development Manual: A Guide for Teachers of

Health Workers. Sydney: University of NSW, School of Medical Education.

McKeachie, W. J. (2002). McKeashie’s teaching tips. Boston: Houghton Mifflin


World Health Organization. (1979).  Notes prepared for Workshop for Teachers of

Health and Medical Record Science.  New Delhi.

Unit 3 – Exercise 1

The objectives of this practice lesson are to give participants of this exercise the opportunity to demonstrate the teaching techniques described in this manual.

  1. Participants should be asked to deliver a 20-minute lesson on a topic of their choice to their fellow participants and leader.


  1. The topic, its content and the demonstration of the techniques of teaching are all regarded as important. The length of the lesson, including questioning during and at the end of the lesson, will be strictly limited to 20 minutes.


  1. A classroom should be prepared and equipped with the necessary equipment the participant will require to complete this teaching assignment.


  1. Time should be allocated for the preparation of teaching material for the practice lesson, and tutors should be available to advise as required.


  1. At the end of each practice lesson the strengths and weaknesses of each teaching performance should be discussed by the tutors and the individuals presenting the lesson.


Unit 3 – Exercise 2

A second practice lesson should be prepared and delivered by each participant using feedback from the previous exercise to improve presentation where necessary. This second lesson should be 50 minutes and should resemble as closely as possible a real situation.

UNIT 4 – Learning Resources 

When we speak of learning resources, we refer to resources as people, facilities or materials that are used to assist in carrying out the teaching plan. This unit will deal with the use of resources such as handouts and Power Point. There will also be discussion of other uses of technology in teaching for face-to-face and distance learning.


At the conclusion of this unit you should be able to:

  1. Assess the available resources and
  2. Choose and prepare the most appropriate to accomplish the learning objectives.



Basic premises to be considered in selecting and using instructional materials are:

a)    Learners tend to function like an information processing system during the process of learning.

b)    Learning materials represent various forms of stored information.

c)    A primary function of instruction is to assist learners to access, process, store and retrieve relevant subject matter.

d)    A primary function of an educator is to select and employ the most appropriate information storage/retrieval vehicle (resources) that will expedite a learner’s attempts to access, store and retrieve subject matter relevant to their achievement of desired instructional outcomes, which are the course objectives.

e)    Resources are considered as “aids to the learner” and not “teaching aids”.

f)     The more control the learner has over the presentation of information the more likely they will be able to access and store, in a retrievable form, desired subject matter.

g)    Instructional equipment and materials should be selected to maximize the learners’ control over the presentation of the subject matter stored in the resources used.

Material and technology for instruction should be selected on the basis of its potential for implementing the learner’s acquisition and retention of the behaviour called for by a stated objective. It should provide a set of stimuli in such a way that will best produce the responses called for by the stated objective. In other words, instructional material should be selected or designed to give learners the opportunity to identify and practice the stimulus/response relationship(s) specified by the instructional objectives.

It is important to also consider what technology is available to the instructor, the comfort level one has with the available technology, instructional goals for the stated objectives to be accomplished, and what is the background and preparation of students and their attitudes towards use of technology. According to McKeachie (2002) some questions to ask are:

  1. What do you expect students to learn from the lesson?
  2. What skills and knowledge do you want them to acquire by the end of the lesson?
  3. What teaching strategies (lecture, discussion, group work, and case studies) will best help students achieve these goals?
  4. Will the students readily accept the technology chosen?



Handouts and printed notes are useful for topics where there are no suitable texts or references available to the students (Ewan, 1984). Handouts are usually printed material handed out during classes and could include:

  • abstracts or full transcripts of lecture notes
  • lists or definitions of important parts of a lecture
  • graphs or diagrams used during a lecture
  • key points of a lecture
  • course or lecture objectives

The most useful types of handouts are ones which provide an outline of the lecture and some stimulus, e.g. questions, to help students organize their note taking and thinking during class.


The use of a chalkboard or whiteboard is usually spontaneous and therefore does not require preparation time. This is extremely useful when you wish to emphasize a particular point or list student responses to a question.


The most common misuse of the Power Point (PPT) is to use it to present too much information in too short a time. This is called “information overload”. Therefore, when planning to use PPT it should be used in a way that will enhance teaching.

a)    Suggested planning sequence

              i.        Objectives: what do you want students to be able to do after viewing the slides?

  1. Ask yourself the following questions: What is the purpose of each slide? Is it to introduce a topic, consolidate information or review subject matter?

            ii.        Purpose: Are the slides meant to introduce information, review, practice, prompt, assist with problem solving, provide a basis for discussion or taking notes?

           iii.        Analyze: Is the material suitable for a PPT presentation?

b)    Points to keep in mind for creating PPT presentations

  1. Use fonts 24 points or larger
  2. Use dark type and light background
  3. Use the slide as a guide rather than reading directly from it
  4. Always face the audience
  5. Distribute or allow students to download a copy of the slides prior to the presentation
  6. Keep the room lights on and avoid showing slides in a dark room for more than 15 minutes at a time
  7. Avoid putting students in a passive mode of receiving information by combining the slide presentation with chalkboard/whiteboard use or any other learning activities
  8. Have a backup plan in case of a power or equipment failure



Audio is another useful resource used as a teaching aid especially with the increased use of webinars, podcasts, and other forms of media being used in distance education. Points to keep in mind when making an audio recording are:

a)    Voice quality

i)             Use a conversational tone

ii)            Vary the tone of voice frequently

iii)           Enunciate clearly

iv)           Speak fairly rapidly, but don’t appear to be rushing. Pace the dialogue well. The pause can often be an effective way of keeping the interest of the listener

v)            Avoid “uh’s” and other distracting speech habits

vi)           It is sometimes a good idea to use different voices, e.g. for one section use a female voice and for another, a male voice

vii)         Use of key words. Emphasizing the right words can effectively communicate the meaning and leads to greater flow and rapidity. Using the wrong emphasis can completely change the meaning.

b)    Content of the recording

viii)        Repetition can be achieved by the student through a replay of the podcast or other media fairly easily. Therefore, repetition by the narrator is unnecessary.

ix)           Specially recorded sounds, voices of outstanding people, or short dialogues when used functionally provide variation and add realism to the information.

x)             Don’t extend a lesson needlessly

xi)           Make sure critical points are clarified. A brief statement often can provide the immediate reinforcement necessary to help the student proceed confidently.



The best resources are those which you have chosen because they will help students to learn what they must know. Remember, resources must:

A. be appropriate to the level of the students’ knowledge and the type of learning

B. present the message clearly and be free from distracting and irrelevant detail

C. encourage student participation in class rather than passive receiving of information

D. be well produced, accurate, readable and/or understandable and educationally sound

E. enable you to use them with confidence to add to the effectiveness of your teaching and to the effectiveness of student learning

F. be accessible to all students in order for it to provide any benefit.


Ewan, C.E. (1984). Teaching skills development manual: A guide for teachers of health


workers. Sydney: University of N.S.W., School of Medical Education.

Kemp, J.E. (1980). Planning and producing audiovisual materials (4th Ed). New York:

Harper & Row.

McKeachie, W. J. (2002). McKeachie’s teaching tips. Boston: Houghton Mifflin



This unit will introduce the various evaluation methods and testing available to ensure students have met the objectives set for them. While there is neither exact method nor preferred method of testing it is important for educators to understand the types of assessments available and determine the best method suited for themselves as well as the class.


At the conclusion of this unit you should be able to:

  1. describe the essential qualities for an effective evaluation of teaching and learning
  2. explain the purposes of examinations and tests
  3. consider the various kinds of tests available to the educator



Evaluation is the procedure by which the results of a student’s encounter with a learning situation are collected and analysed so that the teaching may be improved for the benefit of future and present students.

Subjective and Objective Evaluation

a) The subjective evaluation of an activity or object is an evaluation which is reliant upon the personal view, thought or feeling of the evaluator. Because it is subject to the emotional state of the evaluator and not relevant factual evidence, subjective evaluation should never be used as a basis for educational decisions.

b) Objective evaluation is one based upon relevant facts, free from personal feelings or personal opinion. It is this type of evaluation that alone provides rational grounds for action.


Reliability and Validity of Tests

  • A reliable test is one which gives consistent results.
  • A valid test is one which demonstrably measures what it was intended to measure
  • A test cannot be valid unless it is reliable but it can be reliable without being valid.


 A perfectly reliable test would yield the same results no matter who graded it or if the same student took the same test more than once. No test is likely to be perfect, but objective type tests, which measure clearly defined educational objectives, are far more reliable than tests that are dependent upon the subjective judgment of an examiner or are based on subjectively interpreted fields of enquiry. A test which requires a student to describe how to compute the variance is not a valid test of whether a student could in fact compute it; it is only a valid test of his ability to describe how to do it. The only valid test would be to have the student perform the task.

In short, a valid test is a test which accurately measures the performance precisely described in the educational objective to be achieved by the student as a result of instruction.

Criterion-Referenced and Norm-Referenced Tests

A criterion-referenced test determines whether a student has attained each of the educational objectives set for course. A criterion-referenced test measure what a student should know and tells us what they don’t know. A norm-referenced test measures the relative success of students; the results of this test compare student with student. Norm-referenced tests are used to classify students.

Student Assessment

Student assessment is the determining of a student’s knowledge, skills and attitudes at a particular time so that his change in behaviour over a period of instruction may be measured. This assessment may lead to the diagnostic appraisal of his individual strengths and weaknesses and his individual needs may be discovered. These assessment tests would be criterion-referenced based.

Criteria for Effective Teaching

Teaching effectiveness can be evaluated by an observer or by the educator himself but in both cases the evaluation must be objective if it is to be worthwhile. It is particularly important that the educator learn to evaluate his own effectiveness objectively because, for the greater part of his career, he will not have the benefit of independent internal evaluation.

Some questions which the educator should ask himself in order to determine the effectiveness of his teaching are:

a) Was the interest of the class aroused?

b) Was the subject made relevant and were the students motivated to learn?

c) Were the objectives of the instruction made clear to the students?

d) Was new work linked with previous or complementary instruction?

e) Were appropriate teaching methods used?

f) Were appropriate audio/visual aids used?

g) Was the material presented in a logical order?

h) Was the presentation of the lesson developed progressively?

i) Was sufficient time allotted to each section of the lesson?

j) Were the students tested to ensure that the lesson material had been assimilated?

k) Were the students tested to ensure that the lesson material had been understood?

l) Were students asked relevant and appropriate questions and were the class properly sampled?

m) Was student participation properly controlled?

n) Were the students encouraged to learn by the educator’s manner?

o) Was the delivery clear and fluent, and was the diction good?

p) Were the students inspired?

q) Did all the students learn what was taught?

Of the above criteria, by far the most important is (q) “Did all the students learn what was taught?”

No matter what the teaching method, the educator should be continuously asking this question and monitoring the effectiveness of teaching by using this criterion. The method of obtaining the answer to the question is by effectively questioning the students to discover whether they are learning. This method of monitoring results is known as feedback; without feedback the effective control of any system, human or mechanical, is impossible. Feedback enables the educator to monitor individual student progress, and so be able to assess the effectiveness of the teaching in meeting the course objectives. It is an essential feature of the systems approach to teaching and enables the educator to initiate remedial action immediately if it is necessary.

Assessment and Grading

While the chief function of evaluation is to improve the effectiveness of teaching strategies used by the educator, the function of assessment can be twofold: it can be conducted for grading purposes and for the evaluation of the effectiveness of teaching. It can serve either purpose on its own or both purposes at the same time, but to be effective it must be done continuously.

Feedback to Students on Test Results

Assessment provides the student with evidence of the standard he has reached so that he may learn his own strengths and weaknesses. By providing the student with this evidence his/her interest is maintained. He/she is given an incentive to learn which in turn assists the learning process, and he/she is encouraged to correct deficiencies. The more immediate the feedback the greater its effectiveness, it should therefore be made available to the student as soon as possible after he has performed. To derive maximum benefit it should be provided continuously throughout the lesson and the course. Feedback from the end of course examinations is by itself too delayed for it to be effective for either the student or the educator.

