lively teaching day

Academic day. The residents received questions to be answered from their preparation reading the week before. They sent their answers to us in advance so we can look for areas of misunderstanding. Each week, one Rwandan resident is assigned to be the resident teacher so I prepared the program for yesterday along with her. This helps the residents build teaching skills.

The topic for yesterday was obstetric anesthesia and analgesia. We had an action packed day. The morning session included a review of the homework questions with emphasis on clear, concise answers. Then we had a pro-con debate on establishing a labour epidural service in their hospital. This encouraged the residents to move beyond book knowledge and to think critically about their working environment. After that, we broke the residents into four teams to sequence cards of all the anesthesia actions required from receiving a call for an emergency general cesarean section to delivery of the neonate (thanks for the idea, Amélie). We regrouped to critique and refine the sequencing and then our teaching team ran a demonstration scenario of exactly these events. We let the residents know they would be be asked to role-play this same scenario in simulation in the afternoon. Our morning session ended with a lively game of Jeopardy (always popular) complete with prizes.

In the afternoon, we ran three stations and broke the residents into small groups to rotate through the stations. This included the cesarean general anesthesia induction from the morning, an epidural station and spinal station.

Chris teaching epidural insertion with a task trainer and a banana  for loss of resistance 

Dave at the spinal station

The day was utterly satisfying. One cannot imagine a keener group of learners. They remained enthusiastic and engaged throughout the day.

I have been coming to Rwanda for ten years. When I started there were 8 residents and no designated teaching space. We had to move from one borrowed teaching area to another, often to be displaced by another group. There were no materials for teaching and certainly there was no simulation. Teaching was with powerpoint lectures. The residents struggled with English, so communication was challenging. The curriculum was four page topic list with volunteers choosing a topic to teach from the list.

Today there are 40 residents who have a full academic day each week in a simulation centre with a classroom and sim lab. There is a one year curriculum for foundations (first year residents) and a two year curriculum for core (second and third year residents). Fourth year residents are involved in teaching. We are currently working on a one-year simulation-based curriculum for the first year residents to supplement the academic curriculum. Teaching methods have moved from passive to active. The residents communicate well in English.

The graduates of the CASIEF-Rwanda program are now in leadership positions (university head of anesthesia, hospital anesthesia heads, program director). Reflecting on the situation, I believe CASIEF has now accomplished its original goal of building a sustainable anesthesia training program in Rwanda. There is still a need for support, particularly for subspecialty areas (e.g., pain management, regional anesthesia) but the core elements are in place and anesthesia is thriving.

It has been a pleasure to share this experience with Dave, Chris and Stephen. They have promised to write a few posts as well.

Stephen and Chris enjoying the Serena buffet on Sunday