1. Six thinking hats technique for evaluation and strategic
formulation in postgraduate medical teaching system
Thira Woratanarat*, Patarawan Woratanarat**
*
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
**
Department of Orthopaedics, Clinical Epidemiology Unit, Faculty of Medicine Ramathibodi Hospital, Mahidol University,
Bangkok, Thailand.
Abstract methods in assessment, monitoring, evaluation, and
formulation of effective development strategy.
Six thinking hats technique has been used in private and
Background government sectors worldwide 1, 2 . The technique
Six thinking hats” technique has been used in both private symbolizes six different colors of the hat, i.e. yellow, black,
and government sectors worldwide. The technique white, red, green, and blue, to induce group brainstorming
symbolizes six different colors of the hat to induce group in systematic fashion. Yellow color is to let the group assess
brainstorming in systematic fashion. We share our strengths or good points of the system they are
experience of applying this technique in medical school considering, whereas black is to spell out weak points or
setting. bad things happening in the system. White hat is used to
induce the analysis whether the system has run on
Material and methods evidence-based fashion or not, and which evidence has
Twenty-one departments were invited to send two been used as well as any necessary evidences is absent.
faculties and at least one resident to participate in this For red color, a rapid emotional reflection from the member
activity. “Six thinking hats” technique was introduced to of the group will be generated in order to see overall
all participants, then seven minutes were allocated to each atmosphere regarding the system we are considering.
hat for brainstorming session. Green hat is used to stimulate creative thinking from group
members to find out improvement strategies, and finally
Results the blue hat is for assisting the group to summarize what
and how they may go back to their department to
Twenty-one faculties and 11 residents attended in the implement those strategies step-by-step. This study is to
morning for postgraduate medical teaching session, and share our experience of applying strategic analysis
16 faculties with 11 residents participated in the afternoon technique from business sector named “Six thinking hats”
for medical research session. The analytic results from “Six in medical school setting.
thinking hats” technique were delivered from the group
members in systematic fashion. Material and methods
Conclusions As a pilot project, twenty-one departments involving
postgraduate medical training and medical research were
“Six thinking hats” technique has been demonstrated as a invited to send two faculties and at least one resident to
feasible and acceptable choice to create responsive and participate in this activity. The activity was divided into two
possible interventions to existing problems in the medical main sessions: three hours in the morning involved
school system. evaluation and strategic formulation for postgraduate
medical teaching system, and another three hours in the
Keywords afternoon for medical research.
Six thinking hats, Strategic formulation, Medical school The participants were divided into three groups, 10-12
members in each group. The objective of the activity was
Background explained and the questions were welcome with
clarification until well understanding was achieved.
Faculty of Medicine, Chulalongkorn University, has been
Six thinking hats technique was introduced to all
recognized as one of the best medical schools in Thailand.
participants by Dr.Thira Woratanarat, a facilitator of this
Our missions comprise provision of tertiary medical
activity. Since this was the first time for all participants
services, undergraduate and postgraduate medical
exercising this technique, seven minutes were allocated
training, and generation of high quality and high impact
to each hat for determining and discussing on the issue of
medical research. In order to maintain a top level of
teaching and research in accordance with the sessions. In
standard in those missions amid rapid changes from
real life, five minutes are usually spent for each hat except
globalization trend, it is noticeable that many organizations
a minute for red hat. There was a note-taker in each group
has tried to utilize both conventional and innovative
for jotting down the details as well as consensus on the
108 Indian Journal of Public Health Research & Development. July - December, 2011, Vol. 2, No. 2

2. flip chart. Black hat
In order to assist better understanding and wrapping up
Regarding the weakness of existing teaching system, the
all outputs, after six hats session finished, a representative
results from both faculty group and resident group were
from each group went up to present their outputs to all
shown in Table 2.
participants.
After the activity, all outputs were compiled and analyzed
by knowledge management subcommittee of the Faculty
White hat
of Medicine, Chulalongkorn University, so as to write up a The groups spent their time discussing the evidences they
policy recommendation as well as action plan for the used in current teaching system, and what they thought
administrators, and in parallel send those documents back were necessary to have for teaching system improvement.
to each department for their further use. The results were demonstrated in Table 3.
Findings Green hat
Twenty-one faculties and 11 residents attended in the The participants scrutinized the results from
morning for postgraduate medical teaching session, and aforementioned discussion to generate some “how-to”
16 faculties with 11 residents participated in the afternoon processes in order to improve postgraduate medical
for medical research session. However, the results of teaching system as shown in Table4.
medical research session were reported elsewhere.
Blue hat
Postgraduate medical teaching session After finishing previous five hats, the members configured
the steps necessary to fostering “how-to” ideas into actual
Red hat implementation either at their own departments or at the
Faculty level. The results were demonstrated in Table 5.
