Louis Delamarre, MD, MSc
Fouad Marhar, MD
Sébastien Couarraze, CRNA, PhD
Anesthesiology and Intensive Care
Toulouse University Hospital, France.
From March 16 to 20, as our institution was restructuring to quadruple the number of available ventilated ICU beds, we trained close to 1,500 ICU and OR health care workers at our university hospital to prepare for the COVID-19 pandemic. What did we learn along the way?
2. Think like a hive. You can’t think in a silo. You must go beyond a traditional vertical hierarchy and adopt a “hive mind” to tap into collective intelligence. Make teaching materials widely available, empower trainers to try new things and fail, promote psychological safety, and then allow learners to give honest feedback. Embed educational concepts in practical suggestions. Use a rapid iteration system: Each training session is a beta version that will be modified before the next round of training (even if it is a few hours later). Use flat hierarchical principles and open all communication channels among teams of trainers to allow for growing collective intelligence to flourish. Use graphic means to convey messages.
3. Move fast. In this setting, you must move fast and communicate a lot in short bursts, not long academic speeches. You must recalibrate along the way. Do not use emails; instead use an instant messaging service. Identify a moderator in your group to check that the content of your educational materials complies with your institution’s guidelines to avoid confusing your learners. Negative feedback is essential because it will prevent unnecessary use of bad tools/methods/approaches. Positive feedback will help you choose among the good ones.
4. Take notes. A lot of thoughtful questions emerged from the training sessions. Some related to the learning goals, others related to organizational issues. Here you have two options:
- Be the messenger. Take notes and pass questions unrelated to your training to the institutional authorities so they can be handled by appropriate decision makers.
- Apply collective thinking again. Take a moment at the end of each session to let people propose their solutions to the problems that have been raised. Allow them to discuss the pros and cons. Ask questions. Help them design the procedure. Then, provide the authorities with suggestions for change, not just questions. (That’s not the highest level of leadership, but it drives a significantly higher level of engagement for the teams.)
5. What educational principles did we follow? Use educational methods that are simple, easy to learn and pragmatic for new trainers. Focus on technical proficiency. Instill crisis resource management principles in the feedback you give, but focus first on technical excellence. The motivation of learners has been very high all along our training period, and this gives you a tremendous advantage as compared with a “normal” period! Learners will learn more and faster, and will question more extensively your educational content. Use that momentum.
- Use the 5-step model for learning psychomotor skills: conceptualization, visualization, verbalization, practice, and finally correction and reinforcement.*
- Peer teaching: Use early adopters/local champions to lead the training sessions. Observe and give feedback, then give them full autonomy to train others around them, even out of the training schedule. Allow the learners to speak up and make suggestions or correct their colleagues during training. Intervene only when it’s needed; let them recreate the mutual monitoring they’ll have to do in the real world!
6. Accept failure. We failed repeatedly, badly, and every single day. Yet we trained a bunch of people, and what we have seen during the past few days shows that all the training has paid off.
7. Be humble and learn from others. Simulation and FOAMed communities are exceptionally active online and are willing to share and discuss ideas. This is the best “hive mind” you could wish for. Use it and contribute. On Twitter, see #COVIDfoam and #COVIDfmc.
8. Once you’ve trained everyone, keep doing it. Training is never finished. It is a daily continuous repetition of skills and drills. We keep rehearsing the drills even as our ICU is welcoming more and more COVID-19-positive patients. We have rarely learned as much in so short a time. We have never learned so much from one another—that is the blessing in this crisis.
Received April 7, 2020.
* George JH, Doto FX. A simple five-step method for teaching clinical skills. Fam Med 2001;33(8):577-578.