Train the Trainer Course

Our journey in sharing knowledge and inspiring educators. 

The Beginnings

The European Society of Anaesthesiology and Intensive Care (ESAIC) Train the Trainer (TTT) course is a development of a previous one run by the World Federation of Societies of Anaesthesiologists (WFSA) called ISIA (International School of Instructors in Anaesthesia). Professor Gabbi Gurman developed this as a course designed to educate and bring up to speed the young anaesthetic specialists of the former Eastern Bloc countries. The course covered teaching and other management and organisational issues, such as running a modern anaesthetic department. The ISIA course ran for 3 weeks, each 6 months apart and was held in Bratislava, Romania, and Crete. The first week of the first course was held in 2006.

After 3 ISIA courses, the European Society of Anaesthesiology and Intensive Care (ESAIC) was given the responsibility of closing the gap in anaesthesiology education between European countries.

Starting up

The National Anaesthesiologists Societies Committee (NASC) took the Teaching the Teachers elements from the ISIA course and developed a TTT course, eventually named the TTT Masterclass. The focus on teaching enabled a shorter 2-week program to be devised, with a 6-month gap in which participants could practice their new skills and prepare materials. So, in 2013, Dr Geraldine O’Sullivan, the then Chair of NASC, invited Dr Lesley Bromley, Professor Vojislava Neskovic and Professor Gordana Jovanovic to set up the course.

The first week covered basic teaching skills and introduced interactive teaching ideas. The methodology included a high level of participation by both students and teachers with many small group work sessions and workshops. This has continued to be the philosophy of the course up to the present day. The second week had objectives related to wider subjects within the teaching area, including curriculum design, assessment, teaching safety, and using simulation, and the latter was then in its infancy.

The first course took place in the autumn of 2013 in Timisoara, Romania, and in the spring of 2014 in Brussels, with a wide international cohort of participants. The course was well received by the participants. Review and reflection on the course led to a continuing process of evolving the content.

Following on

Eight more editions of the TTT course, and later a Masterclass, took place in different cities, accommodating participants and faculty from across Europe. By this time, there was a good mix of participants from eastern and western Europe, Turkey, and Israel.

The course content has changed, and the week one curriculum is very different from the one in Timisoara, although some basic elements continue to be introduced and reinforced. The course has evolved and incorporated many new ideas and topics since that first week in 2013, and Online learning was a steep learning curve for all of us. We used to discuss how to teach the millennials; now, we must discuss how to teach the millennials to teach. The principles remain the same; everyone can learn something from the course.

Faculty development included selected participants from the TTT courses graduates who expressed intention and ambition for professional growth in education, particularly to dedicate time and knowledge to further course development. A great number of graduates stayed active, and some joined the leadership as the Presidents of the Regional or National Societies, Heads of Residency programs or Chairs of the Departments in their hospitals, the ESAIC Council or NASC members, or members of a variety of ESAIC Committees. They all remained great advocates of anaesthesia education.

The evolution of the course in detail

The timetable for the original course in 2013 shows an early introduction to the concept of competency-based education and the theory and practice of giving feedback.

The following year, 2014, saw the introduction of more interactive techniques, the principles of assessment, and workplace-based assessments of practical skills. Non-technical skills were discussed for the first time.

By 2015, we had introduced sessions on how to manage time, use PowerPoint effectively, and select material to make a good presentation.

In 2016, week one was moved to Crete, and our timetable evolved again. Until this point, we had incorporated several case presentations the faculty gave as exemplars of good presentation skills. The time constraints and the need to cover a wider range of information led to a reduction in case presentations, the introduction of some elements of the theory of adult education, and the neuroscience and psychological background to the teaching methods. In the same way, the second week, held in Belgrade during this time, which addressed wider issues in education, had expanded to include various methods of assessment. These covered workplace-based assessments and the Objective Structured Clinical Examination (OSCE). As the implementation of the competency-based curriculum moves forward, these sessions have become more detailed and practical. Many of our participants are actively involved in simulation teaching, and we have increased the depth of our teaching on feedback, turning to the learning conversation as a complex model beyond the simpler constructs of feedback.

The course remains essentially practical. It is not a higher degree in Medical Education, but it does create a learning community. It also allows young teachers to learn about and use teaching methods and related skills in a safe and supportive environment. Theoretical information is supported by a wide variety of workshops, where differences between systems across Europe provide new outlooks on teaching.

The major event that affected the course’s structure and challenged its organisation’s future was the COVID-19 Pandemic. The group that did part one in November 2019 never met again but did complete an online module over the winter of 2020/21. As the pandemic struck and face-to-face teaching was impossible, we plunged into Online teaching. Seven modules were prepared to cover most of the didactic content of week 2 and were shared on the ESAIC platform. We followed the flipped classroom model, releasing the prepared material 2 weeks before the Online sessions. We used synchronous Zoom meetings and encouraged interaction by using break-out rooms for small groups. This involved a big commitment from both Faculty and Students during very demanding and difficult times, both personally and professionally.

The success of the module, despite some of the students finding it a disappointment compared to the face-to-face experience, is in part because of the established relationships during week one, which helped them work together in an unfamiliar and new environment.

In October 2022, the last face-to-face group came together in Crete for week one and in Porto for week two in April 2023.

A new structure of the TTT Masterclass starting in 2025 will transform week one into an online educational experience, where we will consider the new medium of teaching and how to be an effective teacher in cyberspace, keeping the main objectives of teaching anaesthesiologists how to teach. Week two will continue to be face-to-face, aiming to further develop what was covered in the online part. We will continue to develop skills for dealing with residents and teachers who are having difficulties. We will continue to “share knowledge and inspire participants to become educators and leaders who strive to improve anesthesiology education”.

It has been 16 years since the first ISIA course, and teaching and the course with it have moved forward on many fronts. Subjects such as assessment, safety, pastoral care of residents, simulation and its role were barely thought of at the beginning but now occupy much of our thinking in the TTT course. It continues to challenge the Anaesthetic Community to develop teachers who can hand on our skills, knowledge, and attitudes to the next generation, who have grown up in a world unimaginably different from the times of our residency.

We want to thank all the faculty of the TTT, past and present, and all the participants who have joined us on the journey of developing new generations of teachers. Professor Gurman, who had the vision to start us all on this road; Dr Geraldine Sullivan, who passed away in 2014 without seeing the course come to fruition; everyone at ESAIC who has provided administrative support, especially Alina Rotaru and Ells Sung, who have worked so hard with us over the years.

So, we move into our 17th year of teaching and learning together. We encourage all those who strive to become better teachers to join us, and with the support of the ESAIC, we hope to continue to grow and learn together.

Author

•  Dr. Lesley Bromley, Retired Consultant Anaesthetist, University College London Hospitals NHS Foundation Trust, United Kingdom

Co-authors

• Prof. Vojislava Neskovic, Clinic for Anesthesia and Critical Care, Military Medical Academy. Faculty of Medicine MMA, Belgrade, Serbia
• Dr. Aeyal Raz Department of Anesthesiology, Rambam Health Care Campus, Haifa 3109601, Israel3Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa 3200002. Israel
• Dr. Carmen Maria Costa Oliveira, Consultant Anesthesiologist, Unidade Local de Saude de Gaia/Espinho, Portugal RISE-Health, Faculty of Medicine Porto University, Portugal