Types of Tests Available to the Educator

Oral questioning

Oral questioning of the student is the most rapid and effective method of providing feedback for both educator and student and is much easier to use than written tests. Only by selectively questioning a sample of the students in a class, always including some of the slowest learners, is it possible to ensure that all the students have assimilated what has been taught at each stage of a lesson. To obtain maximum effectiveness, questions should be addressed to the class as a whole, and after a suitable pause to enable all the students to think out the answer, the educator should select the student who is to answer the question. Questions should not be addressed to the class as a whole so that they are answered only by those who think they know, and such generalized class questions as “Does everybody understand that?” should be avoided because the brighter students will affirm that they do, whilst the slower may be ashamed to say that they do not. It is important too, that questions be phrased clearly, in simple language, and in a manner which will encourage students to attempt an answer. Each question should have been thought out in advance with the specific object of testing essential knowledge at each stage.

Short written tests

The short written test provides feedback from every student in the class and practice in written expression and presentation, which may be one of the enabling objectives. There are, however, considerable disadvantages to this method of obtaining feedback. These are:

  • the limited number of questions that can be answered in the allotted time
  • the delay between student performance and its assessment by the return of graded work, and
  • the uncertainty whether the students interest in the returned work will be extended beyond an interest in the mark awarded


If written tests are given during class time, the loss of class learning time to a procedure of doubtful worth must be considered.

Essay-type tests

Examination questions requiring essay-type answers not only test the students’ knowledge of a subject, but also test their ability to organize their material in logical order and to express it clearly and competently in writing. They are of value when it is as important to assess the students’ ability to express themselves in writing as it is to assess their knowledge of the subject. Examination papers requiring essay type answers can only test knowledge of a small part of the syllabus. Assessment of the answers to the questions is subjective and the assessment of the worth of an answer can differ widely between examiners. Students with good memories or who have been fortunate in their revision may achieve higher marks than less fortunate students possessing greater knowledge. The same examination papers should not be used time and time again.

Objective tests

An objective test consists of a series of questions each of which has a predetermined correct answer so that subjective judgment on the part of the grader is eliminated. The use of an objective test in an examination enables knowledge of the whole syllabus to be assessed. Answers to objective test questions are short, often requiring only one word or the deletion of the wrong answer. Because of this, the students who can express themselves clearly in writing, do not have an unfair advantage over those who cannot. The objective test can be administered to successive classes without alteration and marked quickly by hand or by machine.

There are no optional questions in an objective test and so direct comparison of students is more valid and reliable than with essay type tests. However, they do not test a student’s ability to organize their material or express themselves in writing.

Objective tests require a great deal more effort to design than do essay type tests if they are to test knowledge over the whole of a subject syllabus, obviate successful guessing, be unambiguous, and accurately assess the extent of each student’s knowledge. Their design is a lengthy process and necessitates the building up of a bank of validated questions of different degrees of difficulty from which selections can be made for different examinations.

Types of Objective Test Items

There are a number of different types of objective items of which the following are the most common: ­

i)             Multiple choice item

A multiple choice item is one that consists of a stem and usually four or more common choices; one of which is correct (key) while the others are incorrect (distracters). The item stem usually takes the form of a question or an incomplete statement. The correct answer must be clearly acceptable to the students but each distracter must be plausible enough to appeal to those who are uncertain of the correct answer.


The neonatal death rate is the number of deaths:

1)    Under 7 days of age per 1000 total births

2)    Under 28 days of age per 1000 live births

3)    Under 7 days of age per 1000 live births

4)    Under 28 days of age per 1000 total births

ii) True-false item

A true-false item consists of a statement which the student has to decide is either true or false.


Delete either the word “true” or the word “false” after each of the following statements to indicate whether they are correct or not.

  1. With a normal distribution 95% of the observations lie within two standard deviations of the mean.

 True or False

  1. Incidence and prevalence are synonymous.

 True or False

iii)           Open-ended or completion item

The open-ended or completion item consists of an incomplete statement which the student has to complete correctly.


Supply the word or words that correctly complete the following statements:

1) The infant mortality rate is the number of _______ per 1000.

2) The formula for calculating the mean is ______________.


It is difficult for us to improve our teaching unless we have access to information about the courses we teach and the instructional method(s) we use. When we do have such feedback available, we can use it to modify our behaviour in order to achieve our academic aims. Some of the ways in which we can gather the necessary information are outlined below:

A. Establish a student liaison committee to meet you once a week to discuss the course. This is useful in large classes, especially if you pick students from different parts of the room.

B. Sample students’ lecture notes. Students may be having problems with note taking, or information may not be received.

C. Invite a colleague to attend a class, having first given him some idea of what you want the session to achieve; so that he can help you judge how far you are succeeding.

D. Have a lecture or two video-taped or audio-taped so that you can play it back and assess your own performance – perhaps inviting a colleague to comment on it.

E. Try a simple questionnaire. Ask a few specific questions to a random sample. For instance, a sample of students can be asked to write down on a blank index card, the main problem they are having with the course so far.

F. Use a questionnaire at the beginning of the year to find out something about the students taking the course – why they have enrolled for it, prior experience, special interests, preferences in teaching techniques or methods of assessment.

G. Get the students to rate the course and your teaching style using a proposed set of questions or a rating sheet.

H. Give a somewhat shortened version of the usual lecture followed by questions on student knowledge or understanding of the area covered by the lecture. This will provide feedback to the students, as well as to you, on how much they have gained.

I. Give a more formal multiple choice test at the end of the lecture, with students displaying responses on numbered cards.

J. Develop a climate in the lecture where students feel that they can initiate questions.

A sample teacher evaluation form can be found in appendix A.

 * These points have been adapted from papers prepared by the University of Queensland’s Tertiary Education Institute and the Higher Education Research and Advisory Centre, the University of Tasmania.


World Health Organization. (1979). Notes prepared for Workshop for Teachers of

Health and Medical Record Science.  New Delhi.





                                                                                                                        Yes                 No

The purpose of the lecture was provided.    
The relationship with the rest of the program is obvious to the observer.    
The objectives of the lecture were stated.    
Techniques to be used for arousal and motivation worked well or need work: list examples if necessary.    
Information was organized in a logical sequence    
Identification of key terms, concepts, ideas were emphasized    
Verbal and visual illustrations were given to the students    
Expected responses from students:    
     — Did the lecturer ask questions of the students?    
     — Were students provided handouts/worksheets?    
     — Did students take notes?    
     — Was there any student-to-student interaction?    
Was there an opportunity for student questions?    
Was technology used appropriately to meet the stated objectives?selesai @hakcipta Dr Iwan Suwandy,MHA  2010    

Modul Pelatihan Praktisi rekam medis:”Administration and mangemenent Health Record Departement”

Education Module for Health Record Practice based on ihfro modul




The health information management/health record professional must meet the leadership challenge in his/her quest to develop an efficient and effective health record department.  The management of a health record department involves carrying out the basic management functions of planning, organizing, human resource development, directing, and controlling.  This unit introduces the participant to the management process and its application to the management of the health record department of a health care facility.


At the conclusion of this unit the participant should be able to:

     1.    state four basic management processes and discuss each in relation to their role as a health information management/health record professional

2.    draw an organization chart for the facility in which they work and for the health record department

3.    draw a flow chart to indicate the flow of activities within the health record department

4.    write a job description for each position within their department

5.    illustrate the ability to plan for recruitment, selection and training of health record staff

6.    solve a problem from within the health record department using the steps as set out in this unit.


The management process involves planning for the future, organizing and developing both human and material resources. It also includes directing individuals or groups to assist willingly and harmoniously in accomplishing the objectives of the facility and controlling the efficient use of resources in achieving those objectives.  These processes can be expanded as follows:


1.   This is the process by which an organisation, facility or sub‑section of a facility, such as the health record department attempts to plan effectively for the future. It includes:

  • establishing objectives and selecting future courses of action


  • developing assumptions about the expected future environment in which goals are to be met for instance, a manual or automated environment


  • identifying and selecting alternate courses of action which are available to meet the set objectives


  • initiating activities within the department which will be necessary to translate plans into action, and


  • critically reviewing and evaluating the outcome.  That is, were the planned objectives achieved, if not, why?


2.   The planning process for all health information management/health record professionals therefore would be to:

  • set achievable objectives relative to the perceived requirements of the department


  • examine the present environment and forecast changes that are likely to influence the department in accomplishing the objectives. With the ever increasing developments in technology, health information management/health record professionals must be alert at all times to technological advances, particularly to computer applications in health care


  • identify alternative courses of action, evaluate these alternatives in light of previous assumptions made, and then select the course of action, which, after careful deliberations, appears to be the one which will best suit the department’s requirements. This is part of the decision‑making process in management


  • implement the plans with check points to indicate progress during implementation


  • evaluate the implemented plans with regard to effectiveness, efficiency and achievement of the department’s objectives (Huffman, 1990).


Planning at all levels provides direction and a sense of purpose.  It helps health information management/health record professionals cope with change and contributes to the performance of other management functions.

Planning the physical layout of the health record department is discussed in Unit 8.


This is the process by which employees in the health record department and the jobs they do are related to each other. It consists of dividing work among groups and individuals and providing the coordination required between individuals and group activities. This is often referred to as the division of labor.

Organizing also involves the establishment and recognition of managerial authority.

Individual work tasks must be organized into distinct jobs. This is part of what is normally referred to as job design.

1.   Job design, job analysis and work satisfaction

Job design involves specifying job content, work methods used for the job and the relationship between and among individual jobs within the department.

Each job should be assembled into work units within the department.  In turn, the combination of work units within the department must be logically combined to form an overall organisational framework.  And finally, the design of individual jobs and work units within the department, as well as the overall framework of the facility must be related to the environmental influences within the community.

Once jobs have been defined, further information relating to the proposed content of each job should be collected.  This process is called a job analysis and will help the health information management/health record professional determine the skills, knowledge and abilities required to do the job and at the same time clarify lines of responsibility and authority.  When working through this process, it is important to remember that job content will alter with various changes in technology and the health information management/health record professionals must predict, wherever possible, for future changes.

This identification of the work to be performed in each job provides an extremely important basis for planning personnel requirements.  Because of its importance with regard to recruiting and selection, a job analysis should describe not only content, but also specifications.

If the health information management/health record professional is involved in planning a health record department for a new hospital, he or she will rely heavily on their skills and knowledge of health record management, which will enable them to design the anticipated jobs and conduct a job analysis.  If the department is being redesigned in an existing hospital, the health information management/health record professional will need to analyze existing jobs within the old department and predict future changes.  The tools used in the second case could be a combination of observation and an interview with each staff member.

When organizing the work within a health record department the following should be kept in mind.

a)   Job description and specification

Job analysis will provide two types of information (i) a job description and (ii) a job specification.  Job descriptions actually describe the characteristics of a job.  Job specification will indicate the skills required for each job, e.g. typing and transcription.

b)   Improving work satisfaction

How to induce employees to perform work that is boring and unsatisfying is a matter of concern to employers.  The subject of work satisfaction is an extremely complicated one that defies any simplistic explanation or solution.  There are many variables that help to determine whether or not work in a particular job will prove satisfying to a particular employee performing it.  These variables include:

i)   Variables relating to the work of an employee

Variables considered to have an effect upon the satisfaction to be derived from a job include:

  • variety (tools, equipment, activities and workplace)


  • autonomy (independence and control in performing job)


  • interaction (number and types of inter‑relationships)


  • knowledge and skill (time required for proficiency)


  • responsibility (closeness of supervision and cost of mistakes)


  • task identity (how one’s contributions add to the total effort)


  • feedback (being kept informed)


  • pay (wages and fringe benefits)


  • working conditions (physical work environment)


  • cycle time (time required to perform a unit of work)


   ii)      Individual differences among employees

A major difficulty in determining how to increase job satisfaction stems from the individual differences among employees.  Differences in abilities, backgrounds, and social conditioning affect the specific psychological need patterns of employees and the specific returns that each may seek from work.  As a result of these differences, work that is boring, repetitious and unchallenging to one individual may be satisfying to another.  Methods used to increase satisfaction, therefore, must take into account not only the structure and working conditions of jobs, but also the needs of specific individuals.

      iii)        Differences in abilities

Employees who have the ability to perform their jobs well are more likely to gain satisfaction from their work.  Jobs, however, must provide employees with the opportunity to utilize their abilities to the fullest extent. Otherwise, under-utilization can be a source of dissatisfaction.

  iv)      Differences in attitudes and personnel adjustment

Employees who are well adjusted emotionally are more likely to be satisfied with their job situations than those who are not. Furthermore, if dissatisfaction stems from causes within the individual, it is not likely to be reduced significantly by changing the job design or work environment. Neither are these individuals likely to resolve their internal problems by moving from one employment situation to another.

   v)     Differences in perceptions of equity

It is essential that the various financial and psychological rewards employees receive from their work be equitable, both in terms of what is demanded of them, and in terms of what others are receiving for their work.  Even more important, these rewards must be perceived by the employees as being equitable. Otherwise, the satisfaction and benefits that might be derived from effective job design and employee‑job matching may be reduced substantially.

  vi)                  Differences in occupational prestige

Employees may derive satisfaction from the prestige of their occupation and/or reputation of the organization in which they work. It is a source of satisfaction for employees to have friends and acquaintances know that they are part of a prestigious organization and making a contribution to it, even if only in a very small way. In fact one study indicated that occupational prestige contributes more to job satisfaction than does work autonomy, authority or income.

 vii)      Satisfaction through job enrichment

Job enrichment essentially is an extension of job enlargement (i.e., giving employees a greater variety of duties to perform), which may involve increasing autonomy and responsibility of employees, or including them to a greater extent in the decision‑making process. It provides employees with the opportunity to make greater use of their knowledge and skill by becoming more involved in planning, directing and controlling the work of their jobs. Job enrichment may include delegating to a work group greater authority for self‑management. It also may include improving communications to the extent that employees are made more aware of the fact that good performance will be recognized and will contribute toward the attainment of both personal and organizational goals. The basic contribution of job enrichment, therefore, is to make their work more meaningful and to provide employees with a greater sense of responsibility and better knowledge of the results of their endeavours.