After consensus was achieved, there were two types of
expression regarding postgraduate medical teaching at
Faculty of Medicine, Chulalongkorn University. Most of the
Discussion
faculties expressed urgent need for improvement in Main missions of the medical schools in Thailand comprise
current teaching system, whereas the resident group teaching, research, and service provision. We have been
reflected this as a tough system with impaired work-life acquainted with common problems in every institution,
balance. for instances, limited resources, high work burdens, etc.
Frequently, most of medical schools exercises single-loop
Yellow hat problem solving strategy, i.e., encountering the problem
and then find out alleviating solution. For this kind of
In light of the strengths of existing teaching system, the
problem solving, the solution may be only symptomatic
results from faculty group and resident group were
and temporarily effective. Sometimes this measure also
described in Table 1.
Table 1: Strengths of postgraduate medical teaching system
Faculty group Resident group
• Appropriate specialty diversity· • Good academic environment
• Support for medical service and research system· • Quality of the faculties
• Good source for prospective faculty screening· • Critical and systematic thinking
• Flexibility· • Patience training for tough situation
• Unity and warm relationship such as workloads tolerance
Table 2: Weaknesses of postgraduate medical teaching system
Faculty group Resident group
• Very high workloads • Very high workloads
• Low compensation • Low compensation
• Inadequate workforce • Inadequate welfare
• Young faculty and resident have low tolerance to • Working more than studying
tough works • Inadequate teaching resources
• Inadequate teaching resources such as limited • Complicated working system
spaces, materials, and budget • Limited work safety system
• Some faculties and residents have limited capabilities
on teaching and communication skills
Indian Journal of Public Health Research & Development. July - December, 2011, Vol. 2, No. 2 109

3. Table 3: Evidences used and evidences in need for postgraduate medical teaching system
Evidences used Evidences in need
• Detailed curriculum • Reasons for resignation from residents
• Some monitoring surrogates/indicators such as • Evaluation and feedback from society
numbers of publication, faculty:resident ratio, • Resident guideline for inter-departmental working
workloads report, work schedule, satisfaction survey
• Department working guideline for residents
• Resident evaluation results
• Employers’ feedbacks for residents
Table 4: How to improve current postgraduate medical teaching system
Faculty group Resident group
• Positive reinforcement strategies to increase faculty • Increase the number of faculties
motivation such as increase compensation • Increase compensation for the residents
• Changes teaching system in accordance with societal • Improve welfare and teaching resources
needs • Simplify working process and get rid of redundancy
• Training the faculty for teaching skills at timely for inter-departmental works
fashion • Focus more on work safety for health personnel
• Establish “Professional teaching development team”
in Faculty of Medicine, Chulalongkorn University
• Improve welfare and teaching resources
• Focus more on work-life balance policy
Table 5: Steps to implement for postgraduate medical teaching system improvement
Faculty group Resident group
• Establish a war room for SWOT analysis, priority • Inter-departmental resident meeting for knowledge
setting, and implementation planning and experience exchange
• Additional needs assessment for all faculties • Setting up resident union to have better negotiation
• Collecting residents’ feedback to be essential inputs power
for policy formulation
herald subsequent complication with regards to sessions.
unexpected impact from different demands and needs
among various stakeholders in the system. Conclusion
“Six thinking hats” technique has been demonstrated as a “Six thinking hats” technique has been shown to be
feasible and acceptable choice in applying the strategic feasible, acceptable, and useful for system assessment and
management technique for system assessment and strategy formulation in medical school setting. Data-
strategy formulation so as to create responsive and returning strategy might be of value to keep in touch with
possible interventions to existing problems in the system. all stakeholders after finishing the activity.
With appropriate planning for brainstorming activity by
inviting all stakeholders to share their concerns, needs, and
Acknowledgement
opinions, in a systematic manner, we did achieve the results
that may be used to direct our postgraduate medical The author would like to thank all members of knowledge
teaching system in a common goal. However, the management subcommittee at Faculty of Medicine,
limitations of this technique are the number of Chulalongkorn University, for their invaluable advices.
experienced facilitators, and requirement of only small to
medium sized group (e.g. no more than 7-10 persons per Reference
group). 1. de Bono E. Six Thinking Hats: An Essential Approach
In the organization like medical schools, it would be wise to Business Management. Little Brown and Company;
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specific aims and appropriate stakeholders in each session. 2. Kamal SB. Evaluating the effectiveness of creativity
A data-returning strategy might be useful in order to training. Journal of European Industrial Training, 2005;
continuously engage all stakeholders after finishing the 29(2):102-111.
110 Indian Journal of Public Health Research & Development. July - December, 2011, Vol. 2, No. 2