• Prof Ziva Noval




Trainers are medical doctors who have usually not had any formal education in how to teach. In human affairs generally there is less progress than in technology. Training the Trainers courses (TTT) give trainers tools to deliver better adult education, something which was demanded by the European Network of Trainees in Obstetrics and Gynaecology (ENTOG) from the European Board and College of Obstetrics and Gynaecology (EBCOG). An RCOG course was organised for EBCOG trainers who then started to spread TTT courses within EBCOG countries.

What are Training the Trainers (TTT) courses?

TTT courses are interactive, with around 15 % of the time spent on lectures and 85 % of the time spent on discussion and feedback. The main topics are listed below.

Briefing on the basic adult medical education theory: adults take responsibility for learning, they learn from experience and reflect on experience. Medical teaching is specific, not ordinary adult teaching. Adults are motivated to learn when they have autonomy, can proceed to mastery and see purpose in their work.

Trainers are also shown what ideal trainers look like in the eyes of trainees.

Giving proper feedback is a skill and an art a good trainer should know. Feedback should promote self-reflection in trainees about the strong points they know they have. Trainers should also show them strong points that the trainees are not aware of. Trainees should reflect on their known weak points, and trainers shouldshow how these can be improved together with other weak points which trainees are not aware of. Proper feedback improves training and must not be insulting. The importance of feedback does not end with the end of training. Superior performers intentionally seek feedback continuously.

Practical skills training in a four-step cognitive training method: during training everybody advances from being unconsciously incompetent, through conscious incompetence and conscious competence, to the final level of unconscious competence, proceeding to mastery. Trainers are shown how to teach using the four steps.

Differences between assessment and appraisal are stressed. Assessment is needed to ensure that a trainee reaches minimum standards before becoming a specialist. Minimum standards of theoretical knowledge, skills and attitude should ensure patient safety. Proper assessment is reliable, transparent, feasible and improves education.

Appraisal is personal planning for trainees; it starts with an introduction interview. Trainers and trainees get to know each other’s expectations andpotential and make plans to reach goals. Roles are determined. Everyday work is connected with long term goals. During training, regular appraisals are necessary to help trainees achieve their best, according to their potential. At TTT courses, trainers are taught how to conduct appraisals.

In advanced Training the Trainers courses (TTT2) the topics are: difficult trainees; how to break bad news; the basics of negotiation; how to cope with stress; how to avoid burn-out; how to teach professionalism; how to train in simulation centres, how to use the 6 hats parallel thinking tool.

If very young trainers learn the basics of how to train, they will be able to use appropriate tools for a throughout their professional lives. The attendance of young doctors adds to better understanding among different generations, respect and a good learning climate.

You can read more in the Monograph “When training becomes fun for trainers and trainees”, available free online

at http://www.fvvo.be/monographs/when-training-becomes-fun-for-trainers-and-trainees-medical-education-in-obstetrics-and-gynaecology/

What do the participants think of Training the Trainers (TTT) courses?

New demands in medicine are many: more patients, better educated and informed patients, the tendency towards lawsuits; more trainees, less time spent with trainees, the increasing number of different procedures, less invasive procedures, shorter hospital stays; different modes of obtaining information the enormous amount of information, etc.

We are educating for the near future: that is why trainers should be flexible and be given various tools (and they will themselves invent new ones) adapted for the challenges of the future. We cannot solve the problems and challenges of the future with the models and modes that led to these problems in the first place.

Participants were given autonomy and a road to mastery, and saw the purpose of the TTT. They all acknowledged the need for the courses and expressed the wish to attend TTT courses at least once every two years. As participants were from different specialties, personal communication among different departments increased. Participants were enthusiastic because courses were held in a relaxed but interactive atmosphere. They discovered their own hidden potential. Problems in training, which they thought were only theirs, were found to be general. With the aid of appropriate thinking tools, and by being proactive, ideas for better training poured out. The TTT course also greatly helped the self-improvement of trainers.

Organisation of TTT courses within EBCOG

Convinced of the benefits of TTT, the President of EBCOG created a Working Group on TTT. Its members are: Prof Chiara Benedetto, Dr Angelique Goverde, Dr Tahir Mahmood, Dr Jacky Nizard, Prof Fedde Scheele, Dr Nuno Martins, Dr Karen Rose and the Chair is Prof Živa Novak Antolič.

All departments that apply for EBCOG hospital recognition might be asked if they have already had TTT courses for their trainers. If the answer is no, they may be offered support in organising these courses. TTT is only a part of the process of medical education. It should remain voluntary: a commitment to education, the organisation, the hospital, medicine and patients is thus expressed.

How to apply for a hospital accreditation visit by EBCOG

For further information on EBCOG Hospital Visiting, please contact the Chair of the EBCOG Standing Committee on Training Recognition, Professor Juriy Wladimiroff. His e-mail address is: j.wladimiroff@btinternet.com

CME points

UEMS gives CME points (www.eaccme.eu) to all participants in Training the Trainers courses.

How to apply for an EBCOG Training the Trainers course -


The contact addresses are the the Chair of the TTT Working Group,

Prof Živa Novak Antolič: ziva.novak@guest.arnes.si

and the EBCOG Administrator

Mrs Charlotte Mercer charlotte.mercer@btinternet.com

#Trainthetrainer #training

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