This week the team is out in sunny South Africa taking the opportunity to help run The Teaching CoOp course in Cape Town. This is the same course that we will be running back in Manchester later this year1 so it’s a fantastic time to update on the latest techniques ideas and thoughts around excellence in medical education.
It’s highly likely that you will have been on some form of teaching course in the past, be it an undergraduate module, a life support module or even a postgraduate qualification and I’m sure that they have been useful (they were for me), but there is something missing from most of them and that’s the practical mechanics, delivery and intricacies of teaching. The Teaching CoOp tries to fill that space with a course that delivers real world teaching techniques that are really practical and transferable to the workplace. Wherever possible it’s based on science (we think it;s just as important to deliver evidence based teaching (EBT) as evidence based medicine (EBM)).
So what have we been up to in Cape Town.
— #hello my name is Ross (@ffolliet) March 20, 2018
Day one – This was the P-cubed workshop with Ross Fisher. You almost certainly know Ross and I suspect many of you will have heard him speak at SMACC or some other conference on presentation skills (he has many other talents too). Ross has changed the way that we all present and you can see his influence in every presentation the St Emlyn’s team gives. Most of us have only seen Ross’s one hour talk ‘Your presentation sucks and what to do about it’; the workshop is an extension of this that delves into the practicalities and gets the delegates to start the journey to creating more effective narratives, media and delivery. The feedback from day one was excellent with delegates telling us that it has changed the way they think about their future as medical educators.
We know that presentation skills are something that cause a great deal of stress to pretty much everyone and so it’s right that we kicked off the course with this as a baseline for the rest of the course. If you’re interested in Ross’s work then head over to the P-cubed website here2.
— Sandra Viggers (@StarSkaterDk) March 20, 2018
Day two – Day two brought a larger group together to look at a variety of topics aimed at improving clinical teaching with a focus on interaction, support, theory and simulation.
Introductions – Nat kicked off the day with the business card exercise as an ice breaker and as a means to find out how everyone saw themselves as educators. It’s a fairly basic exercise but often leads to a deeper understanding of participants desires about the course and also tells us a lot more about who is in the room and their past experience.
Theory – Simon went through some basics of educational theory relevant to clinical teaching. We’ve summarised the main theories here as supporting media to past courses, but as always happens we found the disussion around how theories work in practice far more interesting than the theories themselves. In feedback the most powerful learning tools that delegates wanted to take away and use were the concepts around growth vs. fixed mindsets and also concepts around interleaving and variation. I think I agree with this as those are simple changes that can be rapidly adopted and are also based in a reasonable amount of science. If you want to know more follow the links above.
Teaching at the bedside. Sa’ad then took us through bedside teaching based on the complex and challenging workload at Khayelitsha District Hospital in Cape Town. Robert Lloyd told us about his experiences there on one of our most popular blog posts3 which documents the incredible work that the clinicians deliver in very challenging circumstances. Sa’ad is a consultant in that unit and he is utterly inspirational. I’ve not met someone so calm and kind for some time and that, together with the insights around the challenges faced in South African emergency medicine is incredible (actually now I think about it, I am really impressed with all the African clinicians I’ve met). The point is that we all work in systems that are under stress, that are overloaded at times and where we often feel that the care of our patients is compromised by the system. The challenge then of maintaining an educational environment is really hard. So how do you do it?
— Neville (@docvlok) March 20, 2018
- First: We need to recognise that trainees want to learn and trainers want to train and that means that making time to train, valuing the time to train and learning from each other is a cornerstone of positive culture in your department. There will be times when that educational time will get squeezed but it’s up to all of us to protect it and to value it. If we don’t then it is more than just the learning that will be lost, the culture, the esprit de corps and the reputation of your department will be lost.
- Second: Sa’ad talked about the need to understand why people make decisions and not just what decisions they make. We’ve talked about this on the St Emlyn’s blog in the past in terms of the difference between analysing process vs outcome in clinical decisions. Outcomes can simply be correct by luck, it’s only when you explore and value the effort required to come to a decision that you can truly understand the ability of your learners, and more importantly it’s absolutely essential to then direct and target education to help them improve.
- Third: We need to recognise that we can be really influential in how trainees feel about their jobs, their lives and the department they work in. It’s inevitable that when you give feedback then some of that will be corrective. That may well be perceived as criticism and that’s something that can really hurt people if you don’t do it well. This is a difficult skill to master as feedback needs to be honest and formative, but we must be mindful of how it feels to recieve it. How do we improve this? Well we should probably give much more positive feedback than we do to counterbalance that which is corrective. Do that often and in public, share with collegues and recognise that everyone is working hard and under difficult circumstances.
