Dr. Damian Roland (@damian_roland) - #FOAMed supporter

What I learnt this week: The Education in the Observation of Education #WILTW

In #WILTW on December 19, 2014 at 12:21 pm

This is the 31st #WILTW

There is a great deal written and discussed about the ‘art’ of teaching. Numerous theories, articles, strategies and anecdotes are available but often teachers (of whatever discipline) will follow their own path and practice. This is not due to arrogance or cynicism (although this exists) but generally because teachers are lone practitioners. Whether it be by lecture or workshop the teacher educates alone nearly all of the time. Of course feedback is available from the learners themselves, but this is an infrequent exercise, steeped in issues of hierarchy and lack of objective mechanisms to determine poor practice. In Medical Education there is also a third arm, the patient, who witnesses the interplay between doctor and student but often has even less of an opportunity to have their observations taken into account.

To educate

There are events where peer observation of your teaching is available though. The Advanced Life Support Group run a number of courses for health care proffessionals to teach core skills in managing the most ill adults and children. The courses involve a number of faculty who teach via a variety of formats but often with 2-4 faculty members in a room simultaneously. This week colleagues and I were teaching on the Advanced Paediatric Life Support (APLS) course. This is an intensive 2 days in which candidates must demonstrate a uniform approach to the initial management of ill and injured children. Having your teaching observed is a very useful process. It makes you concentrate on a whole spectrum of issues which are easy to let slip in day-to-day un-observed activity. Timing is key, if you over-run, the course over-runs which will be clearly apparent to the other faculty members. If you don’t know core knowledge, the students will suffer, and again it will be obvious to other faculty this is the case.

I know this because I learn as much from these courses as I think the candidates do. You watch others demonstrating core material material (the ALSG have a prescribed format) but in subtlely different ways. There are great demonstrations of using examples, memorable cases, twists of context etc. to clear effect. You see how experienced faculty deal with candidates who are struggling or not engaging, and you learn the critical importance of well delivered feedback. Being able to witness good, and bad practice, stops complacency and helps you realise there are always things still to learn. On this course I mis-interpreted a candidates nervousness for over-confidence and appreciated I still have work to do on the pace of my delivery.

Taking pride in your teaching is important but there is only so much you can learn from theory and irregular feedback from participants. In an ever isolated world of clinical practice the observation of others’ delivering education, and your own, will be vital for patients and the profession.

What did you learn this week? #WILTW

What I learnt this week: How to get people to alter their typical ‘change’ vintage #WILTW

In #WILTW on December 12, 2014 at 9:46 pm

This is the 30th #WILTW

I was at a development meeting for LIIPS (pronounced leaps) today. LIIPS is a collaboration between academia and the NHS with the aim to connect and share expertise, knowledge and support in service improvement across Leicestershire. Unfortunately the need to re-inforce a culture of patient safety and quality improvement persists in health care. This is in part due to some concepts being ‘relatively’ new so that there isn’t the infrastructure of knowledge out there in individuals to embed good practice in trainees, students and juniors. LIIPS hopes to assist in resolving some of these issues. There was a lot of expertise in the room, and therefore a variety of different approaches and suggestions on how LIIPS should evolve and deliver. One commonality shared by virtually everyone was the desire to move from traditional mechanisms of improvement, a reliance on audit alone, to more focused interventions which rapidly audit, review, revise and re-audit using measurements focused on patient outcomes.

Wine Bottles

There is nothing new about why ‘change’ is difficult but I have hit upon maybe something new to try. On the way home from work I stopped to buy some drinks from a local supermarket. As well as some bits and pieces I also picked up a bottle of wine. Try as I might I find it very difficult to move away from tried and tested regions and varietals. In fact that’s a lie: one particular region and one particular varietal.

This compulsion to stick with the familiar has been present since about 2005¹ and only really gets challenged when a new wine I try is unexpectedly pleasant on the palate (while there is no editor for my blogs I self-reflect the middle-class nature this train of thought is taking). It would have to be by an almost accidental wine tasting to prompt a change in tradition.

Moving improvement science from a new-fangled ‘thing’ into the ethos of healthcare culture is going to be long and arduous task. I wonder then if accidental “change tasting” is a realistic possibility within current system dynamics. While this seems implausible, with a generation of medical students and trainees hopefully being exposed to improvement principles at a much earlier stage, perhaps weaning a generation of professionals off their current vintage isn’t an impossible task.

What have you learnt this week? #WILTW

1. Following a year in Perth, Western Australia, Chardonnay’s from Margaret River have become a firm favourite

What I learnt this week: Changing your perspective on time allows time to give you perspective on change #WILTW

In #WILTW on December 5, 2014 at 4:40 pm

This is the 29th #WILTW

You can’t see the wood from the trees

This is a funny expression and one that makes little sense if you spend too long looking at the phrase’s actual construction. It does seem to ring true though. This week our Children’s Emergency Medicine Research group (PEMLA) reviewed its progress over the last year. It has not been ground-breaking: we can’t list Lancet publications, multi-million pound grants or a host of awards. But we have clearly moved fowards. Academic output has increased, we have establishing greater networks and there is an enthusiasm to continue and complete our current projects.


Creating space to review things over a set time period is incredibly useful. On a day-to-day basis I seem to be more likely to receive negative, rather than positive, news. Another grant application rejected, paper needing significant alterations, further delay with governance approval etc. I feel sometimes as if there is no movement forward. Everything is like wading through treacle – my steam roller analogy for NHS Change Day springs to mind. The NHS gets there in the end but is does so really slowly, squashing things along the way and seeming unable to change to direction.

We live ‘in the minute’ at the moment. The instant connection with mobile technology makes everthing happen ‘now’. Always busy and always something to do, and often hearing about others peoples success. Social Media creating a paradigm where you see everyone ‘else’ achieving something without realising you are probably doing exactly the same – except you aren’t taking the time to think about. As we reach the years end and the inevitable reflection on what 2015 might bring it is worth taking some time to think about 2014. Not in comparison to what others have done, but with yourself and what your personal objectives may have been. It’s likely to be time well spent.

What have you learnt this week? #WILTW


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