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Year : 2016  |  Volume : 16  |  Issue : 2  |  Page : 49-50

Training the trainers, walking in a minefield

Consultant Transplant Surgeon, Department of Renal Transplantation, Sheffield Kidney Institute, Sheffield Teaching Hospital, University of Sheffield, Sheffield, UK

Date of Submission04-May-2016
Date of Acceptance29-Feb-2016
Date of Web Publication18-Aug-2016

Correspondence Address:
Ahmed Halawa
Sheffield Teaching Hospital, University of Sheffield, Sheffield
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1110-9165.188530

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Hands-on training is always challenging especially when you deal with mature clinicians who are well established in their career. They may have difficulties in accepting new techniques and different approaches compared to doctors in training.
Aims and objectives
I’m presenting my personal experience in training general surgeons in Egypt; a journey started many years ago.
With high-quality qualitative feedback, I managed to spread evidence-based practice in Egypt. raining the trainer concept has become widely accepted among many clinicians.

Keywords: Hands on training, Nephrologists, Parathyroidectomy and Transplantation, Surgeons

How to cite this article:
Halawa A. Training the trainers, walking in a minefield. J Egypt Soc Nephrol Transplant 2016;16:49-50

How to cite this URL:
Halawa A. Training the trainers, walking in a minefield. J Egypt Soc Nephrol Transplant [serial online] 2016 [cited 2020 Apr 9];16:49-50. Available from: http://www.jesnt.eg.net/text.asp?2016/16/2/49/188530

  Introduction Top

Hands-on training is a popular strategy in clinical medicine because of the strongly ingrained belief among medical professionals that face-to-face and bedside teaching is a prerequisite to learning clinical medicine. This strategy is a challenging approach as it entails changing the behaviour of mature clinicians who are used to certain practices and sometimes imprisoned in their own beliefs.

I started my long journey in 2009 when I visited many centres in Egypt aiming at implementing evidence-based practice in training surgeons and nephrologists in the field of renal transplantation and its related subspecialties (vascular access surgery and surgery of the parathyroid disease). These activities are based on voluntary and non-profit-making training endorsed by the International Society of Nephrologists. Training surgeons on the technique of parathyroidectomy was my main objective during this stage, where I ran a very successful course attracting experienced surgeons in neck surgery from many countries. I adopted a well-known training strategy described by Miller [1] [Figure 1] aiming to achieve competence.
Figure 1 Simple model of competence (Miller’s taxonomy).

Click here to view

I appreciated the concept that medical education is not just a passive knowledge transfer, which works well with the trainees at the receiving end [2]. Rather, I strongly believe that the opposite is true, where training signals the beginning rather than the end of education [3].

To achieve the behavioural changes towards mastering any technique (Does), I have to endorse gaining other skills (knows, knows how and shows how) to achieve the top of the pyramid. This was achieved most of the time by considering the local resources available in the pedagogy to bridge the gap between evidence-based and day-to-day practice. I have to modify the training strategy to match these resources within the framework of the acceptable practice to ensure attainment of maximum patient safety. High-standard radiological investigations were reserved for technically challenging cases such as recurrent hyperparathyroidism. The lack of expert pathologists to perform frozen section was bridged by maximizing the surgical input. For example, two experienced surgeons operate together to ensure that maximum accuracy in localizing the parathyroid glands is achieved.

One of the main challenges faced is the lack of accurate recording of the surgical findings. This has been overcome by many measures. Addressing the importance of appropriate operative details in case of recurrence as the cornerstone of success of the future surgery has helped with the expansion of the training and increased number of referrals. Relying on the histology reports and later on the notes written by the nephrologist attending the operation was another successful approach.

We promoted peer assessment as an innovation in teaching and learning on this course to encourage team-based learning as suggested by Michaelsen and Parmelee [4]. This educational approach provides ‘added value’ to the trainee’s experience, enhancing active learning, critical thinking and promoting engagement of the trainees.

I mirrored the training with a high-quality constructive feedback mechanism as suggested by Hesketh and Laidlaw [5]. Delivery of this extensive feedback was based on face-to-face communication and it was individualized. We focused our feedback on observable behaviour such as dissection, identifying the anatomy, reflection and implementation of the current evidence. This carries more weight and credibility to the students as highlighted by Gordon [6]. We planned the feedback to be a dialogue between the trainee and the trainer rather than a monologue with the trainee at the receiving end. Underperforming trainees were further supported with robust mentoring facilities provided by expert trainers and escalation of the level of communication between the course faculty and these trainees.

The effort was not wasted and managed to establish trained teams spreading this evidence-based practice in many centres in Egypt. These teams are now leading the training successfully and helping other centres to establish their own programme. Significant behavioural changes noted by implementing multi-disciplinary work-based pedagogy are exemplified by qualitative and quantitative improvements in the performance of the Egyptian surgeons compared with my initial assessment during the first visit. This improvement is reflected in the ‘habitual use’ of critically reflective practice, implementation of evidence-based medicine and improvement in the communication between surgeons and nephrologists.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65:(Suppl):S63–S67.  Back to cited text no. 1
Lavis JN, Robertson D, Woodside JM, McLeod CB, Abelson J. How can research organizations more effectively transfer research knowledge to decision makers? Milbank Q 2003;81:221–248.  Back to cited text no. 2
Cumming JJ, Maxwell GS. Contextualising authentic assessment. Assessment in Education 1999;6:177–194.  Back to cited text no. 3
Michaelsen LK, Parmelee DX. Twelve tips for doing effective Team-Based Learning (TBL). Med Teach 2010;32:118–122.  Back to cited text no. 4
Hesketh EA, Laidlaw JM. Developing the teaching instinct, 1: feedback. Med Teach 2002;24:245–248.  Back to cited text no. 5
Gordon J. ABC of learning and teaching in medicine: one to one teaching and feedback. BMJ 2003;326:543–545.  Back to cited text no. 6


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