Five things to do this summer: a Med Ed to-do list
This first year I worked in a post-secondary setting, I was somewhat bemused when students asked me how I was going to spend my summer – they were heading out on a three or four month “break” and assumed I was doing the same. Some had work plans, some travel, some both. Regardless, they would be away from campus and recharging their batteries, and, perhaps, expanding their perspectives in a variety of ways. I, however, would be at my desk.
Two decades and three universities later, I’m still working through much of the summer months as are many of my administration, staff, and faculty colleagues as we stagger vacations with other colleagues and other family members’ schedules.
For those of us at the School of Medicine (including our 2018 clerks!) who don’t have two or three months off this season but maybe a couple of weeks and the odd day here or there to make a long weekend – here’s my list of five things to do that are (loosely) related to medical education. (This list is best perused—and perhaps amended or augmented—while sitting on a patio with your favourite libation).
Read something not related to your discipline
In the crush of academic terms, it’s easy to fall into the trap of reading for work, not for recreation. There’s always just one more journal article to be read, one more new text to review. One more thing to stay on top of. Vow to read at least one novel (or collection of short stories, or poetry) this summer. Regardless of genre, you’ll learn something of the human condition (which is at the heart of medicine and medical education) and it will refresh you, too. So, move it to the top of your To Be Read pile. Among my picks: a toss-up between finally reading at least one of the Harry Potter books, or Abraham Verghese’s Cutting for Stone. Maybe both. The Art of Adapting by Cassandra Dunn is also in the running.
Binge watch a cooking show on the Food Network
Whether it’s TiVo’ed or Netflix, the ability to skip the ads is a godsend for a rainy Saturday’s binge-watching. Opt for something where you might pick up a recipe or tip or two, but pay attention to how the host explains what they’re doing. Is it conversational? Directive? Do you stay engaged? Or pick one of the competition shows (Chopped is my guilty pleasure) and check out how different judges give feedback. Some are brutal; some overly-kind without much substance. Some have thoughtful suggestions. Many adapt their critique delivery, based on the experience and competence levels of the chefs competing. How can this inform how you deliver feedback?
Enlist some pals and build a sandcastle at the beach
Sandcastles are hands-on and best accomplished as a team effort. Building one requires both attention to details and a flexibility to accommodate the sand, water, and tide schedule. The plan is rarely ever 100% completed without modifications along the way. Plus, everybody gets dirty. And, at the end of the day, there’s nothing except pictures as the tide washes it away. So, a fresh slate the next day. And, we can take the lessons learned on to the next one.
Hit the movie theatre to see a summer blockbuster
Enjoy the a/c and see something outrageous. Popcorn optional. Take note of if the story drags anywhere: did you get the urge to check your smart-phone (pre-movie admonishments aside). What made your attention wander? Was it an extraneous info-dump? An overly-long car chase? Just too much of something? A gap in knowledge? If you’re working on online modules for next year, take note of where the show lost you. Adapt this insight to material you create for your students.
Watch some fireworks
Most of us know that fireworks were invented in China centuries ago. According to the “Fireworks University” website, this was an accident when a field kitchen cook happened to mix charcoal, sulphur and saltpeter. What a happy accident*.
There’s no great medical education insight to go with this watch fireworks suggestion: they’re just fun. And maybe that’s the insight right there.
* (I feel obliged to stress the importance of following all instructions for the at-home kind of fireworks and strongly urging you to show up for community fireworks shows instead. Avoid the unplanned side trip to the ER).
Get to the point with Ask-Tell-Ask feedback
By Theresa Suart & Eleni Katsoulas
Giving and receiving feedback effectively is a key part of the UGME curriculum. It’s also key in nearly every workplace, which could explain why there are so many different frameworks and recommendations for feedback “best practices”. Some of these are more effective than others.
Have you heard of the feedback sandwich? It’s one of the more popular feedback techniques and involves “sandwiching” negative or constructive feedback with two pieces of positive or complementary feedback. It’s also sometimes known as “PIP” for “praise, improve, praise”.
The idea behind this is laudable – cushion the blow of negative feedback and reassure the individual that they are doing some things well.
In practice, however, it’s fraught with difficulties, making it not very useful for the person receiving the feedback. Think about it:
- I’ve just received two pieces of praise and one of criticism or a suggestion for improvement: what should I focus on?
- The negative feedback is about something I did today, the positive things were from last week – the positive stuff must not be as important.
- Two pieces of praise and one of criticism – guess that I’m mostly doing well!
- The last thing they said was praise – must be doing great!
Writing in Harvard Business Review, Roger Schwarz also points out the fallacies of this approach. Schwarz notes leaders who use the sandwich approach to negative feedback do so for a variety of reasons. These include:
- Thinking it’s easier for people to hear and accept negative feedback when it comes with positive feedback.
- Assuming the sandwich approach provides balanced feedback
- Believing giving positive feedback with negative feedback reduces discomfort and anxiety.
Schwarz then debunks each:
- Easier: Most people on the receiving end would prefer to skip the sandwich – get to the point.
- Balanced: Saving up positive feedback to sandwich negative feedback undermines timely delivery of the positive feedback. As Schwarz points out, research shows that feedback, either positive or negative, “is best shared as soon as possible.” He also asks: “Do you also feel the need to balance your positive feedback with negative feedback?”
- Reducing anxiety: “The longer you talk without giving the negative feedback, the more uncomfortable you’re likely to become as you anticipate giving the negative news.” Meanwhile, the person on the receiving end “will sense your discomfort and become more anxious.
The UGME Education Team advocates the use of a new feedback sandwich replacing “praise, improve, praise” with Ask – Tell – Ask. This method was brought forward by Dr. Ayca Toprak and Dr. Susan Chamberlain, adapted from French, Colbert and Pien (ASE April 24, 2015)
The ATA Feedback Model is similar to the traditional feedback model as it has three parts. After that, it’s quite a bit different. Using Ask-Tell-Ask, the Preceptor asks the learner for their input, then the preceptor tells them their impressions, then wraps up by asking the learner to help develop an improvement plan:
Ask – Tell – Ask
- Ask the learner for their perceptions about strengths and challenges
- Tell them your impressions backed by observations, and specific examples
- Ask them what can be improved and how– assist you in developing a learning plan
Examples of topics to discuss (referencing objectives of the rotation, course, or activity):
- Functioning in the team context
- Skills (communication, technical, clinical)
- Clinical Reasoning
- Record keeping
- Process or Content (knowledge or the way they use the knowledge; application of knowledge).
- Background knowledge (this is knowledge of the discipline, scientific foundations, knowledge base).
The ATA model helps preceptors focus the discussion while scaffolding self-regulation and self-assessment. It also avoids the mixed-messages of the feedback sandwich approach.
The ask-tell-ask oral feedback is best paired with written narrative feedback. Watch for a blog post on this topic in September.
We used PowerPoint slides from a presentation prepared by Sheila Pinchin and Eleni Katsoulas, with slides from Cherie Jones, to prepare this blog. We thank Sheila and Cherie for their contributions.