I have had the privilege of conducting more than 25 Train the Trainer workshops in over a dozen countries in the past five years. During these seminars, experienced educators share experiences, learn to use competency-oriented training materials such as checklists and assessment tools, master step-by-step teaching techniques for inspection bronchoscopy, and familiarize themselves with coaching methodologies used in case-based exercises. They learn about educational philosophies, and practice various approaches to didactic slide presentations.

A question often raised during these seminars is, “why is there no fixed agenda?” While there are many answers to this question, I thought I would clarify at least one of them.

Conducting seminars in different parts of the world means communicating with physician-leaders from different medical environments, social cultures, backgrounds, and experience. Each participant brings a different set of skills, biases, and assumptions to the program. While part of the seminar is task oriented, another part is dedicated to new challenges, including breaking beyond a traditional way of thinking about medical education.

Change is difficult, and resistance to change is a natural reaction for us all. By sharing various components of a multidimensional learning program with participants, instructors are suggesting that educators let go of some traditional habits, acquire new skills, and reflect on how to overcome resistance to change in their own institutions.

Therefore, one of the major doctrines of our Train the Trainer programs is flexibility.

Flexibility means adapting, in-real-time, to the needs and desires of program participants. It also means active listening on the part of program instructors. In this way, we identify and address needs. Through our example (being flexible and actively listening), we non-verbally provide participants with an experience to take home to their own students, because flexibility and active listening are key to successful individualized instruction; by being able to identify a student’s strengths, weaknesses, and respond accordingly with an appropriate educational intervention.

Train the Trainer seminars are culturally enriching, scientifically rewarding, emotionally challenging, and intellectually stimulating for everyone. In a few days, a seminar in Belgrade, Serbia will include experts from throughout the Balkans, and yes, the agenda is flexible:)

Bronchoscopy educators with their students, Hungary 2017

Perception (definition): a way of regarding, understanding, or interpreting something; a mental impression

It doesn’t take a scientific study to say that practicing in a model is preferable to learning to perform medical procedures on patient after patient during on-the-job medical training. Yet few national bronchology societies purchase airway models to train their members. Indeed, the major obstacle I encounter while fundraising for our global medical education projects, is my inability to respond to the following question raised by potential philanthropists; “Why don’t doctors donate some of their own money to their national bronchology associations to buy models?”

I still don’t have a satisfactory answer.

Last year, I met John Perkins at a writers’ conference in San Miguel de Allende, Mexico. John identifies himself as an agent of change. He invites others to help him make the world a better place by exploring different cultures, spreading love, and protecting the environment. I witnessed firsthand the enthusiasm manifested by his workshop attendees, and I wonder whether a similar enthusiasm is shared by medical doctors attending our Train the Trainer workshops around the world. After all, doctors can make the world a better place by promoting selfless service, enhancing technical skills without exposing patients to the dangers of on-the-job training, and advocating for patient rights. These elements form the philosophical foundation of our seminars.

John writes that “Human activity is determined largely by perceived reality. Religions, culture, legal and economic systems, corporations, and even countries are created and maintained by perceived reality; when enough people accept a perception or when it is codified into law, that perception changes objective reality. The way to change economic and other systems is through crossing a Perception Bridge from old ways of thinking into new ones.” (John Perkins, author of Confessions of an Economic Hit Man).

That is what Certified and Master instructors of the Bronchology Education Project do. We ask bronchoscopists to cross a Perception Bridge. We ask them to abandon the idea that learning on patients is okay, and urge them to commit the intellectual and financial resources necessary to acquire technical skills using models before they perform procedures on people. One of my goals is that every bronchology association in the world has at least one model to help teach medical procedures. This will change our objective reality, and make the world a better place by eliminating patient suffering caused by on-the-job medical training.

Oscar Wilde wrote that “experience is the name that everyone gives to their mistakes” (Lady Windemere’s Fan, Act III, 1892). Just as we are not expected to become champion tennis players without hours of physical training, coaching, and careful attention to our head game, doctors should not be expected to become competent bronchoscopists simply by taking the scope in hand at the patient’s bedside. As in sports, learning requires the acquisition of skills and facts, but also an understanding of how we feel about what we are doing. Professional athletes have recourse to a team psychologist. Doctors are presumed to converse with colleagues or other health care professionals.

When I ask bronchoscopists from around the world whether they practice their response to procedure-related complications such as massive bleeding, seizures, cardiopulmonary arrest, or pneumothorax, in a simulated setting, the answer is almost always no. Nor do they discuss how they feel after the occurrence of such complications. I think this is because doctors have learned by doing for too long, and only recently is there a move toward coaching using models, simulation, and debriefing sessions.

Organized efforts are still necessary, however, before new generations of physicians adopt this as the norm. The same can be said about addressing a doctor’s emotional responses to complications. Most surgery departments have morbidity and mortality conferences to discuss problem cases, but such practices are not routine within the interventional pulmonary community. Even when discussions occur, there is little support for physicians struggling with their feelings.

While it is relatively straightforward to convince an enthusiastic trainee that practicing on a model will accelerate growth along the learning curve, it is less obvious to persuade doctors that talking about their feelings (which addresses their affective and experiential knowledge) can help prevent complications and improve patient care, as well as reinforce positive attitudes toward medical practice.

An educational program that includes simulation-based instruction and open discussions about feelings, therefore, requires a paradigmatic shift where leaders think outside the box monopolized by “see one, do one, teach one” behaviors in order to embrace practices guided instead by a “First, do no harm” philosophy.

Master Instructor Viviana F. implements simulation-based bronchoscopy training in Brazil