Tips & Resources:
Tips on Teaching in a Low Resource Country (LRC)
LENA DOHLMAN, MD, MPH
JO DAVIES, MB, BS
Teaching medicine in a Low Resource Country (LRC) can be a daunting experience for a US trained physician due to cultural and language differences and unfamiliar drugs, equipment and diseases. This workshop will attempt to improve the comfort level and effectiveness of volunteers teaching overseas.
- Discuss basic guidelines of teaching in a Low Resource Country (LRC)
- Discuss how to make a learning needs assessment and teaching plan
- Review basic concepts of teaching methods and techniques which might be useful in a Low Resource Country (LRC)
- Identify resources for learning about unfamiliar equipment and techniques often found in a Low Resource Country (LRC)
- Discuss how cultural, language and resource differences can affect teaching abroad
The ultimate goal of having US trained anesthesiologists teaching in a Low Resource Country (LRC) is to identify and train local anesthetic personnel who can eventually be self sustaining and responsible for the training of others. There are many factors which make this goal difficult to attain. A lack of economic resources and political commitment can lead to chronic shortages or absence of necessary medications, equipment, electricity and even clean water. The health care infrastructure is often poorly developed and the hospitals under staffed. Many anesthetists have inadequate training for the responsibilities they are given. The wages of the medical staff are low and even physicians are often forced to take a second job in order to support their families. This leads to frustration and many younger physicians leave their home countries for better opportunities. Others feel professionally isolated because of a limited access to educational opportunities and become passive about improving the healthcare system. It is important to keep these conditions in mind as you teach.
- Be patient - change is slow.
- Change occurs when you convince administrators, heads of department, and politicians.
- Keep things simple and never assume anything.
- Be flexible and open to ways of doing things that may be different than what you are used to.
- Be prepared for the unexpected.
- Don’t have a patronizing “we know best” attitude. Aim to share knowledge and ideas.
- You will find that you will learn as much from your colleagues in the country you are visiting as they do from you.
Planning ahead: Before you leave for your assignment try to find out as much as you can about the following:
- Who will you be teaching?
- What is the level of knowledge, skills and background of the learner?
- What are the important topics to teach and does the teaching site want these topics taught?
- Which of these topics do you feel comfortable teaching? As much as possible, teach what you know.
- What are the local resources and conditions like in the hospital?
- What types of surgeries are performed and anesthetics are used?
- Will the student be able to use what you teach (will they have the drugs and equipment available)?
- What will the teaching conditions be like? Can you use PowerPoint and a projector (watch out for frequent power outages) or will you be using blackboard and chalk?
- Is a printer and copier available or do you need to bring your own handouts?
- How will you evaluate whether the students have learned what you taught?
- Some of the above information you will not be able to get a full picture of until you arrive in the country and meet your students.
General principles to keep in mind:
- Be as prepared and organized as possible.
- Your audience can vary enormously in experience, training, and specialty.
- Be prepared to lecture on a variety of topics and carry a resource text or CD for looking things up. You may be asked to lecture on something you don’t know much about. It is especially nice if you can leave the resource behind
- Discuss the choice of teaching topics with your host beforehand. Feel free to make suggestions but avoid unwelcome or sensitive subjects.
- Remember “first do no harm”. Focus on techniques that can be done safely with the locally available resources.
- Do not promote the use of equipment and drugs which are inappropriate for the hospital and the country.
- On the other hand, the local staff may want to learn what the “latest” is, even if they can’t incorporate it into their practice yet due to lack of resources.
- The audience will often be particularly interested in hearing about what your hospital and practice and training is like in the US.
Teaching Methods and Techniques:
Techniques: Listed below is a summary of teaching techniques that can be used. The techniques are listed from less active to more active.
- Listening to lectures
- Reading assignments
- Paper and pencil exercises
- Written examples
- Demonstration (by the teacher)
- Story telling
- Small group discussion
- Problem solve/Case discussion
- Demonstration (by the learner)
- Practice (supervised)
The technique chosen will depend on your objectives and the kind of information to be taught, i.e., knowledge, skills, or attitudes. The success of each technique will also depend on the learning styles of your students. In general, students will retain more with the more active teaching techniques. On the other hand, students in Low Resource Counties (LRC) are generally more used to and comfortable with the lecture(passive) technique of teaching. Some have never seen techniques such as “Scenarios” and will need to be taught how to use the technique to learn. Culture and language differences can also get in the way of using some techniques such as group discussion. It’s a good idea for teachers to try several methods to accommodate different learning styles and abilities of the students. Some techniques may be better suited than others to the teacher’s personality and style of teaching.
Knowledge: The most often used method to relay knowledge is the lecture (especially in Low Resource Countries). It can be valuable for providing background information or a foundation of knowledge. Below are some tips for using the lecture successfully:
- Keep it simple and clear.
- Keep it short and to the point.
- Start and finish with the most important points.
- Use pictures and diagrams when possible.
- Write down or show key numbers and words.
- Pause between sentences.
- Avoid colloquialisms and jargon.
- Speak clearly and slowly, especially when using a translator.
- Translation is slow if sequential (the usual).
- Expect lectures to take twice as long as usual when using a translator.
- Allow time for questions.
- Realize that in some cultures it is considered rude to ask questions of the teacher/lecturer.
- Make clear you do not mind questions, even those you do not have answers to.
- Some in the audience may prefer to write down questions and hand them in.
Reading assignments are also a commonly used method for relaying knowledge. Be aware that students in Low Resource Countries may not have access to textbooks and you may want to bring handouts if you wish to use this method of teaching.
Discussion groups are a good way for students to share knowledge and beliefs and can work well to bring out misunderstandings in knowledge. A common language is necessary. This technique does not work well using a translator. As the teacher, your role should be to:
- Introduce the topic for discussion
- Facilitate the group process
- Speak very little (follow the 80/20 rule)
- Encourage all to participate by prompting quieter persons and subduing the talkative ones
- Offer feedback on whether objectives are met
- Find and correct misinformation and misconceptions
- Clarify the goals during the discussion
- Mediate differences
Skills: In a Low Resource Country anesthetic skills are most often taught one on one in the operating room. Some non-invasive techniques can be demonstrated using models or mannequins. Simulators are still rare in Low Resource Countries.
Attitudes: Changing attitudes can be more difficult than teaching knowledge or skills. One way to do so is to be a role model for change. Learners will tend to copy behavior they admire and respect. By attentively listening, encouraging discussion and giving honest and fair feedback, you model respect.
It is important to promote self-education by providing web addresses and other resources which might be used by students after you leave. You can start this process by assigning students a topic they must research and present to the other students with your help.
Resources: Educational resources which might be useful for teaching in Low Resource Countries will be listed in the references or brought to the workshop.
Cultural differences: Cultural differences can affect your success as a teacher. A few key points to think about during your visit to another country:
- Do not assume the host country has the same values as in the US.
- Never criticize the hospital, country or politics of the country you are visiting.
- Attempts to be aware and polite.
- At the same time, be yourself and keep the strengths and uniqueness of your own culture.
- Be open to learning about the customs and traditions of your host country.
- Be sensitive to traditional schedules. Saturday is often a regular work day but weekday afternoons often end earlier than in the US.
- Punctuality varies in countries.
- Go with the flow.
- Be a diplomat of your country and profession.
The following websites contain variations of multiple emergency checklists. We are working with the Stanford group with a view to adapting these checklists to suit different institutions in different countries.
Interesting Articles, Presentations and Global Health Opportunities
World Federation of Societies of Anaesthesiologists (WFSA) Anaesthesia Tutorial of the Week