Healers of Tomorrow Gathering: The benefits of simulation in aboriginal health education

“Doing this with my hands versus watching a video or being told how to do this was the best!”  

– A participant at the Healers of Tomorrow Gathering, Corner Brook, NL, August 2015

This simple statement from an aboriginal high school student actually offers a pretty profound insight into medical education.

The student was one of the participants at a week-long mini-med school held at MUN’s Grenfell Campus last month. The idea behind the Gathering was this: instead of bringing outside doctors into aboriginal communities for temporary placements – which is the current setup, and which can lead to lack of long-term patient-doctor relationships in remote communities– train local residents in medicine so they can bring the skills back home, combine them with their knowledge of their own traditional medicine, and practice in their own communities.

And so, thanks to the Aboriginal Health Initiative, 12 students from across the province participated in a week of activities and discussions designed to spark interest in health care careers, like nursing, pharmacy and medicine.

The week included two days of hands-on simulation activities, where participants learned – and then tried out – medical techniques like intubation, suturing, and IV insertion on mannequins and inanimate models.

While simulation is a standard part of most medical education, it was especially important here. In aboriginal culture, knowledge is often passed down by showing the next generation how to do something, and then letting them do it – an idea kind of like simulation. Lecture-based formats, the kind we’ve grown accustomed to in our Western education system, don’t necessarily resonate.

So while the youth quoted above might have simply been making a casual, enthusiastic statement, they were actually on to something deeper: Sometimes, doing things with one’s hands [rather than watching or being told how to do it] is “the best.” This cheerful statement unintentionally makes a sound point: if you want to create a system that works, you have to start by educating the system’s participants in a method that works for them.

Barry Trenchard, a Medical Technologist at the Clinical Learning and Simulation Centre who ran the simulation portion of the camp, described the students as “inquisitive, intrigued and excited to participate and learn,” and watched confidence levels rise as the students mastered activities by doing.

The camp will be run every two years, with the simulation portion as a regular feature.  Read more on this year’s version of the Camp in this Western Star article.

Research Teams

"If you want to go fast go alone, if you want to go far go together" (African proverb)

In an academic world the word "team" is traditionally not well liked and accepted.  We tend to call ourselves collaborations, networks, and coauthors.  Regardless of the point of view, in order to form and maintain effective research teams, collaborations, networks, or groups, a certain formation and maintenance process needs to be followed. Reviewing business literature, it appears there are 3 key steps to build and maintain teams:

Step 1. Frequent, open communication:  Most team dysfunction is rooted in communication breakdowns, such as poor listening, interrupting, rambling, inability to get to the point, and simply not communicating frequently enough to create team cohesion.  

How to:  Drs. Leonard J. Marcus and Barry Dorn of the National Preparedness Leadership Initiative in their Meta-leadership framework suggest that teams should develop a code word to let each other know when things are starting to fall apart.  

Step 2. Take time to create team cohesion: Relationships cannot develop in a vacuum. Spending less time together will not create stronger team bonds. Building effective team cohesion involves taking the time to get to know working styles, personalities, and preferences.

How to: Yes, we are all super busy.  However, it does not have to be a "pub night" or anything like what we see in the movies, when the whole office hangs out after work hours having fun.  Team cohesion can be built during short, informal interactions.  Glenn Regehr, a master team builder in the medical education world, would have a 5 minute morning ritual of walking by everyones' office during his days at the Wilson Centre (Toronto) and asking them how their day was. As a recipient of his walkabout, I believe we even managed to write a paper like that once, or at least came up with an idea for one.  Coffee also tastes better when it is shared!

Step 3. Give honest, regular feedback: Everyone on the team needs to get feedback in order to feel connected to the team effort. Even if that feedback is critical, the team member knows that their contributions are being noticed and evaluated. For the team to stay on track and avoid retreating into dysfunction, everyone needs to be talking with each other about expectations, goals, performance, and progress. 

How to:  Make it an explicit part of your everyday routine.  An inquiry based approach may be helpful in making feedback less awkward.  "I observed that  ___ & I was concerned that ___.  What did you think about ___.?" Listen and re-phrase what was said. "How could we solve a similar problem in the future?"

In the words of Ifeanyi Enoch Onuoha: “teamwork is the secret that makes common people achieve uncommon results”. In my experience, research teams are not different than any other teams found in business or sports - they all want to achieve uncommon results.  To form and maintain the teams requires work, and this work should be part of the daily activities of any research team.