Feedback isn't always straightforward.
[A Turn in the Road via wikimedia]

I certainly enjoy a good SP encounter. I love discovering how effective behaviours manifest and how they affect me so I can incorporate them into future feedback.

But one of my very favorite things is when a poor encounter becomes an excellent feedback session. This is only possible in places that allow the SP to have a genuine conversation with the learner, rather than using a specific format or a written form. But when it works it makes both of us leave the encounter feeling better. I see how the learners' posture & expressions change and they leave knowing how to make it right, feeling hopeful instead of defeated.

For instance (this is a living list. Last updated May 23, 2017):

• When the learner returned for feedback, he immediately admitted it had been a terrible encounter. Together we analyzed why, then I guided him through creating a specific plan to enhance those skills before the next event.

• During feedback during a poor encounter a learner admitted he had just been going through the motions during lung auscultation, but when he realized it he forced himself to do the exam again paying closer attention. It didn't affect the findings or anything else about the encounter, but I was so impressed I praised him for his self-awareness and integrity. Even if he got nothing else out of that encounter, I felt that was worth the whole thing.

• I could tell the feedback for this unsatisfying encounter wasn't landing for the learner until I stepped laterally and asked her why/how she had gotten into this particularly specialized program. Hearing her answer allowed me to target my feedback to meet her needs and her entire attitude became engaged and curious.

• "Oh, I should ask more questions!" the learner suddenly exclaimed during feedback after a particularly confusing encounter. I wanted to hug him.

• How I learned to begin each encounter with student self-reflection.

• Once a learner who had an awkward encounter came back to feedback crying. I didn't even try to give her feedback: I got her tissues, a drink of water, and asked her what was going on in her life. We talked a bit about how to compartmentalize emotions and release them between patients so she would be ready to do the next OSCE encounter in the rotation.

• We had had a lackluster encounter: even though he was using the right words, I had considered the learner scripted and demanding. So I used the Feedback Hierarchy to talk to him about posture, tone, facial expressions and word choices to convey sincerity. During feedback he became much more animated and engaged. As he left he shook my hand: "Thank you! That was was the best feedback I have ever had. That's exactly what I've been looking for."

• After a difficult encounter with a resistant client, I asked the group what questions they had. Nobody said anything for a long moment, then one woman spoke up: "Why were you so mean?" she asked, only half joking. Everyone laughed nervously, and I was tempted to laugh it off, too. But instead, I said, “Great question! Why was I so mean? Let’s ask the group! What are some reasons why people might be mean in a situation like this?” The group talked about a lot of factors that make people uncooperative: hunger, illness, power/age differentials, independence, control, comprehension. The tone immediately flipped from rejection to empathy & inquiry, which persisted throughout the debriefing. I am certain they will feel more kindly towards this kind of client in the future.

• He was clipped, curt and offered me no empathy for my symptoms. I had a feeling I wasn't the only SP who had worked with him who felt this way, so after the traditional "How did that go for you?" I asked, "What patient interaction skills are you working on? What's something another SP has mentioned that you are trying to incorporate into patient encounters?" When he told me what it was, I was able to validate I had seen him try that and we were able to discuss how to communicate that skill more effectively. That gave me a chance to talk about what I had noticed and he was able to reflect back to me that he really heard it and how he could imagine how small it made me feel. By the end, he was telling me about why he had gotten into medicine, and my eyes were shining with compassion.

• Right from the very start, the learner constantly interrupted me. She would start with an open-ended question but then immediately close it or cut me off or finish my answer before I could even open my mouth! In feedback, when I asked her how it had gone, she said fine, but she felt like she didn't connect with me very well. What was the earliest moment she remembered not being able to connect with me? I asked. "Kind of right from the start," she said. I agreed with her and we walked through how she immediately closed her opening question, and then we examined several instances of other interruptions -- even during the feedback! By the time we were finished, she was astonished. "It's true! I do interrupt people! How could I not know this? I've done a lot of these simulations and nobody has ever told me that before!" She was almost elated at discovering this aspect about herself.

Inside the Simulation Studio

An SP shows us the inside of his studio.
[Self-Portrait (In the new studio) via wikimedia]

Oh, HELLO! Has anyone heard of the free "Inside the Simulation Studio" conference for SPs?  This sounds absolutely delightful!

Unfortunately, I can't find any recent info on it. Most of the information I can find is from 2013. But happily someone has posted videos from all the speakers! They include a wide range of diverse presentations including traditional power point, creative writing, music, roleplaying, films, recorded encounters, etc. The topics also span a wide range: the future of SPs, how to approach specific encounters, case development, active listening, feedback, mannequins, the scope of SP opportunities, etc.

I love the opportunity to watch other SPs talk and do what they love. But one of the things that really makes my heart sing is the specific emphasis on SPs and their creativity. Yes, I am analytical by nature, but the magic of SPs is the combination of heart, head and hand. So I am excited to see a group not only tolerate that combination, but embrace it.

All in all it's funny, informative and heartwarming. I hope they offer it again sometime. Check out the videos for yourself!

https://vimeo.com/channels/644246/82072169

Power ballads for mannequins

Are you an SP who works with mannequins? Then this unabashedly sentimental & irreverent video is for you!

