METHODS OF TRAINING

The theory, rationale and safety considerations of each procedure with a dem onstration by the instructor was taught in the classroom . This was followed by observation of p atien ts in the clinical area and supervised examination of patients by individual students. Group discussion of interest­ ing cases and particular problem s was ongoing throughout th e training period. Students were encouraged to make suggestions for improving the learning process and where possible changes were made to classroom train­ ing and practical experiences. Frequent group and class discussion was initi­ ated.

3.4.3.1 Classroom teaching

Classroom facilities were basic but the use of overhead projection and slides were available. As much as possible, training was carried out in the class­ room with graphic illustration of each area of study. Flow charts w ere commonly used to aid the teaching of diagnosis and treatment, as well as the effect of disease on the community. Many of these have been adapted from tables and illustrations in the book "Hanyane* Other texts used were ‘Eye Diseases in Hot Climates’ ^ and several of the WHO special reports, such as onchocerciasis trachoma ^ xerophthalmia The slide sets that were used came from several sources. These sets have been especially prepared for the training of health workers by WHO, International Centre for Eye Health, in L ondon, T ea ch in g A ids a t Low C o st (T A L C ) an d H e le n K e lle r International. The sets covered a range of commonly seen diseases in tropical and developing countries. Materials from the listed resources were

compiled for this training programme by the instructors of the course.

The instructors consisted of one ophthalm ologist, one eye doctor, two ophthalmic nurses and various external lectures who visited periodically. An ophthalmologist from The Gambia was the external examiner for the course and made periodic reviews of the progress being made by the students.

3.43.2 Practice o f Skills

The practical skills that the students learned were practised with one anoth­ er as far as possible, before they were allowed to use the skill with patients. This was done under the supervision of an instructor, and each students progress was monitored carefully.

3.4.3.3 Clinical Experience

The majority of the students’ practical training was in the clinic where they were given an opportunity to observe and develop the skills that they had been taught. The staff at the hospital were a valuable asset to the students by providing opportunities for experience and frequently giving guidance with problems of patient care. Supervision by an instructor was maintained on a one to one basis until a student demonstrated safety in examination and treatm ent. At any time that the students were in the clinical area, an in­ structor was close at hand. The diagnosis and treatment of every patient was double checked by a member of the clinical staff as well.

The variety and volume of pathology at this hospital provided students with extensive learning opportunities.

3.43.4 Role Play

Role play was frequently used during the training time We found the students to be excellent actors and utilised this ability in teaching. It was particularly useful in explaining community types of situations where the psycho-social aspects of eye health and treatment are important. A clinical or community situation was acted out by one or two people in front of the class. The instructor then asked the class to describe what they had seen and dialogue was then developed about the situation and changes that could be made or strengths that were observed. We found this to be a particularly effective way of teaching in this situation as it often brought out cultural aspects of the community that we were unaware of. It provided the instruc­ tor with feedback from the student as to what was being learned. Perhaps the greatest advantage was the class participation in the learning process that it stimulated.

3.4.3.5 Group Clinical Appreach

In the context of the students training at Lunsar Eye Hospital, we found that the students learned well from evaluating a patient, then presenting the case history to the class for discussion. This approach seemed to stimulate accu­ racy in observation. It produced some positive pressure from peers and plenty of class participation which was productive in arriving at accurate management of the patients.

This method utilised the clinical time to its fullest without undue patient dis­ ruption in the clinical area. The students were divided into pairs or groups

of three and one or two patients were assigned to each group. They were given the results of the patient’s visual acuity, tonom etry and skin-snip re­ sults. Together, the group examined the patient with each m em ber having an opportunity to look at the patient briefly. They wrote down the relevant aspects of the patient’s history, and discussed the treatm ent or referral that they thought would be relevant for this patient. After the clinical time, each group had an opportunity to present to the class the p atien t’s history and the management that they thought was appropriate. The class then discussed the decision of the group with occasional input from the instructor to guide the discussion. Any salient points of management or diagnosis that were overlooked by the group, were quickly pointed out by the members of the class who became constructively critical in their analysis of the patient management. We found this to be an excellent tool in stimulating accuracy in recording patient history and developing proper management skills.