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Promoting Excellence in Teaching General Practice in Nepal

A Course Report, Roderick Macrorie District Hospital Development Programme INF, Box 5, Pokhara, Nepal
You could cut the tension with a knife. The sun streamed through the window of the college, on the first morning of this international course for teachers of general practice. But something was wrong. Unknown to each other, a Jewish GP from the State of Israel had joined a Palestinian from Gaza. Worse, the nationality of both was recorded as 'Israel'. This faux-pas was adroitly handled, by course tutor John Howard. A rapid explanation and apology, and international diplomacy was restored.

There were a dozen of us from nine countries in Europe, Asia and Australia on this pioneering course at the Royal College of General Practitioners in London. I was trying to represent the fledgling GP training initiative in Nepal. The admiration for our efforts there under difficult conditions gave me a resolve to make the theory work which enriched everything that followed.

Needs and Strengths
It was not an easy week. We needed to hold together two simultaneous learning experiences. The 'content' of teaching about teaching was mostly new to us; the assumption that doctors just mature into teachers with age seems to be a cross-cultural fallacy. The 'process' of getting it across to us, as used on the course, itself demonstrated new teaching methods. To learn from both required plenty of concentration and time to reflect on the experiences. Fortunately the course planning ensured enough space to think.

Much ground was covered over the five days, laying a foundation for practical work in the future. An initial glossary exercise revealed a tremendous range of interpretations for jargon terms such as 'vocational training schemes'. Later this would help us to talk the same language in discussions.

We asked ourselves about our preferred learning styles. We found we had representatives of every known learning category. This confirmed for me how, beyond mere cultural differences, general practitioners (and their trainers) could not be pigeonholed, but reflect the breadth of human nature.

To be effective teachers, we have to consider the individual needs of our students. This is not paternalism, but a recognition that the one with whom you are working is a whole person. Insight into our own learning preferences helps us avoid 'prejudice' against other teaching styles that our students may prefer.

Theory and Practice
Learning theory can help us tailor a course curriculum to the student's needs and strengths. They can, participate in the development of their own curriculum. This can suggest a way of evaluating the work that is less an impersonal 'assessment' and more a positive feedback exercise. A mature partnership promises to be more satisfying to both parties than an 'us and them' approach. Teaching and learning can be fun!

Our feet were kept firmly on the ground by discussing real curricula from our own situations in small groups. Critically comparing existing syllabi, we could subject our own work to more enlightened planning.

We had some fun practising skills together. Seminar presentation techniques were enhanced by marketing tips from a commercial ,coach'. We saw videotaped 'tutorials' of GP trainees. What struck me were the common human truths of the value of eye contact and body language that seemed to transcend vast cultural differences between ourselves as participants.

On Reflection
Our disparate cultural backgrounds did not deter the organisers from demonstrating group-building exercises. Pains were taken from the start to ,create a learning environment' through mutual introductions, sharing our hopes and fears for the course. The resulting climate of relaxed respect for each other's values made this time well spent.

The oretical discussions were enhanced by 'reflection group' time. We became familiar with each others' training experience, which generated ideas to take back to our colleagues. It was encouraging to find one's own problems were not unique. Some of the forthcoming challenges to me include:
  • gaining the confidence of other faculty staff in Nepal to stimulate change.
  • providing a learning environment with heavy clinical work burden and limited resources.
  • encouraging trainees from a very traditional educational background to participate in their learning.
  • promoting a positive self-image for GPs to replace inferiority in the medical profession.

More than a Course
Over the coffee breaks and meals, we could not help but make close friends. We shared our heart-felt experiences and dreams in a very intense way. As we were charged with practical projects to work through back 'at base', we look forward to meeting again (funders willing) next year, and to swapping notes.

On Friday evening the sun was quickly disappearing over Kensington as the group did an exercise in exchanging appreciation of each other's contribution. The time came for the Jew to speak to the Palestinian. Words of support melted as they embraced each other in gratitude. Perhaps a new bridge of peace was born. This was more than a teacher training course, and I for one was very grateful for the privilege of participating in it.
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