Insights
Lost in translation: X–ray teaching in Africa Amit Parekh The Billy Riordan Memorial Clinic, Cape Maclear, Malawi
I
t was the hardest teaching session I have ever delivered.
It should have been so simple: as a volunteer doctor in Malawi, I was asked to give a teaching session on chest X–ray interpretation to Malawian clinical officers. I had recently delivered a similar session in the UK but I knew that this would be very different – no computer, no overhead projector and no comfortable seminar room. I had made an interactive lesson plan, keeping the same learning points from the UK session, but adapting it for more limited resources, using X–ray films instead of computers and paper diagrams instead of POWERPOINT presentations. So, I arrived at my classroom, a small, windowless office, only to discover that a light box for viewing my X–ray films was nowhere to be found. Further investigations revealed that there was no light box anywhere in the hospital! Panic set in. After all
my planning, how could this happen? Eventually, I decided to deliver the session outside, holding the X–rays up to the glaring sun. Feeling hot and flustered, I quietly dropped my lesson plan and, reverting to traditional didacticism, explained a systematic approach to interpreting chest X–rays. At last, everything seemed to be going well: the clinical officers were smiling and nodding reassuringly. But then, when I asked one of them to demonstrate the technique back to me, I was met with a blank face, in fact with six blank faces. What had happened? Had they found my English accent impenetrable? After much thought and reflection, I realised that my session should have been more learner focused, although I was unsure how to achieve this. I knew that small group tutorials required three characteristics to
be successful: knowledge base, interaction and learner activity.1 I chose this as my starting point to deconstruct my teaching session. Firstly, I realised that I had very little understanding about the knowledge base of the audience that I was teaching. Clinical officers are health professionals that are unique to Malawi. As a result of the shortage of medical staff, they fulfil many of the tasks that would normally be performed by doctors; however, I knew very little about the training clinical officers receive or their level of expertise. Therefore, identifying the learning needs of my audience became impossible. In hindsight, I should have examined the ability of my audience to interpret chest X–rays to help identify the subject matter that needed to be taught.
After much thought and reflection, I realised that my session should have been more learner focused
I had planned to make my teaching session as interactive as possible, knowing that
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 61–62 61
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1/12/2015 3:50:11 PM
In order to create a safe learning environment, I needed to understand the principles of Malawian culture
interaction promotes learning.2,3 But how could I encourage interaction when the clinical officers had clearly failed to understand what I was saying? This failure in communication occurred because of my use of long, complicated sentences and my tendency to talk quickly. By using short phrases and straightforward English, the clinical officers would have had a better understanding of the subject matter, and been more willing to engage with my interactive style of teaching. Furthermore, the fact that the clinical officers did not ask me to repeat myself or slow down reflects my failure to create a safe learning environment. A safe learning environment encourages audiences to participate in active learning, which is better recalled, enjoyed and understood.3,4 In order to create a safe learning environment, I needed to understand the principles of Malawian culture, which are based on hierarchy, status and respect for the teacher. Malawian culture dictates that ‘when the teacher teaches, the students listen’, and this may explain the clinical officers’ reluctance to speak up. By having an awareness of these principles, I could have discussed these beliefs with the clinical officers at the start of the teaching session, thereby promoting engagement and encouraging participation.
To facilitate my interactive style of teaching, I had planned several learner activities using chest X–ray films and light boxes; however, the fact that no light boxes were available indicates that I should not have assumed the use of any equipment. Even if equipment were available, I would need to ensure that it would be in working order and that there would be an adequate power source. This experience has made me realise that I have many assumptions about students and their learning environments that do not hold true in the developing world. Therefore, when planning a teaching session, I must consider the needs of the learner, their beliefs and their linguistic abilities. This requires detailed research, thorough preparation
and meticulous organisation. Using this approach will ensure that I deliver the very best teaching to health care professionals in the developing world. REFERENCES 1.
Biggs JB. Approaches to the enhancement of tertiary teaching. Higher Education Research and Development 1989;8:7–25.
2.
Ochsendorf FR, Boehncke WH, Sommerland M, Kaufmann R. Interactive large-group teaching in a dermatology course. Med Teach 2006;28:697–701.
3.
Petty G. Evidence-Based Teaching, A Practical Approach. 2nd edn. Cheltenham: Nelson Thornes Ltd; 2009.
4.
Karani R, Fromme HB, Cayea D, Muller D, Schwartz A, Harris IB. How medical students learn from residents in the work place: a qualitative study. Acad Med 2014;89:490–496.
Corresponding author’s contact details: Amit Parekh, Department of Radiology, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgements: None. Ethical approval: Not required. doi: 10.1111/tct.12257
62 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 61–62
tct_12257.indd 62
1/12/2015 3:50:12 PM
Lost in translation: X–ray teaching in Africa Amit Parekh The Billy Riordan Memorial Clinic, Cape Maclear, Malawi
I
t was the hardest teaching session I have ever delivered.
