During my time in Rwanda, I have been confronted with learning about my style of teaching. In general, it would appear that my style is very hands on. I like to demonstrate, to help, to work together with the plan and the skills. Full disclosure, I do not consider myself to be a particularly good teacher. I feel I am often impatient, worried about time, and distracted with my out – of – OR commitments to really focus on teaching. It is something I would like to improve about myself.
However, the goal of this trip to Rwanda teaching! What a luxury! I do not have out of OR commitments, I am not directly responsible for an OR list or any other patient care activities. I can devote myself entirely to teaching. It should be easy, right?
It has been very difficult to figure out how to teach without putting my hands on the patient. At home I will discuss a plan with the resident and we will fine tune the plan together and then do the case together. I am able to tweak things quickly as needed or completely alter the plan in an instant if necessary. In Kigali, I am in a supervisory role. The residents and I still discuss the plan. Usually we take the time to discuss the pros and cons of the possible options before deciding on a plan, but then I have to sit back and watch. As well, our plan often has to be altered in light the available resources. Once the case starts, I cannot rescue. I can make suggestions, but the residents and NPAs make the ultimate decisions, and occasionally the Rwandan staff weigh in when necessary. This has been very, very hard.
When the “extra” people (i.e. volunteers like myself) are not here, the residents and NPAs must carry on their work. They do these cases with their plans and in their way; it is not beneficial for me to takeover. They must be adept at changing their plans to match the current resource availability, something I rarely have to think about. For the most part, the plans are safe and the patients do well, even if the approach is not ideal.
However, for paediatric patients, I can see some things that could be done a little differently that could potentially benefit the patient. But I can only suggest, I cannot convince them it will work by showing them. Here in Rwanda, there is only ONE pediatric anesthesiologist in the whole country!!! ONE!! (There will be two by September). By contrast, we have 11 in Nova Scotia (with 1/12 the population of Rwanda). These residents and NPAs must do their best to stay safe, without the strict oversight of a paediatric anesthesiologist that happens in Canada!
Today we had a young patient come to the OR for a short procedure. The patient already had an IV from a previous surgery. The plan was for some IV sedation and then to hold the mask and deliver anesthetic gas for the case. But the patient HATED the mask. Every time the mask came near his face, he began to hyperventilate. The resident’s plan was for a little bit of ketamine and some midazolam. I suggested some propofol but she didn’t understand why I would want to do that. I obviously wasn’t explaining myself very well. I had wanted to use propofol to put the patient to sleep very quickly without the experience of the mask he so detested. We proceeded with the resident’s plan and our little patient had some IV sedation but was quite awake when the mask went on and he went to sleep very upset.
Most importantly, the patient was safe. But there was another way we could have done this that was also safe and more pleasant for the patient. He did not have to be so distressed. The resident and I debriefed about this and she could see my point when I explained it a different way. However, I don’t know if I will ever get the chance to do another case like this with her where we can try it together a different way.
So much of anesthesia teaching and training is doing, and I am finding it very difficult not to just jump in and DO! I am trying to change my ways and be more creative in my teaching. I suspect this will help me become a better teacher at home as well.