Mind The Gap

The majestic horror of an on-call schedule.
[Grand Canyon of the Yellowstone via wikimedia]

SP schedules are highly unpredictable and mutable.

This instability is one of the reasons why we should be compensated well. As I wrote in Herding Cats, "SP work is meant to be flexible, but in reality many schools maintain a pool of 'reliable' (by which they mean 'available') SPs. If you are unavailable too often it can count against you. I think this is a bit unfair for a profession that offers no benefits, security or regular work."

So articles like this one about The Gap, which is rejecting an even worse on-call approach, are of great interest to me.

Empathy is a choice

So many choices.
[Landscape painting in water-colours via wikimedia]

Another followup to my post The Case Against Empathy, where I examined Paul Bloom's argument that empathy was less useful than simple respect.

The NY Times disagrees:

"While we concede that the exercise of empathy is, in practice, often far too limited in scope, we dispute the idea that this shortcoming is inherent, a permanent flaw in the emotion itself. Inspired by a competing body of recent research, we believe that empathy is a choice that we make whether to extend ourselves to others. The 'limits' to our empathy are merely apparent, and can change, sometimes drastically, depending on what we want to feel."

Of particular note for those of us who work in scenarios:

"Karina Schumann, Jamil Zaki and Carol S. Dweck found that when people learned that empathy was a skill that could be improved — as opposed to a fixed personality trait — they engaged in more effort to experience empathy for racial groups other than their own. Empathy for people unlike us can be expanded, it seems, just by modifying our views about empathy."

And once empathy can be a choice rather than a character trait, empathy can be practiced. Even if a learner already exhibits empathy, it is as important to reinforce good habits as it is to instill new ones. As I wrote in The Value of SPs, empathy remains a choice by rewarding the use of it.

Quote of the Day

[Plato and Aristotle in The School of Athens via wikimedia]

"You can discover more about a person in an hour of play 
than in a year of conversation."

Plato

SP work is not always taken seriously because it looks like we're being paid to play. But I agree with Plato that "play" is a powerful & unique way to learn about oneself and others.

Irregular standards: SP discipline

These SPs don't understand why they're being fired.
[Adam et Ève wikimedia]

One of the worst parts about being an SP is that because SPs are often temporary or tentative contract workers, SPs can be dismissed for almost any or no reason at all.

But schools handle SP disciplinary issues in a variety of ways. Because these processes  -- and the rules it takes to invoke them -- are frequently unspecified when SPs are hired, it leaves us feeling both vulnerable and confused when an issue arises.

Based on my experience, there are several ways schools deal with SP disciplinary issues:

• No warning: Rarely, a school has an SP they know shouldn't be there, but the supervisor(s) never confront the SP due to a fear of conflict or a limited SP program. 

• No warning: More commonly, if a school decides there is an issue with an SP, they just stop scheduling the SP without directly addressing the issue. If the SP then contacts the school to inquire about work after a gap, it is considered an acceptable response to tell the SP s/he will be contacted when work is available -- but without saying it never will be. That misdirection is disrespectful and keeps the SP from finding another job.

• No warning: Sometimes a school fires an SP without communicating the complaint until the time of the firing. This means the SP is unable to remediate or improve performance for that -- or any -- school.

• 1 warning: Better schools directly address an issue of complaint with an SP at least once before firing them. The issue should be presented with kindness, clarity and an expectation of good intentions. If the SP does not improve, the SP knows they will be terminated. That's a lot of pressure to get it right.

• 2+ warnings: The best schools offer an initial warning about the behavior with concrete recommendations for change and a check-in process. If the SP does not improve immediately, one or more additional remediations may be required, each with a clear sense of changes and consequences, including possible termination.

• Infinite warnings: This is also unusual, but sometimes a school continues to give an SP feedback about an issue but the supervisor(s) never follow through with consequences. This can happen with a small SP pool where that particular SP's demographics are rare. But it is bad for learners and may erode standards for other SPs in the pool.

Since SPs are employed so precariously, the power differential means supervisors have a responsibility to act ethically despite the potential for uncomfortable conversations. Schools should role model the behaviors they expect SPs to exhibit to learners during difficult feedback.

As an SP, I want to clearly understand the process for termination for each school. In addition, I want schools to do more to help prevent SP issues from the start. Working in education creates a higher standard for educating employees. Because each school has different and even conflicting details (e.g.: does an SP give feedback about student appearance or not?), new SP training is crucial to keeping SPs from inadvertently breaking a rule they didn't know existed. Good event training (as opposed to irregular event training) would help set appropriate expectations for every SP, every time. And annual reviews would make sure each SP has a clear understanding of areas of improvement before they becomes crises.

Setting the standard:
Schools should offer new SPs training which includes clear expectations for SP behavior as well as the process for remediation and termination. Annual employee training should review those expectations. Individual event training should reinforce standards the school would find actionable. Once a problem is identified, a school should give at least two chances for SP remediation (though not infinite). The SP should be observed in future encounters and given concrete ways to improve performance. If the SP does not improve, the school can release the SP with a clean conscience.