2.   Formalizing organizational structure

Organization charts are the most common method used to formalize the structure of an organization.

a)   Organization chart

An organization chart is merely a graphic representation, or blue print, of all positions in a facility and departments of that facility and how they are connected. The position with the greatest authority is located at the top.  Solid lines are used to show line relationships, that is, those positions that have a direct responsibility in accomplishing the objectives of the organization, and indicate to whom each position reports thus clarifying the position’s authority and responsibility.  Dotted lines are used to show staff relationships, that is, those positions that are of an advisory nature.

No organization chart can totally reflect the facility’s structure.  The informal relationships between employees are generally omitted.

The organization chart should be updated every time there is a change in reporting relationships.  It is therefore important to date the organization chart.

A flow chart of the work in the health record department should also be prepared, and kept updated, to identify any problem areas.

b)   Organizational manuals

The departmental manager must set goals and objectives and provide scope and direction for his/her staff.  S/he must be a good leader, a good listener and a good planner.  The department must have a clear set of policies and written procedures.

Policies provide guidelines for decision-making; they define the area in which decisions are made but do not provide the manager with the decision.  Thus, the policies aid the manager in the decision making process.  It is important that policies be followed consistently, especially as they apply to personnel issues.  Lack of consistency may result in staff issues relating to fairness and equity.

c)   Procedures

A procedure is a structured, action-oriented list of sequential steps involved in carrying out a specific job or solving a problem (LaTour and Eichenwald, 2002).  It is a series of related steps designed to accomplish a specific task.  The health information management/health record professional is responsible for planning the department’s procedures and providing for a standardization of work tasks within the health record department. Each procedure must be carefully planned to help with productivity and reduce time and effort.

When establishing procedures the following points should be considered:

  • display the title and revision date


  • determine all the steps required for a procedure and use only the minimum needed to carry out the procedure


  • determine the best sequence for the performance of each step in the procedure


  • number each step, and begin each activity with an action verb


  • review procedures which might be affected by changes in other procedures


  • test a procedure before putting it into everyday use


  • evaluate the procedure after it has been used for several weeks.


If applicable, include samples of completed forms.  All procedures should be written and updated regularly to eliminate redundancy. 

3.   Organizational change and development

Change is an integral part of the work of any organization and health information management/health record professionals must be prepared for change within the facility and within the functioning of their own department. They must learn to deal positively with resistance to change. This would require the following:

  • continued in‑service education programs for staff


  • open lines of communication between staff and the health information management/health record professional


  • participation and involvement of staff in planned change


  • facilitations and support of staff during and after a planned change


  • negotiation and agreement with staff relating to changed work conditions and other issues


  • co‑operative work performance both from management and staff


  • feedback to staff on effective changes and appreciation of work undertaken by staff in the implementation of the change.


4.   Developing human resources

Staffing and human resource management is the process of assuring that competent workers are selected, trained and rewarded for their assistance in helping the facility and department achieve their objectives. Being effective in this area also includes providing a work climate in which employees can experience satisfaction and development.

Developing human resources, therefore, includes:

  • employment planning


  • advertising for new staff


  • recruiting quality applicants


  • selecting the best person for the job


  • orientating the new staff member to the facility and the department


  • training and developing new employees


  • appraising work performance on a regular basis (at least once a year)


  • compensating the competent worker with the right remuneration.



Directing, also referred to as leadership, and interpersonal influence is the process of inducing individuals (peers, superiors, sub‑ordinates) or groups to assist willingly and harmoniously in accomplishing the objectives of the facility and the department.


This is the process of ensuring the efficient use of resources and achieving the objectives of the facility.  It involves:

  • establishing standards of performance of staff and self


  • comparing current performance against established standards to determine the departments progress toward the set objectives


  • actively working to reinforce a high quality of services by the department and correcting any shortcomings or problems as they occur.



This is an extremely important function of a manager, particularly within a very busy health record department.

1.   Problems must be dealt with efficiently and effectively and should not be handled lightly or ignored.

2.   Steps in the problem solving process include:

  • Defining the problems (What is wrong?)


  • Identifying causes and underlying relationships of the problem.  (What caused the problem?)


  • Analysing the evidence relating to the cause of the problem.  This can become quite detailed and difficult.


  • Developing alternative courses of action and identifying consequences of the action. (What can be done to solve the problem?) You may come up with a number of alternatives.


  • Selecting the ‘best’ alternative and developing defined steps to implement the selected alternative.


  • Evaluating the outcome of the implemented solution.  (Has it been effective?  Is the problem resolved?)



Management is a complex issue.  We would all like to be considered a good manager.  If you remember the basic management principles outlined in this unit, and supplement your knowledge by further reading, you will develop good managerial skills.  Remember, however, no one is perfect and no matter how hard we try we all make mistakes at some time. We are often not as effective or efficient as we would wish to be.  We are, however, capable of learning from our mistakes and by continually learning, become more effective and efficient in our jobs.

To be a good manager, therefore, the health information management/health record professional should set objectives for the services of his department and continually work towards:

  • improving work performance of staff
  • improving work satisfaction
  • planning for change and implementing change
  • improving the layout of the department
  • organizing effective and efficient work flow
  • setting standards of work performance for staff
  • directing the services of the department to see that health records are readily available for patient care at all times


This unit briefly covers some important areas of management and as discussed at the beginning of these learning packages the material presented is not definitive.  There is still a lot to learn and we strongly advise that you continue to do so by reading, listening and participating in as many educational activities as possible.


1.  Why is planning and organizing so important for a health information management/health record professional?

2.  Draw an organization chart of a health facility and of a health record department.

3.  Draw a flow chart to indicate the flow of activities in a health record department.

4.  Write a job description for your position.

5.  Identify a problem and work through the steps of problem solving.


1.         Huffman, Edna K. Health Information Management.  10th ed. Berwyn, IL: Physicians Record Company, 1994.

2.         Johns, Merida, ed.  Health Information Management Technology: An Applied Approach.  Chicago: AHIMA, 2002. (Note:  A good source for a health record director’s job description can be found in this book in Appendix A page 816 and an organizational chart in Figure 20.1 page 766.)

3.         LaTour, Kathleen, Eichenwald, Shirley, ed.  Health Information Management:  Concepts, Principles and Practice.  Chicago: AHIMA, 2002. (Note:  A good source for organizational charts can be found in this book in Figure 231 page 560 and a sample flow chart Figure 22.1 page 528.)

4.         Skurka, Margaret.  Health Information Management:  Principles and Organization for Health Information Services.  San Francisco, CA:  Jossey- Bass, 2003.

 selesai@hak cipta Dr Iwan Suwandy,MHA 2010

Modul Pelatihan Praktisi rekam Medis : Planning Health Record Departement

Education Module for Health Record Practice

Based On IHFRO modul


Health information management/health record professionals are acutely aware of the need for proper facilities for the efficient and effective operation of the health record department.  In fact, it has been recognized for some time that architects, health facility planners, administrators and heads of departments, should plan for construction of specialty areas together, as a team.  Although in many instances this has in fact happened, for a number of departments there has been little participation by health information management/health record professionals.  The reasons for non‑participation are varied and range from the health information management/health record professionals not being consulted or involved because the planning authorities do not realize their ability in this area, or the health information management/health record professionals has not been interested or has felt incapable of involvement in such a daunting task.


At the conclusion of this unit participants should be able to:

1.      explain the functions of a health record department for planning purposes

2.      identify the most suitable place for a health record department

3.      calculate space required for defined functions, staff and health record storage

4.      communicate effectively with architects and hospital administration to ensure departmental needs are recognized.


The hospital administration is responsible for seeing that the health record department of their institution have adequate facilities and equipment for the efficient day‑to‑day operation of the service.  The criteria to meet this standard includes:

1.      the health record department/office should be located in such a place as to facilitate the rapid retrieval and distribution of health records

2.      the Office and work space should be sufficient for health record staff to perform their duties and for other authorized personnel to work with health records, including records on microfilm or computer

3.      there should be sufficient storage space for health records to allow for future storage needs. This includes:

a)   an active storage area with sufficient space to include all health records currently in use by hospital staff, and


b)   available space to provide for both active and inactive health records being stored under statutory guidelines

4.      areas for active and inactive health record storage should be sufficiently secure to protect records against loss, damage, or use by unauthorized persons (ACHS, 1992).

The planning of a health record department, whether for a new hospital or relocation within an existing hospital, should develop from the interaction of three people: the health information management/health record professional, the facility’s planning co‑ordinator and the architect.  The health information management/health record professional contributes ideas especially on the detailed functions of the proposed department; the planning co‑ordinator has an understanding of the total requirements within the facility and co‑ordinates all departmental planning and the architect is responsible for defining, both verbally and graphically the building or complex to meet   specified objectives.

To design a department that will offer both efficient and effective services, the planning team must clearly define the functions of the department and the inter‑relationships of the proposed department with other departments/areas of the facility. For example, will the health record department be responsible for transporting health records, for ordering and storing health record forms, or will these functions be the responsibility of another department. This involves looking at procedures to be performed, staff requirements for the performance of these procedures, the flow of work planned for the department and the hours of services offered. This information should be stated in clear, logical writing, with sufficient detail for an architect to understand what is required. 

The six phases determined by the architects which they believe should be observed when designing a new hospital department are as follows:

A.      Definition phase, is the definition of the precise need the design of the department is to meet

B.      Brief phase, is a detailed nomination of the estimated facilities to meet the defined need

C.      Department phase, the integration of one specific area or department into the greater complex of the total facility.  In this phase the key people in the facility along with the architect and planning co‑ordinator establish ideal working relationships with other departments

D.      Total facility phase, which looks at wants, as compared to needs, compared to available resources.  A total hospital proposal is prepared to enable the selection of the most viable scheme for the department


E.      Process phase ‑ at this stage attention is focused on the actual function of the individual departments.  This means that each proposed procedure to be performed in a department is thoroughly analysed and assessed.  Diagrams illustrating the various processes and procedures, most of which were completed in the definition phase, are extremely useful as graphic expressions of physical requirements and associated services.  It is at this phase that attention must be paid to the welfare, comfort and health of workers in the proposed requirements for the department.

F.      Department design phase is the stage where the architect prepares final proposals to enable an optimum design to be prepared and selected.  Detailed drawings of each department are prepared, including all special requirements. There must be a systematic means of assessing and comparing the various schemes to enable the planning team to reach a final decision.

In this Unit we will concentrate on the first two phases since these require the greatest participation by the health information management/health record professional and also have the greatest applicability in improving the layout of an existing department.


When preparing for this first phase in the planning of a health record department, there are five major points to be considered.  These are:

1.      location of the department in regard to services and inter‑relationship of service areas

2.      space requirements for records, for personnel and for equipment

3.      functional design and logical placement of key work areas

4.      system of communication within the health record department and between the department and other areas of the facility

5.       systems to be used to transport health records within the department and to other departments and wards.

1.      Location

When determining location consideration must be given to the need for the department to be centrally located where it will provide:

  • prompt service for all patients ‑ inpatients, outpatients and emergency


  • ready accessibility for medical officers and other users, and


  • easy availability for administrative use.



That is it should be:

  • adjacent to the Admission Office, the Emergency Department (ED), the Outpatient Department (OPD)


  • close to medical staff office, entrance, or lounge


  • close to the administrative and business offices


  • close to other service departments, e.g. x‑ray, pathology, etc.


