Development and Evaluation of a Train-the-Trainer POCT Competency Program Using Self-Determination Theory: A Multi-Site Implementation Study

Introduction

Point-of-care testing (POCT) is performed at or near the patient. Training many operators across multiple sites and devices presents major logistical and quality challenges. This study developed a standardized train-the-trainer (TOT) POCT curriculum and evaluated its effectiveness using competency and proficiency testing outcomes, guided by Self-Determination Theory to support autonomy, competence, and motivation.

Methods

Comprehensive POCT curriculum and competency assessment tools were developed by Chemical Pathology faculty and POCT coordinator using Clinical and Laboratory Standards Institute (CLSI) and College of American Pathologists (CAP) resources. Structured TOT methodology was implemented; trained faculty and POCT coordinators trained nurse trainers in Nursing Education Service (NES) to serve as trainers ensuring standardized competency across all sites. Competency assessment included direct observation, quiz, quality control interpretation, and supervised patient testing. Ongoing quality assurance monitoring included review of PT performance, QC compliance, operator lockout reports, and audit of documentations. Ethical approval was not applicable as project was conducted as part of a quality improvement initiative.

Results

Standardized POCT curriculum aligned with CLSI and CAP guidelines was implemented across 30 sites. More than 100 NES trainers delivered cascade training, certifying 7,647 POCT operators (nurses, doctors, technician, mid wives) from 2015 to 2025. During 2015–2025, 4,111 PT events were completed, with 4,108 (99.93%) acceptable results and consistently high annual performance (99.5% in 2015, 100% in 2016, 99.8% in 2017, and sustained overall performance of approximately 99.8–99.9% through 2025). Compliance audits showed 99% documentation, full operator traceability through barcode integration, and no unauthorized access after controlled authentication. POCT services maintained CAP and CLSI compliance across four accreditation cycles. TOT model strengthened mentorship, consistent knowledge transfer, and enabled sustainable scaling of POCT services.

Conclusion

The program improved POCT standardization, competency, and compliance across decentralized sites. The TOT model provided a sustainable way to scale POCT services.