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lundi 1 juin 2009

Dont attend too many Educational might not do you any Good!

Incessant Attendances at Conferences and Lack of Knowledge Accrual

I am a Consultant Endocrinologist to some small Clinics at the Indian Health Services of the United States Public Health System (thank God, Indians like the Veterans in the USA have a semblance of Socialized Medical Care!)
But it never ceases to amaze me how often the employees, from the top down, attend meetings, training sessions, educational seminars and the like. And to tell you the truth I have never seen even a small amount of the acquired knowledge filtering through. I was astounded when I learned that a Nurse in one of the small clinics had attended 14 sessions in a period of six months, all paid for by monies of the Indian Health Services! 
A waste of money indeed I thought, the top officials are culpable, since the last meeting I attended at a holiday resort outside Tucson in December 2007 was an absolute waste of time. It looked like some of the top officials of the Indian Health service got together with their friends and wanted to be in that area just before Christmas. The material presented were of no interest, worse still irrelevant and the participants were more interested in shopping just before Christmas than learning anything. I lamented the gross waste of money which could have gone to save some Indians!
So it was very gratifying for me to listen to BBC World Services on 29th May 2009 on my way to the airport to leave the country: they were reiterating all the research  that demonstrates that attendance at conferences with rare exceptions fail to increase knowledge and that most of the information gained is forgotten within a  short period of 7 to 10 hours!
They had didactically studied mechanisms of knowledge accrual and it was something that had been taught to us while we were medical students:  Observe, Practice and Teach.
The four critical paths they identified in knowledge accrual was

And that the knowledge retained well in the following percentage order..
70 per cent of the time it is the experience of actually doing something
20 per cent of the time it is when you learn from others
Only in 10 per cent of the time you learn from attending conferences and educational seminars.

It made me think immediately, many of our workers attend hours and hours of Diabetes care training and I don’t see any improvement in their performances. It is because they had not assimilated the knowledge and nor had any chance to reflect upon it. I had suggested that all people who attend seminars or educational sessions have to give a summary in front of their colleagues what they had learned at the seminars, in this way they would be forced to reflect what they had learned. 

Peer to Peer Education, a concept elucidated and practiced in one of the poorest countries in the world, Cambodia, under the direction of its tireless organizer, Maurtis van der Pelt, is an example of how this form of knowledge accrual is a good model for patient care and welfare and outcome. The fact that they do it at a fraction of the cost of diabetes care in the united states and still have comparable results is truly outstanding.
So it is the method that is important rather than the substance. A professor from Miami coming and talking about the latest innovation to a group of mid level providers leave no impression, but a peer suffering from “Diabetes coming to the slum or suburb where you live and talk to you about his experience of Diabetes is invaluable. In these times of economic insufficiency in the West and other regions ( The Government of Samoa just cut their annual Health Budge by 25 %! Solomon Islands is accused by Amnesty International of neglecting to provide health care to the slum dwellers of Honiara!), this would be a good model to adapt not only in the poorer countries but also in the richer countries. Cuba has taught us that economic difficulties need not stand in the way of providing excellent general medical care to the population as long as the inherent strengths in the society (solidarity, friendship, caring) are made to play a role. American Indian Tribes and their health care systems are an unique opportunities of taking into consideration the social strengths inherent in their culture and employing them for their own benefit. This is much more than the usually touted Cultural Sensitivity, Cultural Competence, Cultural Knowledge etc. It is about the Sufferers to teach the Providers about the Illnesses they suffer from, rather than the current mathematical model, a mechanical idea of cause and effect and treatment and cure.
A wonderful professor in Madurai, India has done studies in the medical community about knowledge accrual and the preferences of the participants. Doctors in India seem to prefer to gain knowledge at small group sessions and discussions rather than attending large conferences. American Indian patients much prefer learning about their diseases at a one to one level and in an ambience of cultural sensitivity. Peer to Peer Education was highlighted by the Team Up Educational events held by the HoCank Diabetes Programme in rural Nebraska where patients suffering from Diabetes were educated in small groups and they learned from each other. As one participant put it: We have been given diabetes education numerous times before, but have never received it until now. It is interesting to note that every one who attends those peer to peer sessions becomes knowledgeable to look after their illnesses and the laboratory measurements demonstrate that.
So in poorer countries, in poorer communities in richer countries, the care for diabetes is not to follow the technological pattern of care provided in richer countries. There is a tendency in the poorer countries, I noticed that in Jamaica, where the doctors try and practice Medicine as if they are living in a richer country, mainly going from a human approach to a technical, mechanical approach. But there was no money and there is no money and there is no sight of it in the future.. In the budgets of these struggling economies.
Peer to Peer Care takes into account the strengths of the communities, which will be determined by the culture of the participants, there is no need for direction from outsiders ignorant of the inherent cultural strengths. and can be independent of Governments and organized health services
If you are interested in knowing more about Peer to Peer Medical Care for Chronic Conditions in your community, please do get in touch. I will facilitate that for you with the help of some eminent friends..

PS  In some very poor countries, notably in India and Cambodia, the doctors and providers are paid to attend these meetings, with drug companies picking up the tabs for their transportation, hotel accomodation and a stipend! Think about the Ethical implications of this..