While it is desirable to have the health record department centrally located, it is accepted that this is not always possible.  If this is the case and the department cannot be logistically situated near all these areas, the first three should have top priority and, in most situations, the proximity to the outpatient and accident and emergency departments would have the highest priority, as these two areas usually have the greatest utilization of records with speed of access often essential.

2.      Space

Regardless of the type of facility, when planning for space requirements for records, personnel and equipment, the health information manager/health record administrator must consider the following:

  • population of the district served by the hospital
  • hospital services proposed
  • number and type of beds
  • current and projected number of discharges/deaths and outpatient and emergency registrations and visits
  • major functions to be performed in the department
  • number of personnel required to perform proposed functions
  • equipment most suitable for the work to be done
  • extent of computerization anticipated
  • type of filing system to be used
  • the numbering system
  • whether the record services are to be centralized or decentralized
  • whether emergency/casualty records are to be included in the main record
  • number of years of active storage
  • length of time original records are to be retained and whether inactive records will be selectively purged or microfilmed,
  • type of secondary storage required
  • special services to be offered by the department.


a)   Space for records

Before calculating file space required, decide how many years of health records should be kept in active filing and estimate the number of records generated per year.

The retention schedules for health records recommended by the local health authority (or national retention schedules where appropriate) should be considered when determining record activity.  These retention schedules usually take into consideration:

  • the statute of limitations for legal protection, and
  • state or national regulations


Retention for longer periods than determined by health authorities or national retention schedules, however, could be influenced by:

  • available storage space, and
  • the clinical and/or research value of the records.


Once the proposed numbers of records and the activity rate have been determined the estimated number of medical records over the number of years of active filing can be calculated.  The steps required are as follows:

  1. Given the number of annual discharges/deaths and OPD registrations (+ ED/A&E new patients if to be filed in main health record) and the number of years required for active storage, e.g. 7 years, you can determine the number of records to be generated over a 7 year period, e.g.


Annual OPD registrations                       3000

Annual discharges/deaths                   2,3000

(No ED/A&E)                                                _____

26,000 records per year

26,000 per year for 7 years = 26,000 x 7 = 182,000 health records in 7 years

It should be noted that these figures overestimate the number of actual records, as discharges will include readmissions. However, this is a better figure to use as it allows space for the expansion of the file with each re‑admission plus the workspace needed for efficient filing and retrieval.

  1. The next step is to determine the average size of each health record e.g. one record = 2cms of linear shelf space


  1. Determine how many records to 1 meter of linear shelf space,

i.e.  100 = 50 records to 1 meter

  1. The total filing space required, therefore, for these health records can be calculated as follows:


annual discharges/deaths + OPD reg  x storage years required

records per meter

e.g.  using the above example:

23,000 + 3,000    x    7          =          182,000  =     3,640

                        50                                               50

Therefore for 182,000 health records, 3,640 meters of shelving is required.

  • As well as determining what is adequate to meet the needs of the present, the needs of the future, i.e. in 10 or even 20 years, should also be considered.  This can be achieved by an estimate, for example a 10% increase in discharges/deaths and OPD registrations over the next 10 years.  This will change the filing space required to:


10% of 3640 = 3640 + 364 = 4004 meters required.

  • To calculate the total number of units required:


determine the number of meters of storage per unit,

e.g. each unit      = 6 shelves high x 2 meters wide

= 12 meters of storage per unit

4004  = 333.66 or 334 units of 6 shelves


  • For terminal digit filing, to calculate the number of meters of shelving required for each primary digit the following formula should be used:


meters of shelving required

number of sections in file


100     = 40 meters per primary section

Each terminal digit will therefore occupy 20 full shelves.  Should, however, the calculations show that each terminal digit will occupy only a portion of a shelf one might want to adjust the number of shelving units to be acquired (or reduce the space allotted to each terminal digit).

b)  Secondary storage

If a secondary storage area is considered it should ideally be located within the department, or immediately adjacent to it, or directly underneath with its own stairway. There are a number of advantages for keeping non‑active health records readily accessible and available, two of which are that:

  • it is time saving for staff, and
  • offers easy access for refiling.


If storage space is a problem and microfilming of inactive records is being considered a special room for microfilming will need to be planned.

To calculate the space required for secondary storage, divide the total number of records to be stored by the number of records to 1 metre, i.e. 150,000 inactive records to be stored and there are 50 records to 1 metre divide 150,000 by 50. Health records, however, are generally filed in serial order in secondary storage allowing for shelves to be packed to capacity, and this could allow for 80 records to 1 meter.  The reason you can get more records/meters is (i) no need to allow for growth of individual record and (ii) no need for working space since there will be little movement.  The calculation would then be:

150,000  = 1875 meters of shelving required for secondary storage


c)  Master Patient Index (MPI)

Consideration must be given to the space the patients’ master index will occupy. When all or part of the MPI is on cards, the space requirements can be considerable. The steps to be followed in calculating the space needed to file the index cards and guides are the same as those for the health record files.

d)  Planning space for personnel and equipment

When planning for personnel and equipment requirements, consideration must be given to the functions to be performed within the department and the services offered by the department to other areas.

The number of staff determines the floor space; desks, files and other equipment necessary, and ample room must be provided for each employee.  Huffman (1994) recommends that the minimum space allocated for each office worker should be 5.57m2 (16 sq ft), although this estimation may vary, it is still a good guideline.

It is generally accepted that the staff of a medical record department are responsible for the initiation, completion and maintenance of a medical record for every person attending the facility as an inpatient, outpatient or accident/emergency patient.  The major functions of a health record department usually include:

  • the initiation of health record documentation and the design and control of all record forms


  • initiation and maintenance of a unique patient identification system and master patient index (MPI)


  • preparation of new outpatient and emergency department health records and the update of records of returning patients


  • assembly, completion and control of incomplete records for discharged/deceased inpatients


  • classification of diseases and the collection of morbidity/ mortality statistics for all hospital discharges/deaths


  • collection of health facility statistics relating to discharges/deaths, length of stay, occupancy rates for administrative and health department use


  • filing and retrieval of all inpatient and outpatient health records with an inbuilt record control system


  • transcription services covering discharge summaries, operation reports, outpatient letters and medico‑legal correspondence (using word processing facilities)


  • services to medical and other health professionals for the retrieval of health records for research and teaching purposes


  • in some situations the functions of the health record services includes patient reception and processing in the outpatient department, admission office and accident and emergency centres.


3. Staff required

Once the functions of the department have been determined, consideration should be given to the number of staff required. Hospital policy regarding the number of hours in the work week and the hours of service for the health record department (24 hours a day, seven days a week versus some other schedule) will be a major factor in this determination along with the functions to be performed, the number of annual discharges/deaths, OPD and ED/A&E visits (if ED/A&E reports are incorporated in the unit record), and research undertaken by medical staff.

(a)  Forecasting:

Once the health information management/health record professional has:

  • determined the predicted number of discharges/deaths, and OP/ED visits, and predicted specialised work, e.g. research, quality assurance, etc.


  • determined the functions of the department and services to other departments


  • determined the hours of service eg 24 hours x 7 days per week or less


  • defined each function and determined the tasks to be performed


  • defined how each task is to be divided into manageable work units or jobs


  • analyzed each job to determine the content, skills, knowledge and responsibilities, and


  • prepared a job description and job specification for each job,


The next step is to forecast the number and type of staff required to perform each job. That is, the health information management/health record professional needs to be able to predict the number of direct employee hours required to cover the jobs outlined in each job description. There are a number of forecasting techniques used to cope with the problems involved with human resource forecasting. For our purposes, traditional statistical projection could be used by using the correlation of staff to patient discharges/deaths and attendances. The time to process one health record of a discharged patient can be estimated as suggested in the following hypothetical example:

  • Collection of records from designated collection area             3 minutes
  • Pulling of work cards from the hospital box                               1    “
  • Assembling record into correct order                                            3    ”   
  • Checking record for deficiencies and retrieval

                        of loose sheets                                                                                 3    ”

  • In case of re‑admission, retrieval of old records or

                        if new patient, preparation of new folder                                     3    ”

  • Assigning record to appropriate doctors for completion            2    “
  • Filing record in incomplete file area                                             2    “
  • Filing work card in work box                                                          1    “
  • Filing outguide on file                                                                       “

            20 minutes

By the above calculations, it is estimated that the discharge procedure for each record takes 20 minutes.  If there were 70 discharges/deaths per day for seven days, the total time to process these records would be:

70 x 20 x 7 = 9800 minutes or 163.3 hours

If each clerk worked 7.5 hours per day for five days, the number of staff required for this process would be:

163.3  = 4.35


That is, 4.5 full-time equivalent staff members would be required to complete the discharge procedure in a hospital with approximately 25,480 annual discharges/deaths.

A similar procedure could be undertaken for each job within the department using the prepared job descriptions.

Alternatively, another method would be to use a work distribution chart as illustrated below.  By this method, previous information relating to departmental functions and jobs can be used to estimate the time each job takes.  That is, by listing the work activities performed and the estimated time it takes to perform them, we can estimate the number of staff required.

  Hours                                               Hours

Activity                         per week      Activity                       per week

Record assembly           106           Retrieval of

Record analysis               50              records for Clinics               76

Admissions                       57            Transcription                         114

Filing recent discharges   18         Release of Information         40                 

Telephone/enquiries        16          Filing                                        38

Statistics                            19            Research                                 36                    

Coding                              13                                                304

Indexing                            25           


Based on a 37.5 hour week, calculate staff as follows:

608   = 16.2


The health information management/health record professional could then indicate the actual staff required for each job, e.g.

Record retrieval & filing                                 3

Transcription                                                   3

Release of Information                                   2

Separations & Enquiries                                5

Coding & Indexing                                          1

Admissions & Statistics                                  2


Relief staff based on estimated absences such as recreation leave, sick leave, etc. should also be determined, as should supervisory and professional staff requirements.

e)  Health information management/health record professional’s office space

Since privacy is desirable for the health information management/health record professional (for talks with personnel, doctors, lawyers, administrators); a private office may be necessary.  However, in smaller hospitals the director may prefer to be with the staff in the main department area.

f)   Other special areas

  • A section of the health record department should be provided away from the flow of traffic for the medical staff so that they can complete their records or review records for research in reasonable quiet and comfort.


  • A special area is often required for transcription. Medical transcription should be confined to one area because of noise ‑ sound proof booths or partitions help reduce the noise of computer equipment and printers.


4.      Equipment

The number of staff and the functions of the department will determine the equipment required.

As well as planning space requirements for records and personnel, consideration must also be given to the allocation of sufficient space for the equipment required to cover the defined functions of the department.

The major areas for consideration are:

a)   Filing

Type of shelving to be used is important and it is generally accepted that open shelving is the most practical. It utilizes less floor space than other forms of filing equipment, allows for faster filing and retrieval and lends itself to any type of filing system used. Once the amount of shelving required is calculated, the amount of floor space required for the shelving can also be calculated using the width and length measurements of each bay of shelving.

The space should also be allocated for aisles and it is generally accepted that main aisles should be 150‑155 cms wide and secondary aisles 90‑95 cms wide.

b)   Computer facilities

The level of initial computerization would have been defined in the determination of functions and job analysis and sufficient space must be planned for terminals and ergonomically sound work areas.  If the entire department is not air conditioned, provision should be made to protect the computers from excessive heat and dust.

c)   Dictation/transcription

Appropriate space for dictation and transcription services needs to be carefully planned to allow for ergonomically sound facilities and work areas.  The use of a dictating service with a central receiving unit encourages doctors to dictate reports and discharge summaries promptly. Computers for word processing are now widely used in health care facilities and appropriate space must be allocated to ensure efficiency and also the health and well-being of the staff.

d)   General

The number and therefore, space requirements, of desks, chairs, typewriters, telephones, filing cabinets and other office equipment will be based on the jobs to be performed and the number of personnel required. Staff working different shifts can occupy the same work area.

Department personnel should have a place to store their belongings (handbags, umbrellas, coats, etc) safely.  A tea or lunchroom should be available for staff to take their break so that they do not eat and drink at their desk.  Convenient access to hand-washing and toilet facilities is needed.

e)   Special space

Space requirements for a photocopier, storage cabinet (for supplies and folders, etc), bookshelves, and any other special equipment should also be defined at this stage.  If microfilming is planned, space for the necessary equipment, e.g. microfilm camera, reader‑printer, jacket‑filler, filing cabinets and work area must be considered in the planning stage.