- Lastly; You need to know that Sa’ad is not just an amazing clinican and educator but he is also a master Barista, competing in coffee competitions in Cape Town. Everyone has a secret skill I guess.
Teaching Practical Skills. Ross Fisher returned with a really interesting session on teaching practical skills from his perspective as a surgeon who has spent years training other surgeons. Practical skills are a vital part of our practice but many of them are fairly infrequent and yet also challenging. As learners we are often desperate to get the opportunity to practice and train, we want to do as much as possible and cannot wait to do it for real (and not just in the sim lab). As educators and senior clinicians we know that our trainees want to get their practical skills up to speed but we also know that we could often do a better/faster/cleaner procedure and yet we cannot do everything or else there will be no-one there to look after us when we retire! The bottom line is that it’s tough as a trainee and it’s tough as a trainer and we need to recognise and understand that. In surgery, Ross talks about how having a trainee for several months and so can develop a close understanding of where his trainees are, when they need help and more importantly when they don’t. The challenges are different in emergency medicine in that we are often working with trainees who we may not know that well, but the principles remain the same. We should understand what skills our trainees already have and then teach to an appropriate level that reflects that.
There was some overlap with the 4-stage teaching process taught on a lot of life support courses as Ross highlighted but in addition we really focused on the concept of active watching. This is a bit like active listening in that the learner is tasked to ask ‘why’ things happen and work (or don’t), rather than simply observing that something happened. It’s especially important in practical skills because the learner will have to do the task themselves in the future. In order to do that they need to observe AND understand; active watching and not just observation.
Simulation. In the afternoon, Sandra Viggers led on the simulation workshop with Natalie May and Jo Park-Ross. Simulation is pretty well known these days and there is increasingly an acceptance and understanding of its intrinsic value. Despite this, we know that we don’t do it as often as we would like to. There are very few (if any) clinical services around the world that have adopted simulation as a training mechanism with the same organisation or frequency as other industries such as the airline industry. We need to understand why that is and how we can improve our engagement with simulation training and learning.
- Exercise one: Barriers to Sim using the horror movie exercise. The learners explored the barriers to simulation. In groups they were tasked to explore why we struggle to deliver sim training in practice (even amongst this group of enthusiasts). The obvious elements of time and money came through early on but we also explored cultural and traditional barriers to getting started and maintaining a sim program. We used a technique of rotating groups to set problems that were then answered by the next group, who then set some more problems and so on. It’s an interesting educational technique that I will copy in the future when working with a group of senior learners.
— Natalie May (@_NMay) March 20, 2018
In the second phase of the horror movie exercise, teams move to a different set of problems and come up with solutions. Then the whole group comes together to discuss the problem/solution combinations that speak to them #TTCCT18 pic.twitter.com/jW42AG7L1d
— Natalie May (@_NMay) March 20, 2018
- Exercise two: CRM. We explored how we can teach CRM elements within the simulation experience. We used the ANTS model for understanding CRM [Ed – at Sydney HEMS we use Prehospital Advanced Non-Technical Skills: PANTS) and discussed how we value and deliver that in a range of sim scenarios. Inevitably the conversations extended into how we apply this in practice and the balance of understanding between educators and risk management.
— Neville (@docvlok) March 20, 2018
- Exercise three: Resources and fidelity. This was linked to the first exercise in getting the participants to think beyond the plastic dummy and to really think about what it is they are trying to deliver in simulation training. We talked a lot about the advantages of using real people or very simple mannequins to focus on those elements of sim that are really valuable, notably CRM as explored in exercise 2. At St Emlyn’s we recognise this as most people’s perception of sim is a plastic mannequin which let’s face it is not that real and is clearly not the best tool to explore communication. leadership and other team behaviours. It’s time for us to think about what we are trying to achieve, what’s the best way to explore that and then choose the tools to support it. At the moment there are far too many sim programs that start with the tools available (usually a mannequin) and then work backwards from there. That approach is clearly resrtictive and a bit bonkers.
The tables are turned as the delegates now live meta-debrief the teaching sessions.
— Simon Carley (@EMManchester) March 20, 2018
A great first 2 days in Cape Town. We are back tomorrow to talk about student support, feedbook, social media, more on presentation skills and much more.
Remember that if you are not here, then you can always come to Manchester.