Innovative training in Zambia

Lectures, case-based discussions, critical incident meetings, a journal club, and acting out emergency scenarios;

the ZADP partnership has many approaches to training and education.

The Zambia Anaesthesia Development Project (ZADP) is a partnership between the Association of Anaesthetists of Great Britain and Ireland and the University Teaching Hospital Lusaka, in Zambia. Through ZADP, senior UK anaesthetic trainees go to Lusaka as visiting lecturers for the country’s only training facility for anaesthetists.

In addition to teaching physician anaesthetists and clinical officers, ZADP doctors provide support in clinical governance and leadership development. For UK trainees, it is an enriching experience, and a valued training opportunity.

Every day, students and visiting UK faculty work together in the hospital’s theatres, learning through practice and mentoring. The ZADP programme also includes traditional lecture-based learning, but the core of the programme is made up of a variety of regular case-based discussion spaces. Students are encouraged to present cases to a group of their peers, which are then discussed and the learning shared.

A regular critical incident meeting provides a ‘no blame’ space to present, discuss, and learn from real-life incidents. Naomi Shamambo, a senior student at the facility, explains that these discussions

are an important way of learning from each other’s experiences, and also provide a forum to work through feelings about cases where something went wrong, or resources weren’t available. “Sometimes things go wrong, things happen. It’s very helpful, as it’s an opportunity to highlight areas which could improve, learning points as well, and also as a place to let out your frustration.”

A monthly journal club develops critical appraisal of literature, with students encouraged to select a particular topic and journal, present an article and discuss what was good about the approach and any learning points.

One of the most successful and enjoyable elements of the ZADP training programme has its roots in a chance conversation with Dr Lowri Bowen, a former visiting lecturer. A second-year student asked Dr Bowen whether she could show him how to use a defibrillator, and Dr Bowen quickly established that none of the second-year students had been shown this. Around the same time, she discovered that the university next door had a simulation lab – and soon after, the Zambian Emergency Simulation Training was born. “We call it ZEST”, says Dr Bowen, “a refreshing twist on medical education!”

Students act out different emergency scenarios, in as lifelike a way as possible, roleplaying and using equipment. The scenario is followed by a short presentation on an ideal way of dealing with the situation. The simulation definitely works, according to Dr Bowen:

It’s very different and enjoyable not only for the students; it’s enjoyable for the teacher. It’s doing something hands on and it’s incredibly lifelike in a simulation lab.

For Naomi, teaching other year groups has also been a key part of her learning, consolidating her knowledge as she passes it on to others. “The more you teach, I think you get that solidification of knowledge, more than if you are sitting listening.”

For the UK partner volunteers, the experience is valuable for their continuing professional development too. There are opportunities to work with unfamiliar and challenging pathology,

to work with different equipment and drugs, and to get involved with formulating guidelines and developing research.

Dr Bowen explains, “It developed us greatly as educators, and as managers. I learned how to behave as a supervisor, and I think that’s a vital step between being a senior registrar in the UK and becoming a consultant. I’ve enriched my UK practice by being in Zambia.”

Dr Bowen was given a piece of advice before she arrived in Zambia, and she passes it on, “there’s nothing worse than somebody coming in and saying ‘in the UK, we do it like this, so you must do it like this’. It’s important to watch and learn; you have to be mindful that whatever you do is locally relevant.”

Educating health workers naturally includes giving information about particular diseases and conditions, and teaching how to use equipment, techniques and drugs, all of which may be very different in the two partner countries

It’s important for the person taking the teaching role to be prepared to watch and listen to the context people are working in, and to be flexible in adapting and developing teaching methods and content to meet their needs.

Absorbing a new context, and working with new people can spark new ideas and limited resources mean creativity is important. As Dr Bowen says, “You can make dummy arms from neoprene and bottles, you don’t actually have to have the dummies, you can do it with minimum costs. You learn to be far more resourceful.”