The predetermined departmental functions, job descriptions and number of proposed staff, however, will enable the health information management/health record professional to determine the equipment and furniture needed and the approximate space required for the work area.

5. Functional design and logistical placement of key work areas

When considering functional design and layout, a key consideration is workflow.  At this stage of definition, the health information management/health record professional should prepare work flow diagrams   to indicate the workflow from procedure to procedure or desk to desk.  Keeping in mind that:

  • desks should be arranged so that paper moves in a straight line and only a short distance at a time


  • desks should be next to each other for procedures performed in sequential steps


  • amount of floor space required will depend largely on record activity and whether or not data processing or microfilm programs are established, and


  • equipment should be chosen for reasons of both efficiency and appropriateness.


The use of a layout diagram or flowchart, sometimes called or movement diagram (LaTour 2002), which is a diagram of the flow of work through the layout, can assist with determining that furniture and equipment are placed effectively.

When preparing a layout for the architect, the health information management/health record professional should be able to use appropriate terminology and blueprint symbols to illustrate the essential features such as columns, lifts, doors, windows, furniture and equipment, etc.  This will give everyone including the health information management/health record professional, a visual image of the proposed department. 

6.      System of communication

During the definition stage, consideration must be given to the communication system to be used within the department and between the health record department (HRD) and other departments or areas.

Most health record departments require numerous telephones placed at strategic points within the department. In addition, some hospitals may use intercom systems between the ED/A&E and the HRD, or the OPD and the HRD.

If computer terminals are to be used, both as communication devices between the HRD and other areas and for the input and output of data, the cabling for such devices is an important part of the planning process.   If the entire department is not air conditioned, consideration must be given to air conditioning the area where the terminals are located not only to prevent them from overheating but also to protect them from excessive dust.

7. Transport

Consideration must be given to how the health records are to be transported both within the HRD and to other areas. If carts are to be used within the department they have to be able to be pushed freely between desks and files. If a dumb waiter or pneumatic tube or other automated device is to be used, special space provision in the appropriate place must be made.  Some hospitals use motorized trolleys, which need to be stored in the HRD when not in use. Provision for all these needs must be considered in the definition phase of planning.

8. Layout

In determining the physical layout the following points should also be considered (LaTour, 2002 and Huffman, 1994).

  • it is important that full use be made of available space. Desks and files must be arranged to provide maximum efficiency, light and air


  • to eliminate the hazard of electrical cords, attention should be given to the most convenient placing of electrical outlets for the use of any electrical equipment


  • temperature control and circulation of air, i.e. adequate ventilation, fans, windows


  • adequate lighting ‑ i.e. well positioned lighting (experts should be consulted as to levels required and correct placement). Workers should not face glaring lights


  • use of colour ‑ walls, floors, furniture and equipment (light colours for walls ‑ bright for accents and trims)


  • to keep traffic flow in the medical record department to a minimum, it may be desirable in many hospitals to have a reception and/or waiting area where an employee may attend to requests


  • employees handling enquiries should be placed near the main entrance


  • equipment should be near users and the doors wide enough for record carts


  • desks should face the same direction with 1 to 1 ½  meters between desks


  • supervisors should be at the back of the people she/he is supervising ‑ should be able to see all employees without leaving desk


  • two desks placed side by side in the same direction is a compact arrangement


  • it is best to place the file space to the back of the department ‑ it should not be placed near the main entrance (for safe keeping)


  • sufficient space for workers to stretch and move around.



At the completion of the definition phase the health information management/health record professional should be ready to prepare a brief for the architects, which will include the proposed functions and services of the department, the preferred location, and the capacity with regard to space, staff and equipment, relationship to other departments, and any other design features to be considered. Requirements may be illustrated by drawing a plan.

The brief should include work flow diagrams, and a proposed layout with specific reference to ergonomic consideration in all aspects of the design. If the health information management/health record professional does not feel confident in making determinations on ergonomic issues an expert in this area should be consulted.


Effective planning of a health record department for a new facility or in an existing one is an important responsibility, which should be readily accepted by the health information management/health record professional. As discussed previously, the planning process should begin with clarification of the functions to be performed and services to be offered. The health information management/health record professional is the best person to undertake this important step and should be prepared to do so.


1.         Davis, Nadinia, and LaCour, Melissa.  Introduction to Health Information Technology.  Philadelphia, PA:  W.B. Saunders, 2002.

2.         Huffman, Edna K. Health Information Management.  10th ed. Berwyn, IL: Physicians Record Company, 1994.

3.         Johns, Merida, ed.  Health Information Management Technology: An Applied Approach.  Chicago: AHIMA, 2002.

4.        LaTour, Kathleen M., and Eichenwald, Shirley.  Health Information Management:  Concepts, Principles and Practice.  Chicago:  AHIMA, 2002. (A good source for a flowchart for loose chart filing can be found in this book in Figure 22.1 page 528.  Also a movement diagram in Figure 22.2 page 530.)

5.         Skurka, Margaret.  Health Information Management:  Principles and Organization for Health Information Services.  San Francisco, CA:  Jossey- Bass, 2003.

 selesai@hak cipta dr Iwan Suwandy 2010

Modul Pelatihan Praktisi Rekam Medis unit 4 c “The key of Question Answer”

Appendix 2 – Answer Key to Appendix 1

Education Module 4 – Healthcare Statistics

 based on IFHRO modul

EXERCISE 1 – Patient Care Unit CENSUS

1.    Using the information from the left of the page, complete the daily census for patient unit A.

UNIT A                                                                        DAILY CENSUS FOR DATE 6.3.06


John Smith adm. from                                    a.         No. on unit last report              40

O.P.D. (Dr. Richard)

Adam James adm. Dr. Maurice                                 No. admitted                             5

Stanley Paul adm. G.P.                                              No. transfers in                         1

Anthony Greech trans.                                   b.         Total                                          6

from other hospital

Patrick Sterling trans.                                                 No. discharges                          5

from Med. (Ward B)

Gordon Thompson died 10.30 a.m.                            No. Deaths                                2

Wayne Johnson emerg. adm.                                    No. transfers out                       1

Brett Arnold disch. O.P.D.                              c.         Total                              8

Michael Stephens disch. G.P.           

Adam Carpenter trans.                                               Today’s census

to Psych. (Ward D)                                                     a + b ‑ c           =  40 + 6 – 8 = 38

John Trip trans. to

other hospital

Wayne Johnson died 4.30 p.m.

John Smith disch. O.P.D.

Thomas Adams disch. O.P.D.

2.    Number of patient days for patient unit A on 6-3-06:   40

38 + 2 patients admitted and discharged on 6-3-06  =  40


                                    EXERCISE 2 ‑ HOSPITAL CENSUS REPORT

Date:        6-3-06    

Complete the data for Unit A from Exercise 1.

Complete the Hospital Census report.

What checks for accuracy can you use?

 Unit  Prev.







 Discharges  Transfers




 Alive  Deaths
 A   40  5  1 from B  5  2  1 to D  38
 B   35   4  2 from C      1 to A  41
 C   23   8     4     2 to B  25
 D   28   3  1 from A   2   1    28
 E   30   6     3      33
 TOTAL  156  26  4  14  3  4     165


Accuracy checks:

1.    Total transfers in equal total transfers out

2.    Today’s hospital census is result of adding total admissions and transfers in to previous day census, and subtracting from this the total discharges and transfers out.

156 + 26 + 4 – 14 – 3 – 4 = 165


                                             EXERCISE 3 ‑ HOSPITAL CENSUS

Complete today’s hospital census report



August 27, 2006.

 Unit  Prev.







  Discharges  Transfers




 Discharges  Deaths
 A   40   3     2    2 to B   39
 B   26     2 from A   4  1  1 to D   22
 C   31   8  2 from D   5  1     35
 D   45     1 from B  10    2 to C   34
 E   12   6           18
 TOTAL  154  17  5  21  2  5  148



                                                                EXERCISE 4

1.    Compute the length of stay of 10 patients who were discharged from hospital on October 6, 2006.  Their dates of admission were as follows:

(a)        September 12                     24                 (f)        September 11 ­   25

(b)        September 28                  ­­­     8                 (g)        October 5                        1

(c)        September 30                       6                  (h)       September 16    20

(d)        September 26                     10                  (i)        October 6                          1

(e)        October 4                  2                              (j)        August 13                        54 

(k) What was the average LOS?     15.1  151 divided by 10

2.    In a 200 bed hospital, the patient days for 2006 were 62,050.   The 6,495 patients who were discharged or died had a total of 61,930 days care.  Using the above figures, compute the following averages and rates, showing formulae used.

(a)        62050 divided by 365 = 170 patients

(b)        (62050 x 100) divided by (200 x 365) = 85.0%

(c)        61930 divided by 6495  =  9.54 or 9.5 days



1.    A Coronary Care Unit in a large teaching hospital had a total bed count of 20 beds in 2006.  During the year the patient days for the unit were calculated at 5,260 days.  The 1,255 inpatients who were discharged from the unit during 2006 spent a total of 5,066 days there.

(a)   5260 divided by 365 =  14.41 or 14 patients

(b)   5066 divided by 1255 = 4.03 or 4.0 days

(c)   (5260 x 100) divided by (20 x 365) = 72.054 or 72.1%

2.    The following data have been collected from a 700 bed general hospital during 2006:

Patients admitted                                                          14,117

Total discharges/deaths                                                14,086

Total discharge days                                                   137,202

Total inpatient patient days                                         226,842

Total registered outpatient attendances                      192,846

From the information above, calculate the following, showing formulae:‑

(a)        137202 divided by 14086 = 9.74 or 9.7 days

(b)        226842 divided by 365 =  621.48 or 622 patients

(c)        (226842 x 100) divided by (700 x 365) =  88.78 or 88.8%

3.    In a local hospital, the average length of stay in January 2006 was 10.4 days.  The number of patient days care rendered to discharged patients in the same period was 5,460.  How many discharges were there in January?

                             5460 divided by 10.4  = 525 discharges/deaths

4.    A 460 bed general hospital assigned 215 beds for general medical service, 125 beds for general surgery including Orthopedics, the remainder, 120, were divided among the other services.  For the past 12 months (2004) the number of patient days within the three major categories were:

Pt. days                            Beds                       Bed days

A.  General medicine       59,059                         215      x 365                 78690           

B.  General surgery          43,070                         125      x 365                 45750

C.  Other services                        35,040                         120      x 365                 43920

Using the above information calculate the following for each of the three categories:


General Medicine                           General Surgery                  Other Services

(i)     5905900/78690= 75.1%         4307000/45750 = 94.1%       3504000/43920 = 79.8%

(ii)   59059/365 = 161.36 or 161    43070/365 = 117.67 or 118   35040/365 = 95.73 or 96







A 477 bed general hospital had 15,746 patients discharged/died in 2006.  Total deaths for the year were 487.  There were 81 cases reported to the Coroner, and 351 autopsies were performed.

Total patient days were 136,995 and the total length of stay of discharged/died patients was 136,540. 

Give the formulae, and using the above information, compute the following:

1.    (487 x 100) divided by 15746 = 3.09 or 3.1%

2.    15746 divided by 477 = 33.01 or 33.0

3.    (351 x 100) divided by (487 – 81) = 86.453 or 86.5%

(The 81 Coroner’s cases were NOT autopsied at the hospital)

4.    136450 divided by 15746 = 8.67 or 8.7 days



1.    The following data have been collected from a local hospital.  The average length of stay in June was 5.2 days.  The total length of stay of discharged/died patients in the same period was 2,730.  There were 18 deaths, including 2 unautopsied Coroner’s cases and 12 autopsies were performed.

a.          Number of patients discharged/died = 525

(18 x 100) divided by 525 = 3.43 or 3.4%

b.          (12 x 100) divided by (18 – 2) = 75.0% (.0 for uniformity with other indicators)

2.    The following data have been collected from a 700 bed general hospital during 2006.

Patients admitted                                                             19,957

Total discharges/deaths                                                   19,933

Patients remaining in hospital midnight

Dec.31, 2005                                                           632

Patients remaining in hospital midnight

Dec.31, 2004                                                           656

Total length of stay of discharged/died patients           218,515

Total patient days                                                         236,842

Total deaths                                                                         615

Total autopsies performed                                                   485

Coroner’s cases (unautopsied)                                              43

Number of anaesthetics administered                             6,925

Number of operations performed                                    7,700

Total registered outpatients                                           192,846

From the information above, calculate the following:

a.         236842 divided by 365 =  648.88 or 649 patients

b.         (615 x 100) divided by 19933 = 3.08 or 3.1%

c.         (700 x 365) – 236842 divided by 19933 = 0.93 or 0.9 days

d.         (485 x 100) divided by 615 =  78.86 or 78.9%

e.         (485 x 100) divided by (615 – 43) = 84.79 or 84.8%

f.          (236842 x 100) divided by (700 x 365) = 92.69 or 92.7%

g.         218515 divided by 19933 = 10.96 or 11.0 days  (.0 added for uniformity)



The following information was collected from a 500 bed hospital and includes the census figures for the 30th September, 2006 and the monthly figures for the month of September, 2004.

