First Week of Work

I'm an international supervsor for the fourth quarter of this 52-week long post-graduate certificate program.  I'm here with one other international supervisor, E.  She got here a week before me so that she could overlap with the two women who were supervising during quarter 3.  I'm grateful for her extra week of knowledge, which is making my "week 1" (aka, week 40 of the program), much less nerve wracking.  She is more comfortable with the grab app for ordering tuk tuks, she knows the addresses of all of the hospitals, and once we arrive on site, she's pretty good at finding the correct conference room in which we are supposed to meet our trainees and interpreters.

Our shifts are about 2.5 hours long- two shifts per day.  When we arrive, the trainee and interpreter are waiting for us and the trainee has picked out the right patients for us to see for the day.  Just as a graduate student would do in the US, the trainee reviews the chart history for us, answers some theoretical questions and tells us their plan.  The conversation is supported by our amazing interpreter (there are two of them- S and C) who provides consecutive interpretation for our 1:1 conversations and simultaneous interpretation once we're up on he wards.  After the eval is finished, our trainee excuses us from the ward and we return to the office or another private area to finish the written note, review the trainee's recommendations and plan.  After receiving our approval, the trainee will return to the ward later in the day (on their own) to share the verbal recommendations with the patient and their family.  

The first hospital, a public hospital, was about what I expected.  In comparison to the American hospitals that I'm used to, there was less privacy for the patients - 5-12 patients in each ward and no curtains between them.  The second hospital I visited is a private hospital with a bit more privacy for each patient - two per room, but otherwise quite similar from first blush.  The families seem to be present at bedside all day every day and they are responsible for a much higher percentage of patient care than back in the states.  They also provide many (all?) of the consumable supplies that the patient needs during their stay, such as food, tissues, and even pillows.

Wednesday and Thursday were next level excitment, as I continued to meet new-to-me trainees and get to know additional hospitals.  The furthest away hospital takes us about an hour by car (too far to comfortably tuk tuk).  It's quite far into the suburbs and rural area - we do travel past fields of growing veggies and grazing cows - so we carry a lunch with us rather than finding a restaurant near by.  The hospital is HUGE with long indoor/outdoor hallways and wards with 60-100+ people all in orderly lines in one room.

Running my own 2.5 hour session with my trainee went well on Wednesday.  Prior to my arrival he had selected two patients for us to see together.  One ended up only needing a swallow screening (we use, essentially, a Yale Swallow Screen) and the other a full evaluation.  He completed a good write up for both and also was open to my asking of critical thinking/why questions after his evaluation was complete.  

Friday was, essentially, more orientation time for me.  I spent the morning pouring over the gobs of materials that are available for us volunteers - handbooks and competency forms and materials from previous workshops, etc.  You all know me  - I like to see and understand the big picture so that I can find where my puzzle piece fits in.  This time to re-write or read through all of the materials and resources was invaluable to me as I sort out how I can be most helpful to my trainees moving forward.

Friday afternoon I also had the opportunity to zoom with A, our clinical lead, to get my questions answered about the trainee & mentor programs, understand more about the required documentation, and discuss what my trainees know and don't know about various research and clinical dysphagia management principles.  I want to ensure that what I'm teaching, off hand, is consistent with what they've learned in their classrooms and with supervisors before me.

And finally, my week ended with co-teaching the Saturday morning workshop with my co-volunteer, E.  This week's content was addressing how dysphagia evaluations/management vary with different specific diseases.  We covered stroke (left, right, and brainstem), TBI, ALS, and Myasthenia Gravis.  We looked at a case study & video of a patient with a TBI and, not surprisingly to my own students back in the states, focused on what was done well in the case study and what was missing/could have been improved on.  Teaching confidence in self-reflection and critical thinking will be an essential component of this summer's training.  Our last activity (also not surprising to my students back home) was about reviewing research articles, creating annotated bibliographies, and brainstorming which articles could be cited in which types of cases.  All of our trainees will write up a comprehensive evaluation in a few weeks, based on a case that they have seen clinically recently.  They will need to explain rationales for their decision making and cite resources as they do.