Lara, Luis F. MD
The World Gastroenterology Organisation (WGO)—Train the Trainer (TTT) program was developed and is organized together with a national member society. The most recent WGO-TTT workshop was held in Bogota, Colombia, hosted by the Asociación Colombiana de Gastroenterología. I attended the workshop and was sponsored by the American College of Gastroenterology.
The TTT program is an intense experience, where gastroenterology educators with varying degrees of experience and expertise participate in a comprehensive curriculum with the ultimate goal that participants will learn skills that will allow them to better transfer information to their peers at all levels of training. Basically, it reviews techniques to make it more efficacious for adult educators to communicate with adult learners.
It was a tremendously well-organized meeting. It was clear that years of experience, academic grade, time since finishing training, and familiarity with the material, such as the use of evidence-based medicine, were variable between the participants. A premeeting survey was completed to gauge the degree of experience and expectations of the participants. I am certain this information was used to construct a course that was relevant to all of the participants. This is no small task and indicates the dedication of the 10 faculty members from Colombia, Peru, Chile, Uruguay, and the United States who were active participants during the course.
Forty-eight physicians from all over Latin-America, Poland, and the United States participated in the course, which was held in Spanish for the second time since the WGO-TTT started in 2001.
We had a warm welcome from WGO President Henry Cohen, MD, and Maria Teresa Galiano, MD, President of the Asociación Colombiana de Gastroenterología, and from other colleagues from Colombia. The morning started off with a didactic session, where all of us attended presentations that would prepare us for the group sessions that occurred the rest of the day. Groups were divided in a very clever manner. Instead of being identified just by a letter or a color, we were grouped (8 each) according to 6 indigenous tribes of Colombia: Muiscas, Tayronas, Quimbaya, Pijaos, Zenú, and Motilones. A paragraph described each tribe and a map showed us where they were located in the country. We were also divided into colored stars (blue, yellow, green, and red), but it was curious to note how with each passing activity we became identified with our tribe (not our star) and how this led to healthy competition with the other tribes. Perhaps, it was because the groups divided by tribes were smaller and the tasks were active, whereas the group sessions in the colored stars were more didactic. The highlight of the competition was the team-building exercise, where we had to score points by shooting metal rings through the mouths of metal frogs. Tribe Motilones won.
The program was very ambitious and covered a host of topics, including education in adult learners, how to teach endoscopic skills, how to prepare a CV, professionalism, evidence-based medicine, critical review of the literature, study design, publications, oral presentations, how to develop a training curriculum, developing a research protocol and program, competency assessments and evaluations, accreditation, interpersonal skills and team-work, and a brief overview of the WGO.
The general topics were first reviewed in a formal public communication format but even these were interactive. Each topic was then covered in the group sessions, where each team was given a task based on what was learned during the didactic session.
For example, after the presentation on study design, Tribe Motilones had to develop a protocol to study the natural history of gallstones. We had to devise a hypothesis, establish the methods including the type of study (prospective, case-control, etc.) and decide on statistical design, and identify the study limitations. We then had to prepare slides for a 5-minute presentation to the entire group, and we had all of 1 hour to do this. Faculty members participated as observers and rarely as facilitators. It was intense. Every person in the group had a different opinion and point of view. We did notice that with every passing task, it became easier. Working as a group with a rotating leader, a “scribe” who made the slides, and a moderator, we became better and more efficient. This was noticeable as the quality of the projects and slides increased as the course went on.
The format of the course was all inclusive, and every single member had to participate. This truly was no trainee left behind.
It was interesting to note the different backgrounds and degrees of experience with the material presented. For example, critical appraisal of the literature was a novel concept to a few members and some had never designed a study. Reviewing statistics is always welcome and was carried out in an excellent manner by Drs Piscoya and Rios. I used the calculator provided during the course to impress my trainees by calculating the relative risk, RRR, ARR, and NNT in all of the papers discussed during the Journal Club I moderated on my return from TTT. Negative and aggressive feedback is not part of education in the 21st century. Pendelton’s rules were presented by Dr Saenz and emphasized throughout the meeting and was even applied by the faculty themselves at the end of the course. A humble demonstration that even those who master subjects can always learn to be better. I fancy myself a decent speaker, but I had never been so nervous to address an audience as I was when it was my turn to present. I also had never given much thought to formal methods of speaking in public, from where and how to stand to the intricacies of slide development and speech delivery that I learned from Dr Olano. I was impressed by the degree of endoscopic expertise in our host country, especially by the procedures performed by Drs Sabbagh, Cañadas, and Emura, which are at the level of the rest of the world.
We had interesting discussions on accreditation and professionalism. Some problems were ubiquitous, and others may be common in one place because of economical constraints or idiosyncrasies, whereas they may be rare somewhere else.
Dr Cohen, WGO President, explained the objectives of the organization. I and most of the participants were unaware of the reach of the WGO, the many programs it supports, including the international training centers, and the ambitions it has to guide training, education, and the practice of gastroenterology and hepatology in the world with a special emphasis on developing countries. They are akin to a United Nations of Gastroenterology. I know I will be more conscious about their efforts and I hope to partake in their growth.
The international nature of the course is what probably gives it its most valuable edge and having it in the mother tongue of the majority of the participants, Spanish, allowed most to take full advantage of the opportunity. Our common denominator was that we were all physicians involved in endoscopy or gastroenterology and active teachers who want to be better at it. The different educational backgrounds, academic interests, degrees of access to medical care (or lack thereof), years of experience, and professional goals made the group heterogenous enough that each person had something to contribute and we all learned. I remain in awe and inspired by my colleagues who give so much in rather trying environments and sometimes with so little to show in return for their love of teaching, academia, and research. They are giants.
I would like to emphasize the effort made by our hosts to make us feel at home. Colombia is a resurgent democracy full of welcome, proud, and warm people. We experienced the joie de vivre of our wonderful hosts during the cultural night, where many of the participants, faculty included, surprised us with impressive dance moves and musical abilities. We enjoyed but a small part of the beautiful capital of Bogota as we traveled to the colonial downtown. The farewell party came too soon and was a fantastic way to end one of the most enjoyable educational activities I have been involved with.
In terms of teaching, education, research, and career development, we are now at least competent conscious and have a duty to become competent unconscious. It was a treasured learning experience, which I encourage anyone with the luck to be invited to attend.