(a)  September 30

Patients in hospital at midnight                             418

Patients discharged 30th September                     17

Patients admitted 30th September                        24

(6 patients were admitted and discharged

the same day.)

(b)  September  2004

Total number of discharges/deaths                     1088

Total deaths                                                               43

Coroner’s Cases (unautopsied)                                  4

Total number of autopsies performed                       28

Total number of anaesthetics administered            467

Total number of outpatient attendances              16203

Total patient days during September                   12332

Total length of stay of discharged/died   

patients                                                     10943

From the above figures, calculate the following:‑

1.    Census for the 30th September                           418 – 17 + 24   =  425

2.    Patient days for 30th September                         425 + 6  =  431           

3.    12332 divided by 30 =  411.06 or 411 patients

4.    (12332 x 100) divided by (500 x 30) = 82.21 or 82.2%

5.    10943 divided by 1088  =  10.06 or 10.1 days

6.    (28 x 100) divided by 43  =  65.12 or 65.1%

7.    1088 divided by 500 =  2.18 or 2.2

8.    (43 x 100) divided by 1088  = 3.95 or 4.0%

9.    (28 x 100) divided by (43 – 4)  =  71.79 or 71.8%



1.    In an obstetric hospital there were 310 live births in June 2004; of this number 7 died within the early neonatal period.  The hospital also registered 8 fetal deaths for the same month.  What rates were calculated below?

a.  (8 + 7) x 100 divided by (310 + 8) = 4.72 or 4.7%                 Perinatal death rate

b.  8 x 100 divided by (310 + 8) = 2.52 or 2.5%                          Fetal death

2.    An obstetric hospital published the following figures in 2004.

Obstetrical discharges

  • delivered                                      2288
  • undelivered                                  327
  • aborted                                            39

Total infants discharged/died                         2255

Total births (live)                                                2309

Infant deaths (early neonatal)                            56

Fetal deaths                                                            36

Maternal deaths                                                          3

Using the above information, calculate the following:

a.  3 x 100 divided by (2299 + 327 + 139)  =  0.1%

b.  56 x 100 divided by 2255  =  2.48 or 2.5%

c.  36 x 100 divided by (2309 + 36)  =  1.54 or 1.5%  

d.  (36 + 56) x 100 divided by (2309 + 36) =  3.92 or 3.9%

3.    A 320 bed obstetric hospital had 10,220 obstetric separations in 2006. There were 7,016 live births; 139 fetal deaths; 523 caesarean sections were performed with a total of 6,968 deliveries for the year and 2 maternal deaths.  There were 4 infant deaths classed as early neonatal.  Using the above information, calculate the following:

a.  139 x 100 divided by (7016 + 139)  =  1.94 or 1.9%

b.  523 x 100 divided by 6968  = 7.51 or 7.5%

c.  (139 + 4) x 100 divided by (139 + 7016) = 1.99 or 2.0%

It is not reasonable to have only 4 infant deaths.  The medical record professional should investigate to be sure that infants who die minutes after birth are not being classified as fetal deaths.





You have received the following medical statistics for review prior to their publication in the Annual Report of a General Hospital.  What comments do you have regarding the accuracy of the data?

Available beds (Bed complement)                                                                             430

Total admissions                                                                                                    11,285

Total discharges/deaths                                                                             11,123

Total deaths                                                                                                                521

Patients in hospital at midnight on 31 December 2003                                              344

Patients in hospital at midnight on 31 December 2004                                              371

Autopsies performed (including 2 autopsied Coroner’s Cases)                                 378

Coroner’s cases                                                                                                            44

Total patient days                                                                                                 128,954

Total length of stay of discharged/died patients                                                  126,872

Out‑patient visits                                                                                                  106,750

There is an inconsistency in the inpatient data.  If there were 344 patients in hospital at the beginning of the year and 11,285 admissions and 11,123 discharges/deaths, there would be 506  patients remaining at the end of the year which is impossible given that the hospital has 430 beds.   344 + 11285 – 11123 = 506

Average daily census                         352                  Divided by 365 rather than 366

Percentage of Occupancy                 81.9%

Turnover rate                                      25.9

Hospital death rate                              46.8%              Multiplied by 1000 rather than 100

Gross autopsy rate                             0.73%              Did not multiply by 100

Net autopsy rate                                 0.79%              Did not multiply by 100

 selesai @hak cipta Dr iwan suwandy 2010

Modul Pelatihan Praktisi Rekam Medis Unit 4 ”

Education Module for Health Record Practice

based on IFHRO  Modul



In this unit participants are introduced to the collection of statistical data in hospitals, community health centers and primary health care areas.

The various rates and percentages generally calculated in health facilities are discussed along with the formula for their computation and definitions relating to statistical collections.


At the conclusion of this unit participants should be able to:

1.   state the uses of health care statistics

2.   list the type of statistical information routinely collected in hospitals on a monthly and annual basis

3.   state the formulae used for the calculation of rates and percentages used in the collection of statistical data

4.   calculate rates and percentages used in the collection of statistical data in hospitals

5.   describe the process of statistical collections in an ambulatory setting

6.   prepare appropriate statistical reports.


The collection of meaningful statistics is an important function of a hospital or clinic.  Health records are the primary source of data used in compiling health care statistics. The medical record department staff, therefore, may be responsible for the collection, analysis, interpretation and presentation of statistical data wherever possible.  Today, computerized systems automatically collect and calculate many of the statistics that were once previously done manually.

Statistics are only as accurate as the original sources from which they are taken.  The health information management/health record professional should see that medical records and other source documents are complete and readily available to meet the requirements for the production of useful statistics.  Health service statistics are used for:

·     comparison of present and past performance of the hospital or clinic

·     guide for planning future development of the hospital or clinic

·     appraisal of work performed by the medical, nursing and other staff

·     hospital or clinic funding if government funded

·     research

When deciding to collect statistical data, or if reviewing existing collection systems, the hospital administrator and health information management/health record professional should ask:


  • Why are the data being compiled?


  • What use is being made, or will be made, of the information?


Before proceeding, we should become familiar with some definitions relating to terms used in statistical collections.


Definitions used for the collection of statistical data on hospital utilization vary from country to country.  To enable you to recognize the terms used in this Unit, the following is a list of definitions used in some countries.  If your country has a different definition for an item, or if the item is known by a different term, change the one in this Unit to the one used by your hospital/country.

1.   Admission

The formal process whereby a person is accepted by a hospital for the purpose of hospital treatment as an inpatient. If an inpatient is formally discharged from the hospital and then returns for further treatment, the admission process is repeated and a second admission is recorded in the statistics.

Live births in the hospital are considered inpatient admissions, but are always recorded separately as newborn admissions whether or not they require, during their continuous stay in the hospital since birth, special medical care in the nursery or in another clinical service of the hospital (for example, neonatal intensive care unit).  A newborn admission is deemed to occur at the time of birth in the hospital.

Typically, a patient should be admitted as an inpatient if treatment and/or care is provided by hospital staff over a period of 24 hours.

2.   Visit (also called Attendance)

A visit is a single encounter with a healthcare professional that includes all of the services supplied during the encounter.  (Horton)  This term is usually used to refer to non-inpatient services, such as outpatient.  An outpatient is one who receives ambulatory care services in a hospital based clinic or department.  A visit occurs each time an outpatient attends a hospital, nursing home or community health center and receives one or more occasions of service.


3.   Bed count (also called available beds or bed complement)

The number of beds (both occupied and unoccupied), set-up and staffed in an inpatient area of a hospital, which are immediately available to be used by inpatients.  In statistical returns the number of beds should always be shown as a whole number.

Bassinets used by normal newborns are counted and reported separately from other hospital beds.  Recovery room beds and labor beds are not counted as hospital beds if patients who occupy them for brief periods are assigned to another bed in the hospital.

4.   Bed count day

A unit of measure denoting the presence of an inpatient bed (occupied or unoccupied) set-up and staffed for use in one 24-hour period.

5.   Census

A count of inpatients at a given time.  The census is always taken in a hospital at the same time each day, usually midnight. The census provides the number of inpatients at census taking time

      6.   Daily census (daily inpatient census)

The daily census is the number of patients present at census taking time, plus any patients who were admitted after the previous census-taking time and discharged before the next census-taking time.


7.   Delivery

The act of giving birth to either a living child or a dead fetus. A pregnant woman who delivers may have multiple births.  For example, a woman who gives birth to twins will have one delivery but two births.

7.   Discharge (Separation)

The formal process whereby an inpatient leaves the hospital at the end of an episode of care.

The number of discharges includes discharges to home, transfers to other hospitals, nursing homes or other institutions, and deaths of persons who were inpatients at the time of death.

     8.    Encounter

The direct contact between a patient and a physician or other licensed independent practitioner, to order or furnish healthcare services for the diagnosis or treatment of a patient. (Horton)

      9.   Fetal death


“Fetal death is death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles.”

WHO ICD 10: Vol.1, p. 1235-1236

 10.      Health facility

A health facility refers to any of the following:

  • State, public, general or country hospitals
  • Private hospitals
  • Psychiatric hospitals
  • Hospices
  • Nursing homes
  • Community health centers
  • Ambulatory care centers
  • Primary health care centers


  11.     Hospital patient

An outpatient or an inpatient to whom a hospital provides comprehensive care, including all necessary medical, nursing and diagnostic services and, if they are available at the hospital, dental and allied health services, by means of its own staff or by other agreed arrangements.

  12.     Inpatient

       A person who occupies a bed in a hospital for the purpose of hospital treatment.  

Where a patient is admitted on the expectation that he or she will remain overnight, but the patient dies or is discharged before the midnight census, the patient should still be regarded as an inpatient, whether or not a hospital bed is occupied or treatment is provided.  For example, the patient may die in the operating room or the recovery room, or may be discharged because surgery cannot be performed for medical or administrative reasons.

Patients who are held for observation in the Emergency Department or other observation areas, pending a decision whether to admit or not to admit to an inpatient bed should NOT be regarded as inpatients.  However, if a decision is taken to admit such a patient, the time of admission should be regarded as the arrival time at the Emergency Department or observation area.

A hospital newborn inpatient is an infant born in the hospital at the beginning of the current inpatient admission.  These infants are may be classified as normal newborns, or as those requiring special care because of prematurity, congenital malformations, etc., and are admitted to the neonatal intensive care unit (NICU).   Well newborns staying in the regular nursery are listed separately from those in the NICU.  Some countries include the special care newborns with regular inpatients; others group them with the well newborns.  In both instances the special care newborns should be listed separately.

Policies also vary from country to country regarding certain short-stay cases.  In some countries, for example, the following are classified as inpatients (patients may have to meet minimum length of stay criteria); in other countries they are considered outpatients, day patients or day cases.

  • outpatient or same day surgery


  • chemotherapy patients


  • renal dialysis patients


  • endoscopic procedures


  13.     Length of stay (discharge days)

The total number of patient days for an inpatient episode.  The duration of an inpatient’s hospitalization is considered to be one day if he is admitted and discharged on the same day and also if he is admitted on one day and discharged the next day.  The day of admission should be counted but not the day of discharge.

  14.     Live birth

       “The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live born.”

                                                                                              WHO, ICD 10, Vol.1, page 1235

  15.     Maternal death

Death of any woman while pregnant, or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy, from any cause related to or aggravated by the pregnancy, or its management, but not from accidental or incidental causes.

Maternal deaths should be divided into two groups:

(1) Direct obstetric deaths


Those resulting from obstetric complications of the pregnant state (pregnancy, labour and puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above.

(2) Indirect obstetric deaths

Those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiological effects of pregnancy.

                                                                                              WHO, ICD10, Vol. 1, page 1238

 16.      Neonatal death

The neonatal period commences at birth and ends 28 completed days after birth.  Neonatal deaths (deaths among live births during the first 28 completed days of life) may be subdivided into early neonatal deaths, occurring during the first seven days of life, and late neonatal deaths, occurring after the seventh day but before 28 completed days of life.

