From Circo Pobre: The Growth of Medical Education in Chile

By Michael Gisondi (@MikeGisondi

I recently had the privilege of speaking at a faculty development course in Santiago de Chile, offered by Medutopia and hosted by Medicina de Urgencia y Emergencia (MUE). MUE is the fourth emergency medicine residency program in Chile, established in 2012, and affiliated with Universidad San Sebastian. Theirs is an urban residency program, located in the central Santiago neighborhood of Providencia, serving approximately 110,000 emergency department patients annually at Clinica Santa Maria hospital.

This conference was an incredible experience for me, as I learned so much about the progress of medical education in Chile. Given that this is the International Clinician Educators Blog, I thought I would share several observations from participants of this wonderful event.

Attendees included faculty members and trainees from several different disciplines and four Latin American countries. Surprisingly, very few audience members reported previous formal training for their roles as clinical educators. Most described their teaching as something that came naturally, skills that resulted from years of observation when they themselves were trainees. This conference was a unique experience for the majority of attendees.

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Are there truly no opportunities for faculty development in medical education?

Dr. Ximena Jara, an anesthesiologist who practices in Santiago, described herself and her fellow faculty members as Circo Pobre – a poor circus. “When you go to a traveling circus, the carnival workers perform many different jobs. The ticket collectors also assemble the tents, perform in the show, and clean up after the event. No one has just one role. Our faculty is similar – we all pitch in and do everything – the teaching, the evaluations, everything. Because of this arrangement, none of us are experts in any one aspect of teaching.”

Despite an historical Circo Pobre approach, these conference attendees were keen to learn both theory and practical skills to enhance their individual roles as educators. Opportunities for small group practice of teaching skills were among the most important reasons that many attended the course. Dr. Magda Torres, an MUE alumna who practices emergency medicine in Punta Arenas (the southernmost city in the world), described her experience as, “a great opportunity for learning how to teach in a different way. I think I can apply what I learned in my current job and make things better. Maybe I can change the education of other doctors in order to make them love medicine?”

“In our country, medical education has been led for years by ‘old and traditional’ professors that had no actual training as educators,” said Dr. Carlos Donoso (Assistant Professor of Emergency Medicine, MUE, Universidad San Sebastian). “A few faculty members are starting to review the literature in medical education, so that they can have actual knowledge of best practices (and why the old methods weren’t right). Most physicians here are eager to improve their clinical skills, but not as many are eager to become better educators. This is the reason that courses like this are a huge step for Chile, and probably for Latin America. Education saves lives! I’m fully committed to this idea and I want to share it with the world.”

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Dr. Adolfo Barraza (Assistant Professor of Emergency Medicine, MUE, Universidad San Sebastian) agreed, “in general, education methodology used for teaching medical students here is old and out-of-date. Most doctors do some teaching, but they are not trained in clinical teaching or mentoring. Clinical teachers usually don’t have any protected time for scholarship or performing feedback to students.”

“I believe medical education in Chile is still focused on [foundational] knowledge, not on what our patients need,” shared Dr. Sergio Alvizu (Assistant Professor of Emergency Medicine, MUE, Universidad San Sebastian). “We need to change the classic approach to teaching new generations of learners how to learn, [while] always keeping our patients’ needs in the center of everything we do. We need to reward those behaviors and competencies that we want to develop, rather than focusing on the punishment of mistakes. Everything we teach must have clear goals, meaning, and… [improve] patient wellness.”

Leaders in Chile are now charting a much different path for educators.

Dr. Nicolas Pineda, the Residency Program Director of MUE, paints a wonderful future: “This week was awesome! It strengthened what we believe medical education should be: interactive, dynamic, entertaining, effortful, and learner-centered.” Dr. Pineda acknowledged the challenges and work to be done. “It wasn’t easy to get people to register for the course at first, especially with a young specialty here [emergency medicine] and residency programs that depend on young, inexperienced faculty. Then, when I saw the level of participation, people engaged, doing their homework, sharing their thoughts and ideas, shooting educational videos, creating Twitter accounts… it was amazing! So many creative ideas, different points of view, and great pearls! We strongly believe that better educating doctors, nurses, and other team members will save patient lives, so that we can continue to reach as many people as we can. Education saves lives!”

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Personally, I’m excited to follow the medical education scholarship that will come from Latin America educators in future years.

Daniel Schubert, a 6th year medical student at Rio de Janeiro’s State University (UERJ, Brazil), summed up the energy at the end of the course: “When you light a flame, you never really know how large of a fire you might make. I feel this is particularly true when we are advocates for better medical education. This conference created a spark here in Chile. Big fires are lit in the hearts of many educators here, with the potential to change the world and save patient lives. That’s what we believe – education can transform lives, and it has already transformed mine.”

Buena suerte a mis nuevos colegas Chilenos!

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I’m grateful for the incredibly kind hospitality offered by our MUE hosts and conference co-faculty members: Drs. Nicolas Pineda, Carlos Donoso, Michel Rey, Sergio Alvizu, Adolfo Barraza; and to my fellow Medutopia faculty members: Rob Rogers, Seth Trueger, Anna Kalantari, Tarlan Hedayati, Rob Cooney, Daniel Schubert.