It should have been so simple: as a volunteer doctor in Malawi, I was asked to give a teaching session on chest X–ray interpretation to Malawian clinical officers. I had recently delivered a similar session in the UK but I knew that this would be very different – no computer, no overhead projector and no comfortable seminar room. I had made an interactive lesson plan, keeping the same learning points from the UK session, but adapting it for more limited resources, using X–ray films instead of computers and paper diagrams instead of POWERPOINT presentations. So, I arrived at my classroom, a small, windowless office, only to discover that a light box for viewing my X–ray films was nowhere to be found. Further investigations revealed that there was no light box anywhere in the hospital! Panic set in. After all
my planning, how could this happen? Eventually, I decided to deliver the session outside, holding the X–rays up to the glaring sun. Feeling hot and flustered, I quietly dropped my lesson plan and, reverting to traditional didacticism, explained a systematic approach to interpreting chest X–rays. At last, everything seemed to be going well: the clinical officers were smiling and nodding reassuringly. But then, when I asked one of them to demonstrate the technique back to me, I was met with a blank face, in fact with six blank faces. What had happened? Had they found my English accent impenetrable? After much thought and reflection, I realised that my session should have been more learner focused, although I was unsure how to achieve this. I knew that small group tutorials required three characteristics to
be successful: knowledge base, interaction and learner activity.1 I chose this as my starting point to deconstruct my teaching session. Firstly, I realised that I had very little understanding about the knowledge base of the audience that I was teaching. Clinical officers are health professionals that are unique to Malawi. As a result of the shortage of medical staff, they fulfil many of the tasks that would normally be performed by doctors; however, I knew very little about the training clinical officers receive or their level of expertise. Therefore, identifying the learning needs of my audience became impossible. In hindsight, I should have examined the ability of my audience to interpret chest X–rays to help identify the subject matter that needed to be taught.
After much thought and reflection, I realised that my session should have been more learner focused
I had planned to make my teaching session as interactive as possible, knowing that
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 61–62 61
tct_12257.indd 61
1/12/2015 3:50:11 PM
In order to create a safe learning environment, I needed to understand the principles of Malawian culture
interaction promotes learning.2,3 But how could I encourage interaction when the clinical officers had clearly failed to understand what I was saying? This failure in communication occurred because of my use of long, complicated sentences and my tendency to talk quickly. By using short phrases and straightforward English, the clinical officers would have had a better understanding of the subject matter, and been more willing to engage with my interactive style of teaching. Furthermore, the fact that the clinical officers did not ask me to repeat myself or slow down reflects my failure to create a safe learning environment. A safe learning environment encourages audiences to participate in active learning, which is better recalled, enjoyed and understood.3,4 In order to create a safe learning environment, I needed to understand the principles of Malawian culture, which are based on hierarchy, status and respect for the teacher. Malawian culture dictates that ‘when the teacher teaches, the students listen’, and this may explain the clinical officers’ reluctance to speak up. By having an awareness of these principles, I could have discussed these beliefs with the clinical officers at the start of the teaching session, thereby promoting engagement and encouraging participation.
To facilitate my interactive style of teaching, I had planned several learner activities using chest X–ray films and light boxes; however, the fact that no light boxes were available indicates that I should not have assumed the use of any equipment. Even if equipment were available, I would need to ensure that it would be in working order and that there would be an adequate power source. This experience has made me realise that I have many assumptions about students and their learning environments that do not hold true in the developing world. Therefore, when planning a teaching session, I must consider the needs of the learner, their beliefs and their linguistic abilities. This requires detailed research, thorough preparation
and meticulous organisation. Using this approach will ensure that I deliver the very best teaching to health care professionals in the developing world. REFERENCES 1.
Biggs JB. Approaches to the enhancement of tertiary teaching. Higher Education Research and Development 1989;8:7–25.
2.
Ochsendorf FR, Boehncke WH, Sommerland M, Kaufmann R. Interactive large-group teaching in a dermatology course. Med Teach 2006;28:697–701.
3.
Petty G. Evidence-Based Teaching, A Practical Approach. 2nd edn. Cheltenham: Nelson Thornes Ltd; 2009.
4.
Karani R, Fromme HB, Cayea D, Muller D, Schwartz A, Harris IB. How medical students learn from residents in the work place: a qualitative study. Acad Med 2014;89:490–496.
Corresponding author’s contact details: Amit Parekh, Department of Radiology, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Acknowledgements: None. Ethical approval: Not required. doi: 10.1111/tct.12257
62 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 61–62
tct_12257.indd 62
1/12/2015 3:50:12 PM