                                                                                              WHO, ICD10, Vol. 1, page 1237

  17.     Occasion of service

An occasion of service is a specified, identifiable service involved in the care of patient that is not an encounter, such as a lab text ordered during an encounter.  (Horton)  Any examination(s), consultation(s) or treatment(s) or other service(s) provided to a patient by a functional unit of a health service facility.  On each occasion such service, each specimen, or simultaneous set of specimens for the one patient, referred to a hospital department, constitutes one occasion of service.

  18.     Outpatient

An outpatient is a patient who receives care without being admitted to inpatient or resident care.

  19.     Patient day (inpatient service day)

A unit of measure denoting the services received by one inpatient during one 24-hour period.  

  20.     Perinatal death

A perinatal death is one occurring during the perinatal period, which commences at 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500 g), and ends seven completed days after birth.

                                                                                              WHO, ICD10, Vol. 1, page 1237


NOTE:  In ICD9 it was recommended that countries should present, solely for international comparisons, “standard perinatal statistics” in which both the numerator and the denominator of all rates are restricted to fetuses and infants weighing 1000 g or more (or, where birth weight is unavailable, the corresponding gestational age (28 weeks).

                                                                                                    WHO, ICD9, Vol.1, page 766

  20.     Surgical procedure (Surgical operation)

Any single separate systematic manipulation upon or within the body which can be complete in itself, normally performed by a licensed practitioner or dentist, either with or without instruments, to restore disunited or deficient parts, to remove diseased or injured tissues, to extract foreign matter, to assist in obstetric delivery or to aid in diagnosis.

Although surgical procedure and surgical operation are considered synonymous here, a surgical operation is defined as one or more surgical procedures performed at one time for one patient via a common approach or for a common purpose.  (Horton)

  21.     Total length of stay (total discharge days)

The number of days of care rendered to a group of inpatients from admission to discharge. The sum of the length of stay of any group of inpatients discharged during a specified period of time.

  22.     Total patient days (total inpatient service days)

The sum of all inpatient service days for each of the days during a given period. This is taken from the census forms. Every inpatient receives one inpatient service day each day he/she is hospitalized. 

  23.     Transfer

The movement of a patient from one medical care unit to another within a hospital.  Transfers to another health care institution are classified as discharges.

  24.     Underlying cause of death

  • the disease or injury which initiated the train of morbid events leading directly to death; or


  • the circumstances of the accident or violence, which produced the fatal injury.

                                                                                              WHO, ICD10, Vol. 1, page 1235



Inpatient statistical data routinely collected and calculated in hospitals on a monthly and annual basis include:

  • number of admissions – total hospital and by service
  • number of patient days
  • number of discharges (live and expired) – total hospital and by service
  • number of deaths – total hospital and by service
  • total length of stay (total discharge days)
  • number of autopsies
  • number of Coroner’s (medical examiner’s) cases
  • number of deliveries (obstetric patients)
  • number of live births
  • number of fetal deaths
  • number of obstetric discharges
  • number of maternal deaths
  • number of perinatal deaths
  • number of surgical procedures
  • number of anaesthetics administered


       The above information is used to calculate the following rates and percentages:


(a)   Hospital utilization

  • daily census
  • average daily census
  • average length of stay of inpatients
  • percentage of occupancy of hospital beds
  • turnover interval
  • turnover rate


(b)   Death rate

  • hospital death rate
  • net death rate
  • postoperative death rate
  • anesthesia death rate


(c)  Autopsy rates

  • hospital autopsy rate
  • net autopsy rate


(d)  Obstetric and perinatal rates

  • caesarean section rate
  • maternal death rate
  • fetal death rate
  • perinatal death rate


The above rates and percentages may be calculated using the following


1.    Hospital Utilization

  • Daily Census (Daily Bed Occupancy) 




Census    =    Inpatients                 Admissions up       Discharges/deaths

remaining at              to the next                  between census

midnight the    +        census hour ‑           taking hours

previous night

  • Average Daily Census (Average Daily Bed Occupancy) 


The average number of inpatients present each day for a given time period.  This figure is derived by dividing the sum of patient days for a period by the number of days in the same period.



Total number of patient days for a period (except newborn)          

Total number of days in the same period



In May a hospital rendered 4,280 patient days (excluding newborn babies).  May has 31 days. Using the above formula the average daily census is calculated as follows:


 31  =          138.06 or 138.1

This would be rounded to give the average daily inpatient census during May of 138 patients.

NOTE:  This indicator is calculated separately for newborns.

  • Average length of stay (ALOS) of discharged patients 


The average number of days that inpatients (exclusive of newborn) remained in the hospital.



Total length of stay of discharged patients for a given period 

Total number of discharges and deaths in the same period


In June a hospital discharged 2,086 patients (including deaths, but excluding newborns). Their combined length of stay was 13,654 days. Using the above formula the average length of stay of these patients was:


 2086         = 6.54 or 6.5 days

  • Percentage of occupancy of inpatient beds 


The percentage of inpatient beds occupied over a given period.




Total number of patient days for a given period x 100 

Available beds (bed complement) x the number of

days in the period


A hospital with 210 available beds (excluding newborn bassinets) rendered 4,780 patient days in June.  June has 30 days.  The percentage of  occupancy for the hospital in June was:

4780 x 100           =          78000 =

          210 x 30                             6300              75.87 or 75.9%

  • Bed Turnover Interval 


Average period in days that an available bed remains empty between the discharge of one inpatient and the admission of the next.

Indicates the time that available beds are free.

Indicates a shortage of beds when negative, and under-use of the hospital or an inefficient admission system, if positive.



Available beds x days in the period ‑ patient days for the period 

Number of discharges, including deaths, in the period


A hospital with 210 available beds in June rendered 4,780 patient days and had 736 discharged/died patients.  The turnover interval rate using the above formula is:

210 x 30 ‑ 4780    =          1520

736                             736     =          2.06 or 2.1 days

  • Bed Turnover Rate


The mean number of patients “passing through” each bed during a period.

Indicates the use made of available beds.



Number of discharges (separations) in the period 

Available beds


During the month of June there were 736 discharges (including deaths) from a hospital with 210 beds.  The turnover rate for June was:

736  =

210                        3.50 or 3.5

2.    Death Rates

Note:       Patients who are dead on arrival (DOA) at a hospital are not included when calculating these rates.

  • Hospital Death Rate 


A ratio of all inpatient deaths for a given period to the total number of discharges and deaths in the same period.




Total number of deaths of inpatients in a given period x 100 

Total number of discharges and deaths in the same period


A hospital had a total of 15 deaths during the month of June.  A total of 540 patients were discharged (including the 15 deaths) during the month.  The hospital death rate according to the above formula is:

15 x 100

  540          =          2.77 or 2.8%

  • Net Death Rate 



A death rate, also known as the institutional death rate, that does not include deaths, which occur within 48 hours of admission (24 hours of admission in some countries).  Previously, it was that those deaths that occur within 48 hours of admission should not be counted because not enough time had lapsed to allow the health care providers adequate time to directly affect the patient’s condition.  However, with today’s technology, this concept is no longer thought to be valid.  Therefore, it is recommended that net death rates not be calculated unless there is a special order to do so.



                        Deaths minus those w/in 48 hours of admission in a given period x 100

Total number of discharges and deaths, minus

Deaths w/in 48 hours of admission w/in the same period



Taking the above example, of the 15 deaths, 4 patients died under 48 hours, leaving 11 patients who died 24 hours or more after admission.  The total discharges, including deaths were 540. According to the formula the deaths under 48 hours of admission are deducted.  Therefore, the calculation of the net death rate would be as follows:

15 ‑ 4 x 100          =          11 x 100

     540 ‑ 4                               536                 =          2.09% or 2.1%

  • Postoperative Death Rate


The ratio of deaths within 10 days after surgery to the total number of patients operated on during that period.  Some healthcare providers question the usefulness of this rate, as it is questioned how ten days is considered the “magic number.”



  Total number of deaths(within 10 days of surgery)    X    100

Total number of patients who were operated on for the period


During the month of November a hospital performed 275 operations, and 269 patients were operated on.  There were 2 deaths that occurred within 10 days of surgery, and 1 that occurred after 10 days.  The postoperative death rate according to the above formula is:

              2 X 100  = 0.74%


Note:  it is recommended with small percentages of this nature, that the percentage be left at two decimal places.

  • Anesthesia Death Rate


The ratio of deaths caused by anesthetic agents during a specified period of time to the number of anesthetics administered. This formula includes those deaths that occurred within 10 days of surgery.



  Total deaths caused by anesthetic agents   X    100

         Total number of anesthetics administered


During the month of August a hospital performed 750 operations, and 750 anesthetics were administered.  There was 1 death due to anesthesia.  The anesthesia death rate according to the above formula is:

              1 X 100    =    0.13%


3.    Autopsy Rates

  • Hospital autopsy rate


The ratio of all autopsies performed in the hospital to all inpatient deaths in the hospital.  Patients who are dead on arrival (DOA) at the hospital and fetal deaths are excluded from both the numerator and the denominator




Total number of autopsies for a given period  x   100

Total number of inpatient deaths for the same period


In a hospital with 15 deaths during the month of June, 7 autopsies were performed on hospital patients whose bodies were available for hospital autopsy.  The hospital autopsy rate is calculated as follows:

7 x 100

  15             =          46.66 or 46.7%

  • Net autopsy rate


A hospital may be prevented from performing an autopsy because the death is a coroner’s or medical examiner’s case and must be sent to the coroner’s court for autopsy.  It would not reflect the scientific interest of the doctors to include such cases in a measure of unautopsied hospital cases. Cases, which are not available for autopsy, are not included in the net autopsy rate.



Total number of autopsies for a given period x 100

Total number of deaths minus unautopsied

Coroner’s cases for the same period


In the above example, of the 15 deaths and 7 autopsies in June 2 deaths were reported to the coroner/medical examiner and the bodies removed from the hospital and no hospital autopsy was performed.  The net autopsy rate, therefore, was:

7 x 100      =          700

15 ‑ 2                     13       =          53.84 or 53.8%

4.    Obstetric and Perinatal Rates

  • Cesarean section rate


A ratio of the number of cesarean sections performed to total deliveries.



Total number of cesarean sections performed in a period x 100

Total number of deliveries in the period


During the month of May, 310 deliveries occurred.  Of this number 5 deliveries were by cesarean section.  Using the above formula, the cesarean section rate is calculated as follows:

5 x 100

   310         =          1.61 or 1.6%

  • Maternal Death Rate


The ratio of maternal deaths to total obstetric discharges, including deaths.  NOTE:  Deaths due to abortions are maternal deaths even though the patient may have been hospitalised on a gynaecology ward.




  Total number of maternal deaths for a given period    x   100

    Total number of obstetric discharges, including deaths,

                               for the same period



During May an obstetric hospital discharged 230 obstetric patients, of this number, 1 patient died.  Using the above formula the maternal death rate would be:

1 x 100

230                        =          0.43 or 0.4%

  • Perinatal Death Rate


The ratio of perinatal deaths to live births and fetal deaths.         



Total number of perinatal deaths in a given period x 100

Total number of live births and fetal deaths in the same period



In the month of May, there were 294 births, including 4 fetal deaths, and 2 babies subsequently died within seven days of birth.  The perinatal death rate for May, therefore, was:

6 x 100

   294         =          2.04 or 2.0%

  • Fetal Death Rate


A ratio of fetal deaths to the total number of live births and fetal deaths in a period.



Total number of fetal deaths for a given period x 100

Total number of births and fetal deaths for the same period


The fetal death rate, using the perinatal death rate example above, is calculated as follows:

4 x 100

   294         =          1.36 or 1.4%



  • number of outpatient visits
  • number of outpatient visits for each clinic
  • number of emergency department visits
  • occasions of service (i.e., number of special services, e.g. Ultrasound, X‑ray, pathology tests)


Most of the above are collected to assess the workload of each department or clinic, and plan for future needs. It may be found that the Wound Clinic staff see twice as many patients than other clinics, therefore more staff will be required in the clinic area on the wound clinic days; or, patient waiting time may be too long and the administration decides to look at the statistics for each clinic to see if it is because too many patients are given appointments when sufficient medical staff are not available.

This data may be manually tallied each day and totalled at the end of the time frame, or if a computerized patient registration system is used, the computer may automatically count these statistics.  Therefore, no formulae are necessary to calculate this information.

