Thursday, May 5, 2011

Teaching Palliative Care, Esther Luo, Ho Chi Minh City, Viet Nam April 2011

Blog 2 Teaching international Palliative Care
One of the skills I am learning during this trip is how to teach palliative care to an international audience. How does one present a power-point presentation with an interpreter? How does one teach home care not knowing the Vietnamese language? How does one facilitate small group palliative care teaching using an interpreter?

As it turns out, it was not as complicated if one remembers some of the basic principles. Some of the golden rules about presentations still apply. For example, "what's in it for me?" "Who's telling?" and "How do you tell it?" are important questions to answer in order to capture the audience and keep their learning proactive and motivated.
What's in it for me?

I was amazed to see the amount of interest in learning palliative care in an Asian country like Vietnam where death is often a taboo topic. When I asked this question recently to a physician researcher in HIV/AIDS epidemiology, she replied, "We are not as worried about such necessities such as food and are able to focus on other things that are important to the quality of life such as eating healthier, exercising, and palliative care." "For example," she continued, "in her apartment complex, there is a yoga club for the residents and it is for free." As Vietnamese people's economics and home security continues to improve, the focus on quality of life is palpated even more vividly. Even though the field of palliative care in Vietnam is a new field, the Ho Chi Minh Cancer Hospital is embracing it without any reservation. Under the mentorship of Dr. Eric Krakauer, two cohorts of approximately 32 physicians have already received basic training in palliative medicine. Upon the opening of the new inpatient palliative care unit, many clinicians including both physicians and nurses want to learn more palliative care skills.
Who's telling?

I was lucky to participate in the building of the palliative care home care program in Ho Chi Minh City's Cancer Hospital with two giants in international palliative medicine: Eric Krakauer and Frank Ferris. Given both of their extensive experience, knowledge, and expertise in this field, it was not too difficult to retain a captivated audience. Under their wings, fellows like myself, had a rare and unforgettable opportunity to experience their teaching styles and an opportunity to model after them. Teaching in an international setting means learning how to work with your interpreter, speaking clearly, concisely, and slowly, and demonstrating respect for your international audience. Having had experience with translation in the past and giving multiple presentations as an internal medicine chief resident, I was more at ease with these two aspects. Demonstrating respect was easier said than done. Even though we were here teaching them about how to do home care, it was paramount to respect the Vietnamese physician and nurses knowledge about their health care system and listen to their ideas on how best to incorporate the home care program in order to make it sustainable.

How do you tell it?

We taught using various methods including large group presentation, small group facilitation, and role play. For me, the most challenging and rewarding was facilitating in my small group. Each day after we saw our home care patient in the home, we returned to the hospital to discuss the case further in our small groups. A very useful tool we employed was called the "Squares of Care." This tool was developed by Frank Ferris as a model to guide patient and family care (Ferris et al. J of Pain and Symptom Management 2002). We had physicians and nurses complete separately the squares of care and then compare their information. Each square represented common issues faced by patient and family members during illness and bereavement. By using this model, we were able to teach our Vietnamese physicians and nurse how to make a palliative care assess including both the physical symptoms as well as the psychosocial assessment of our patients. Another technique we used in our small group teaching was role play. One of the role plays we did in our group included an interview of a patient and doctor visit. One person played the role of the doctor and the other person played the role of a metastatic breast patient who wanted to know whether where was going to be cure for her cancer.

My personal reflection on teaching as our two weeks of home care training came to an end was: "this is amazing work and what a privilege to have this international experience as part of my fellowship training!"

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