PE R IOPE RAT IVE PRACT ICE
would describe as shoe lockers for securing medicines. Each locker had a padlock and the set of keys, which was enormous and heavy, was held by the sister in charge, who might be busy in the office away from the clinical area and needed to be interrupted each time any of the theatres needed a top up of their anaesthetic drugs. We saw instruments and single-use tubes soaking in gluteraldehyde for re-use and the poor quality of some of the instruments as they were soaked immediately after use in chlorine to reduce risk of HIV cross- contamination. This rusts the instruments and causes great pits in the stainless steel. We saw huge tubs of cold water beside the sinks at which the staff had to scrub, as the hospital had no running water. The hospital visit also served to introduce facilitators who had not been to Africa before, to the local environment, so that they understood the situation the delegates worked in. It was an unspoken learning for experienced perioperative staff to see how the students managed their situation and the poor conditions in which they worked.
Teamwork Teamwork among the facilitators has been a learning experience in itself. Some are better prepared than others and the whole team has to revolve around them, helping where possible. As you would expect, the programme has to constantly move in emphasis and timings are changed all the time. This may be due to extended conversations and learning on some topics or feedback from group work taking longer than expected. Some facilitators, including me, get enthused with their topic and take too long to explain the concepts, overrunning on their time. This requires some sophisticated manoeuvrings to meet the lunch break time slot or the finishing time. Sometimes we manage it well – other times it has impacted on the following sessions.
Group work
Group work can be revelatory. It is usually very noisy and full of laughter and they
work hard writing their feedback flipcharts. Frequently, the same people are chosen to give the feedback, so we learned to say anyone who has already done feedback should not do it again – to give the others a chance. The work is comprehensive and feedback often extensive. There is much team encouragement from the same group participants to the person feeding back – which is unlike the similar situation here. Group work always evaluates very well and they obviously learn much from each other. We facilitate the group work and enjoy the less formal interactions with individuals, as well as helping groups to explore the topic.
Teaching and learning What have I learned? I have learnt that the preparation time for all the topics in a week of teaching is about double the time it takes to deliver each session, which is often underestimated. I have also learnt that my learning style is not always the same as that of my students and, latterly, we have included short videos to some of our sessions which has animated the group considerably.
Whether they absorb the lessons better with visual help is difficult to assess. However, we have learned over time that there can be too much powerpoint and a need for a different structure to the learning which may be via a quiz, group work with scenarios, discussion in pairs or a more
engaged means of instruction with individual participation.
The role of technology in the learning process is interesting and often creates challenges for us. Much depends if we carry our own projector with us or if we decide to hire at the venue. There are tales to tell of the early technology, each individual to the place and venue – including cockroaches nesting in a hired overhead projector. Since that time, we have admired investment in technology, not only at university teaching hospitals but also at surgical skills centres, and happily had access and support to use it. In general, there is a high degree of engagement with the learning opportunity and the delegates really want to be there and to be learning. However, in common with training in this country, students find it hard to sit all day and listen. Frequent stops to stretch, or to have short breaks are essential. Lunch breaks are a long affair, often needing at least an hour in the middle of the day as, when food is free, a huge plateful is taken and made the most of. It is often a good opportunity for facilitators to review the morning and make changes to the afternoon as necessary.
Common to many of our courses and to many teachers all over the world is the role of disruptive students. Often, they can be senior people or even tutors who wish to show their knowledge, which we challenge, as it is often based away from best international practice; I remember an interruption regarding the purpose of ventilation, which the challenger said had nothing to do with infection prevention. In front of a class of eighty other students it is difficult not to ridicule the speaker, and to deal with the situation appropriately. Students sleeping after a large lunch, and the modern phenomenon of ‘phones in the classroom’, need dealing with individually and appropriately. By and large most of the delegates want to be there, find very few other continuing professional development opportunities and love learning! I have heard and seen some horrific stories from the clinical areas, particularly health and safety issues. I wish I had written
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