1.    Outpatient Visits (per day or per clinic session)

The average number of patients seen per day or per clinic session.




 Total number of visits in period     

Total number of days in the time period (or clinic session held)


During the month of September the Wound Clinic was held 12 times and there were 287 visits.  Using the above formula, calculate the number of visits per clinic session.

287            =          23.92 or 23.9



Quite frequently, the health facility’s administrator, accreditation agency, or a government agency establishes various reports that must be presented. It is important to ensure that these reports are prepared in a timely and accurate manner since, directly or indirectly, this is one of the ways the health record department is evaluated.

The data collected and reports prepared should be reviewed and evaluated on at least an annual basis to determine if they are be used. Data that are collected for no apparent reason or reports that are prepared that no one uses are a waste of staff time and resources.

Sometimes reports prepared only present the work accomplished during the reporting period, and may not be particularly useful for problem identification or for decision-making. A report that compares selected data and indicators over different time periods may prove useful. 

For example, the data and indicators for a month and the year to date can be compared with data for the same month and year to date of the previous year.

                                                                        Current year                          Previous year

                                                                        Month    YTD                         Month     YTD




Patient days

Average daily census

Average length of stay

Percentage of occupancy

Turnover rate

Outpatient visits            



Health record professionals are evaluated on the timeliness, completeness, and accuracy of the statistical reports they are responsible for preparing.  It is therefore important to have policies and procedures that help ensure that reports meet these criteria.

Policies and procedures should include the following points:

1.  Monitor that the Health Record Department receives all reports within the established time period (e.g., unit census reports received daily; operating room reports received within 5 work days following end of the month).

2.  Follow-up immediately on delinquent reports.

3.  Check each unit census daily to be sure that:

  • ·    every patient listed as a transfer in or transfer out appears as a transfer on the census report of another ward;


  • ·    the number of patients remaining at the end of the day agrees with the number obtained by adding to the patients remaining the previous day the number of entries to the ward (admissions and transfers in) and from this total subtracting the number of departures (live discharges, deaths, transfers out) from the ward.


4.  Verify that for the hospital as a whole the number of transfers in agrees with the number of transfers out.

5.  At the end of each day, month, and year (or other time period), check the hospital inpatient statistical report as outlined in point 3 above.

6.  Check all indicators for accuracy and to be sure that they make sense.  For example, the number of patients remaining at the end of the time period should be lower than the number of beds unless, of course, more than one patient occupies a bed.

7.  Proofread all reports before distribution to be sure that they contain no typographical errors.


Before proceeding to collect or compute any statistical information, the health record professional must find out what is needed and how and when it is to be used.

The reports generated are also very important and are used as a tool of communication.  All presentations should be simple and readable with important facts highlighted.  Although most reports will be in tabular form, they would be easier to read if visual aids such as graphs, bar charts and pie diagrams were used to illustrate clearly what the figures indicate.

In addition, reports should be clear and concise, and leave no doubt as to what the figures represent.

Many health facilities around the world today use computers to analyze and present their statistical data.  This often results in the collection of more than basic data, which is readily retrievable and useable.

To assist in your understanding, complete the following exercises in Appendix 1.  Answers are included in Appendix 2, but please work through each exercise before checking your answers.  If any of your answers are incorrect, work through them again to find out where you went wrong.


1          Davis, Nadinia, and LaCour, Melissa.  Introduction to Health Information Technology.  Philadelphia, PA:  W.B. Saunders, 2002.

2.         Horton, Loretta A.  Calculating and Reporting Healthcare Statistics.  Chicago, IL:  AHIMA, 2004.

3.         Huffman, Edna K. Health Information Management.  10th ed. Berwyn, IL:    Physicians Record Company, 1994.

4.         Johns, Merida, ed.  Health Information Management Technology: An Applied Approach.  Chicago: AHIMA, 2002.

5.         Skurka, Margaret.  Health Information Management:  Principles and Organization for Health Information Services.  San Francisco, CA:  Jossey- Bass, 2003.

6.         World Health Organization (1994). International Classification of Diseases and Related Health Problems, 10th Revision, Volumes 1, 2 &3.  Geneva: WHO.

Appendix 1 – Excercises

Education Module 4 – Healthcare Statistics




EXERCISE 1 – Patient Care Unit CENSUS


1.  Using the information on the left of the page, complete the daily midnight census for Unit A.

UNIT A                                                           BED RETURN FOR DATE 3/6/2006

John Smith adm. from                                 a.         No. in ward last report         40

O.P.D. (Dr. Richard)

Adam James adm. Dr. Maurice                             No. admitted               ______

Stanley Paul adm. G.P.                                          No. transfers in           ______

Anthony Greech trans.                               b.         Total                            ______

from other hospital

Patrick Sterling trans.                                              No. discharges            ______

from Med. (Ward B)

Gordon Thompson died 10.30 a.m.                      No. Deaths                  ______

Wayne Johnson emerg. adm.                               No. transfers out          ______      

Brett Arnold disch. O.P.D.                          c.         Total                             ______

Michael Stephens disch. G.P.      

Adam Carpenter trans.                                            Today’s census

to Psych. (Ward D)                                                        a + b – c     =             ______

John Trip trans. to

other hospital

Wayne Johnson died 4.30 p.m.

John Smith disch. O.P.D.

Thomas Adams disch. O.P.D.

2.    Calculate the number of patient days for Ward A on 03/06/2006:



            Date:  ____________

Directions:         Complete the data for Unit A from Exercise 1.

                             Complete the Hospital Census report.

                             What checks for accuracy can you use?




































2 from C










 2 to B

























                                          EXERCISE 3 ‑ HOSPITAL CENSUS

Complete today’s hospital census report



August 27, 2006.


































2 to B






 2 from A






1 to D
















 1 from B




2 to C














                                                               EXERCISE 4

1.    Compute the length of stay of 10 patients who were discharged from hospital on October 6, 2006.  Their dates of admission were as follows:

(a)        September 12                ______           (f)        September 11           ­______

(b)        September 28                ­______           (g)       October 5                   ______

(c)        September 30                ______           (h)       September 16           ______

(d)        September 26                ______           (i)         October 6                   ______

(e)        October 4                        ______           (j)         August 13                  ______

(k)        What was the average LOS?   ________

2.    In a 200-bed hospital, the patient days for 2006 were 62,050.   The 6,495 patients who were discharged or died had a total of 61,930 days care.  Using the above figures, compute the following averages and rates, showing formulae used.

(a)        Average daily census for 2006

(b)        Percentage of occupancy for 2006

(c)        The average length of stay of discharged patients during 2006



1.    A Coronary Care Unit in a large teaching hospital had a total bed count of 20 beds in 2006.  During the year the patient days for the unit were calculated at 5,260 days.  The 1,255 inpatients that were discharged from the unit during 2006 spent a total of 5,066 days there.

       a.         How many patients, on the average, were cared for in the unit per day?

       b.         How long, on the average, did patients remain in the unit?

       c.          What percentage of beds were occupied during the year?

2.    The following data have been collected from a 700-bed general hospital during 2006:

Patients admitted                                                       14,117

Total discharges/deaths                                           14,086

Total discharge days                                               137,202

Total inpatient patient days                                    226,842

Total registered outpatient attendances              192,846

From the information above, calculate the following, showing formulae:

a.         Average length of stay

b.         Average daily census

c.          Percentage of occupancy

3.    In a local hospital, the average length of stay in January 2006 was 10.4 days.  The number of patient days care rendered to discharged patients in the same period was 5,460.  How many discharges were there in January?

4.    A 460 bed general hospital assigned 215 beds for general medical service, 125 beds for General surgery including Orthopedics, the remainder, 120, were divided among the other services.  For the past 12 months (2006) the number of patient days within the three major categories were:‑

A.         General medicine         59,059

B.         General surgery                        43,070

C.         Other services               35,040

Using the above information, calculate the following for each of the three categories:

  • Percentage of bed occupancy
  • Average daily census




A 477-bed general hospital had 15,746 patients discharged/died in 2006.  Total deaths for the year were 487.  There were 81 cases reported to the Coroner, and 351 autopsies were performed.

Total patient days were 136,995 and the total length of stay of discharged/died patients was 136,540. 

Give the formulae, and using the above information compute the following:

1.    Hospital death rate

2.    Bed turnover rate

3.    Net autopsy rate

4.    Average length of stay



1.    The following data have been collected from a local hospital.  The average length of stay in June was 5.2 days.  The total length of stay of discharged/died patients in the same period was 2,730.  There were 18 deaths, including 2 unautopsied Coroner’s cases and 12 autopsies were performed.

a.         What was the hospital death rate?

b.         What was the net autopsy rate?

2.    The following data have been collected from a 700 bed general hospital during 2006:

Patients admitted                                                                      19,957

Total discharges/deaths                                                           19,933

Patients remaining in hospital midnight

Dec.31, 2005                                                                                              632

Patients remaining in hospital midnight

Dec.31, 2006                                                                                             656

Total length of stay of discharged/died patients                218,515

Total patient days                                                                 236,842

Total deaths                                                                                               615

Total autopsies performed                                                           485

Coroner’s cases (unautopsied)                                                     43

Number of anaesthetics administered                                    6,925

Number of operations performed                                            7,700

Total registered outpatients                                                192,846

From the information above, calculate the following:

a.        Average daily census

b.        Hospital death rate

c.         Turnover interval

d.        Gross autopsy rate

e.        Net autopsy rate

f.         Percent of occupancy

g.        Average length of stay



The following information was collected from a 500-bed hospital and includes the census figures for the 30th September, 2006, and the monthly figures for the month of September, 2006.

(a)  September 30

Patients in hospital at midnight                        418

Patients discharged 30th September                 17

Patients admitted 30th September                     24

(6 patients were admitted and discharged

the same day.)

(b)  September, 2006

Total number of discharges/deaths                 1088

Total deaths                                                                                     43

Coroner’s Cases (unautopsied)                             4

Total number of autopsies performed                 28

Total number of anaesthetics administered     467

Total number of outpatient attendances       16203

Total patient days during September             12332

Total length of stay of discharged/died        

patients                                                    10943

From the above figures, calculate the following:

1.    Census for the 30th September

2.    Patient days for 30th September

3.    Average daily census

4.    Percentage occupancy

5.    Average length of stay

6.    Gross autopsy rate

7.    Bed turnover rate

8.    Hospital death rate

9.    Net autopsy rate


1.    In an obstetric hospital there were 310 live births in June 2006; of this number 7 died within the neonatal period.  The hospital also registered 8 fetal deaths for the same month.  What rates were calculated below?

a.        (8 + 7) x 100 divided by (310 + 8) = 4.72 or 4.7%

b.        8 x 100 divided by (310 + 8) = 2.52 or 2.5%

2.    An obstetric hospital published the following figures in 2006:

Obstetrical discharges

  • delivered                                      2288
  • undelivered                                  327
  • aborted                                            39

Total infants discharged/died                         2255

Total births (live)                                                2309

Infant deaths (early neonatal)                            56

Fetal deaths                                                            36

Maternal deaths                                                         3

Using the above information, calculate the following:

a.  Maternal death rate

b.  Infant death rate

c.  Fetal death rate

d.  Perinatal death rate

3.    A 320 bed obstetric hospital had 10,220 obstetric separations in 2006. There were 7,016 live      births; 139 fetal deaths; 523 caesarean sections were performed with a total of 6,968 deliveries for the year and 2 maternal deaths.  There were 4 infant deaths classed as early neonatal.  Using the above information, calculate the following:

(a)       Fetal death rate

(b)       Cesarean section rate

(c)       Perinatal death rate                     



You have received the following medical statistics for review prior to their publication in the 2006 Annual Report of a General Hospital.  What comments do you have regarding the accuracy of the data?

Available beds (Bed complement)                                                                                    430

Total admissions                                                                                                 11,285

Total discharges/deaths                                                                                    11,123

Total deaths                                                                                                              521

Patients in hospital at midnight on 31 December 2005                                                 344

Patients in hospital at midnight on 31 December 2006                                                371

Autopsies performed (including 2 autopsied Coroner’s Cases)                     378

Coroner’s cases                                                                                                                      44

Total patient days                                                                                              128,954

Total length of stay of discharged/died patients                                          126,872

Out‑patient visits                                                                                               106,750

Average daily census                                             352

Percentage of Occupancy                         81.9%

Turnover rate                                                25.9

Hospital death rate                                      46.8%

Gross autopsy rate                                         0.73%

Net autopsy rate                                             0.79%

 selesai @ hak cipta dr Iwan suwandy 2010