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TB Notes 3, 2008
Director's Letter
Highlights from State and Local Programs
  Florida TB and Corrections Team Wins 2008 Prudential-Davis Productivity Award!
  Program Collaboration and Integration Activities in Connecticut
  Los Angeles County TB Control Program Collaborates with Community Groups to Organize and Present a Successful World TB Day Symposium
  Arizona TB Nurse Case Management Course
NTCA Workshop Poster Contest
2008 EIS Conference a Success for DTBE
Release of New Civil Surgeon TB Technical Instructions
Nurses’ State and National Partnership Celebration
Partners Recognized for NTIP Development
Updates from the TB Education and Training Network
  Member Highlight
  Ask the Experts
  TB ETN Cultural Competency Workgroup Update
Clinical and Health Systems Research Branch Updates
  A Ferguson Fellow’s Experience
Surveillance, Epidemiology, and Outbreak Investigations Branch Updates
  TBESC Task Order 12 Update
  13th Semi-annual Meeting of the TBESC
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TB Notes Newsletter

No. 3, 2008

TB ETN’s Ask the Experts

This feature is brought to you by the TB ETN Membership Development Workgroup.

I conduct a TB Update every year for our staff of nurses. What are some methods of presenting the material that will increase interest, yet maintain continuity of content?

Engaging participants in a training course can be both challenging and rewarding. Participants are more likely to learn training content and gain skills if they are actively engaged in the training. There are many training techniques that can help in this. Some methods you can readily apply include–

  • Following four important training concepts
  • Using adult learning principles
  • Providing a variety of training methods

Following four important training concepts

Understand and follow these four training concepts to provide a solid foundation for developing an engaging training course for adults:

  1. Facilitate a learning environment; build on the experience of the participants
    When training adults, it is important that the trainer create a collaborative environment by including the participants’ ideas, knowledge and experiences. The trainer’s role is to enhance, assist, and foster learning that builds on the experiences of the participants, rather than being the only one providing content.
  2. Training is not education; it should be applied immediately
    • Training is providing participants with skills, knowledge, and attitudes that they can apply immediately to their job.
    • Education is providing students, patients, and colleagues with content information that they may or may not use at a later date.
    • An example that illustrates the difference between training and education: Driver education teaches one about the rules of the road and the correct procedures for driving, but driver training actually teaches one how to drive.
  3. Telling is not training
    Simply telling participants things and providing a Power-Point presentation does not mean that they will actually learn the information and gain the skills. Participants who engage actively in the learning process increase retention.
  4. Including more content does not mean that more learning will occur
    Including more content may mean that too much information is being provided in the time available. It is better to concentrate on the most important or essential information to ensure participants actually learn it. Too much information can overload participants with content and they will lose interest at a certain point.

Using adult learning principles

Many people think that training adults is the same as teaching students in a traditional school system, but this is not true. Adults learn differently from children and require different training approaches. Knowing and applying adult learning principles helps you use the right training techniques to enhance learning, and is critical to the success of your training courses. The following chart describes some important adult learning principles and training techniques you can use to engage the adult learner.

Adult Learning Principles and Training Techniques

Principle Training Technique
Adults bring a wealth of knowledge and experience and which they want to share. Encourage participants to share their knowledge and experiences. Include activities that utilize their knowledge and experience, e,g., role play.
Adults are decision-makers and self-directed learners. Include problem-solving activities such as case studies.
Adults have different learning styles that must be respected. Provide multiple ways for participants to learn the material, e.g., print materials, question and answer, modelling of the skill.
Adults want to participate rather than just listen to a lecture. Create a participatory learning environment with various types of activities, e.g., lecture followed by group exercise.
Adults a re motivated by information or tasks that are meaningful and applicable to their jobs. Ensure that the right participants attend the training. This can be done by restricting enrollment via the application process, required prerequisite to training, pre-test with a minimum required score, or limited to a specific job series.
Adults prefer training that focuses on real- life problems. Relate content to the types of problems they encounter in their jobs. Have participants send questions or a description of problems before the course begins.
Adults expect their time during training to be used carefully. Follow a realistic time schedule; get started on time; ensure all equipment and supplies are in place before participants arrive.
Adults feel anxious when participating in a group that makes them look uninformed, either professionally or personally. Avoid criticism. Acknowledge all participants contributions.
Adults learn best in a positive environment where they feel respected and confident. Create a positive environment by provide positive feedback and showing respect to all participants.
Adults come from different cultures, life-styles, religious preferences, genders, and ages. Respect all differences and encourage participants to respect each other’s differences, as well.

