International Association for Hospice & Palliative Care

International Association for Hospice & Palliative Care

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IAHPC Hospice and Palliative Care Newsletter


2005; Volume 6, No 4, April


IAHPC Regional Report

India News

 Report of the Training the Trainers Course held in January 2005

 Dr. Mallika Tiruvadanan

Many ways to help support palliative care.

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Message from the Chair & Executive Director:
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Article of the Month:
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The Terri Shiavo Case in the US

Reports: The 6th Asia Pacific Hospice Conference

2nd Global Summit of National Hospice and Palliative Care Associations

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Roger Woodruff, MD

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Asia Report
India Report of the Training the Trainers Course

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Dr. William Farr

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Palliative Care in the Developing World: Principles and Practice

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I attended the six day Training Trainers Course with 16 other colleagues from all over India and one from Nepal . It was held from the 10 th to the 15 th of January 2005 in the congenial atmosphere of the Auditorium Conference Hall Area at the Tata Memorial Hospital (TMH), Mumbai.

The course was initiated by Pallium India , a non-governmental organization; but the bulk of the organization (including finding funds) was provided by Dr Maryann Muckaden and her team from TMH. The faculty included Dr Robert Twycross from Oxford , Dr Ramnarayan and Dr Sudhakar Nayak, two medical educationists from Manipal, Dr Reena George from Vellore , Dr Maryann Muckaden and Dr Gayatri Palat and Dr M.R.Rajagopal from Kochi .

At the outset, the objective of the training course was made clear – to make us more effective teachers. Dr. Sudhakar Nayak explained the need to be effective not only in our professional but also in our personal lives. Growing only in part is akin to developing cancer.

To be effective we should (a) understand needs (of patients / students), (b) possess communication skills and (c) find out if those taught have understood. Teaching is effective only if it leads to effective learning.

Three things that will help us all to be effective are knowledge, skills and attitudes, which is the harmony of the head, hands and heart. We should create an atmosphere of love and trust, develop empathetic listening and facilitate change of behaviour (including one’s own). It is better to describe someone’s behaviour rather than be judgmental. It is also important to silence the ever active mind every now and then, as it is in the gaps of silence that we find ‘Muktha’ or liberation. This ultimately leads to everlasting happiness and helps us become more effective in our multiple roles in life.

Dr. Ram Narayan next described how an effective lecture should be given. Students’ silence does not always mean they have understood everything. Giving too much information is hard to digest. One must “uncover” the salient aspects, reinforce important points, be creative and carefully prepare so that we profess and not confess, give take home messages and references. He also explained how visual aids should only facilitate our teaching and not hinder our presentation. The sessions on how speeches such as welcome address, master of ceremonies and vote of thanks should be given were very useful for public speaking.

Dr. Reena and Dr Gayatri next taught us how we can effectively teach communication by using some simple exercises. Importance of ground rules for Role Play was explained. A practical exercise reinforced the importance and also helped to understand how to be a good facilitator. Dr. Reena also discussed how a student could learn from the teacher through modeling, mentoring and reflecting. The role plays done by faculty and the participants made the learning process easy.

Dr. Rajagopal explained how to conduct small group work effectively. Proper planning, appropriate environment, self-introduction, ground rules, ice-breakers, negotiating agenda and defining objectives will facilitate this. He brought out the important duties of a group leader and how the latter should facilitate when handling different types of people in the group. He conducted the ‘gold fish bowl’ exercise to bring out the important features of a group discussion.

Dr. Rajagopal suggested including ‘Pharmaco-economics’ in our teaching sessions. The session on journal club was food for thought. He said that all conclusions by authors of papers in journals may not be correct and so we need to evaluate the methods and results before embarking on testing them on patients.

Dr. Gayatri gave a talk on controversies over Coxibs.. This talk was given more with the idea of suggesting to us to include such thought provoking topics of current interest in our future teachings.

Dr. Robert Twycross taught us how effective teaching should be Informative, Interactive and ‘Infectious’ (infect with enthusiasm). He said the aim of teaching is to improve clinical practice. A good session should be tailored to the audience and not be the same every time. He also presented ‘What’s new in Therapeutics’ and discussed a questionnaire, which was circulated to us previously.

He explained the various points in making a presentation legible, simple and correct. He made us chart out a programme for conducting a two day seminar or CME incorporating all that had been taught to plan in the correct manner, like target audience, objectives, topics with details, time table and take home messages.

Altogether, the Training Course was very useful and stimulating to both our heads and hearts. Education in palliative care has progressed and is spreading in a large way in our country too. All of us who had attended the Course have had some experience in Palliative Care in the clinical and teaching fields. But we realised that we had reached a point where we felt an acute need to improve our teaching methods and skills. This course turned out to be the answer to our questioning minds.

There is certainly a need for such courses on a regular basis now in our country to enable the trained to teach better and keep up a momentum of spreading education far and wide ultimately benefiting the needy.

Dr. Mallika Tiruvadanan is the organizing secretary of Indian Association for Palliative Care’s conference February, 2006

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