A saying well known in training courses is--
I hear and I forget.
I see and I remember.
I do and I understand.

The following chart provides information on what adults remember. This is very important for knowing how to design your training. If a trainer only lectures, then participants will probably only remember 20% of what is said. Creating a participatory training where participants are active and “saying and doing” will help them remember more from the training. It will help ensure that participants actually gain the desired knowledge and skills. (Source:

Percentage of what adults remember: Adults remember only about 10% of what they read, 20% of what they hear, 30% of what they observe, and 50% of what they hear and observe. But they remember 70% of what they say, and 90% of what they say and do.

Providing a variety of training methods

If variety is the spice of life, it is also the spice of training. Providing a variety of training methods will help participants stay engaged. In fact, you should change the pace and activity about every 20 minutes.

Following are some methods you can use to create variety in your training.

  • Change the presentation styles.
    • Change facilitators often. Just having a different facilitator can change the pace and create a different energy in the room.
    • Use two or more facilitators for one presentation.
  • Create participatory learning situations; participants should-
    • Stay involved and active;
    • Share their knowledge and experiences.
  • Provide various learning activities to help participants apply the content, including the following:
    • Exercises (e.g., case studies, study questions/tests, problem solving exercises)
    • Group discussions (e.g., large group that involves all the participants, small groups that allow more interaction
    • Role plays (if appropriate)
    • Games
    • Demonstrations/modeling of the new skill
  • Use a variety of media
    • PowerPoint slides
    • Overhead transparencies
    • Flip charts
    • White boards/black boards
    • Videotapes
    • Audiotapes
    • Music
  • Use a variety of visual aids
    • Charts, graphs, diagrams
    • Illustrations
    • Photos
    • Props
  • Change how participants work during the different activities
    • Alone
    • With their neighbor
    • In groups
      • At the same table or several tables together
      • By other factors related to the activity (e.g., location where they work such as region or health facility, job duties such as physician or nurse)

Vary the group composition for the different training activities to ensure participants interact with a variety people in the training course. (Note: This can also help ensure no one person always dominates the same group.)

  • Change seating arrangements
    • Change where and with whom people sit in the room. It is helpful to have participants sit in different locations and interact with other participants. (Note: This can be an effective tool to manage difficult participants; if two or more participants are continuing to talk together throughout the training, you can split them up.)
    • For a group discussion, have people sit in a circle in a different part of the room.
    • For group exercises, participants can move to different parts of the room.
  • Take frequent breaks
    • Take at least a 15 minute break at least every 1.5 hours or
    • Take a short 5 minute break every hour (make sure participants return from breaks on time)
  • Use various presentation techniques
    • Use analogies to make a comparison. This is helpful for teaching about a complex concept or process. For example, latent TB infection is like having a thimbleful of bacteria in us; with TB disease, it is like having a bucketful.
    • Give quotes to provide a clear statement related to the content. For example, “The mind is a wonderful thing. It starts working the minute you’re born and never stops until you get up to speak in public.” Roscoe Drummond
    • Provide interesting statistics to help prove a point or show validity. For example, it takes eight or nine positive comments to undo the damage of one negative comment.
    • Provide different points of view to enhance understanding. For example, some people think that training adults is the same as educating students. But training provides adults with skills, knowledge, and attitudes that they can apply immediately to their job. Education, however, provides students and patients with content information that they may or may not use at a later date.
  • Use humor (where appropriate)
  • Use questions to engage the participants
    • Encourages all participants to contribute and to share knowledge and experiences
    • Allows for differences of opinions
    • Keeps participants alert


The following resources provide additional information on engaging participants.


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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