Rumination, automation or facilitation?

How do you really feel about reflective writing? It’s frequently demanded and is an expectation of being a good doctor. You know: “You have now completed this course. Please complete your Reflective Learning Statement.” And you have to keep your e-portfolio up to date for your appraisal or ARCP meeting. Many doctors report feelings of irritation. “Here we go again.” “What’s the point?” “I could be doing something useful instead.” Such thoughts often lead to procrastination. But you know that you still have to do it eventually.

Automation

There are a lot of things in life that we do on auto-pilot. It happens when we’ve completed a task over and over again without negative consequence. So, we default to ingrained, habitual behaviour. We do it quickly and efficiently without really thinking about it.

This is a common approach to reflective writing. It’s the chore that has to be done. Going through the motions. Ticking the box. If this is the case, then it genuinely has become a time-wasting activity. If there’s no benefit then what really is the point? You would definitely be better off doing something else. But what’s the alternative?

Rumination

Things can and do go wrong. Sometimes we say the wrong thing in the wrong way at the wrong time. Sometimes, no-one has done anything wrong – yet we are still exposed to events and circumstances which are upsetting or confusing.

It’s easy to fall into rumination, where repetitive thoughts go round and round in circles. We can become victims of our own thinking. Problematic ideas undergo fermentation. This can lead to pre-occupation and to poisonous fixation. Anxiety, depression and burnout are all-too-familiar results of un-managed rumination. So, we need an alternative to that too.

Dislocation

“Keep a lid on it.” “Dissociate yourself from the situation. Concentrate on the task.” “Move on, there’s another patient here to be cared for.” “Keep your work at work and your private life private.”

On a personal level, tucking our toughest experiences away in our darkest corners can seem like a logical, attractive solution. But what to do when thoughts start to resurface? Drown them out with some form of distraction? This can lead to problematic ‘coping’ mechanisms and even fragmentation of character.

And what about the impact on others? Does ablation of our memories and experiences go hand in hand with abdication of responsibility over our behaviour and actions? If so, then does this lead to constriction of self-awareness? Does it close the door on learning, meaning there is stagnation rather than progress? This is one clear reason for empathy to measurably decrease over the course of a doctor’s training. So this doesn’t seem like the right way forward either.

Facilitation

What’s really required is a method which enables facilitation of strong foundations for stability and growth. Different people prefer to do this in different ways. Silent introspection, discussion with a mentor or reflective writing are good examples of this. When done well, they utilise awareness of the past to inform a better future. But none of these methods should be taken for granted.

Silent introspection can work well for those who have learned and practised a disciplined approach. Otherwise rumination and lack of conclusion may be just a small step away.

Discussions with an experienced coach, mentor or colleagues offer the benefits of externalising thoughts. When we do this, we are more likely to channel our mental processes into something constructive.

The same can be said of reflective writing when it is conducted for the right reasons and using effective methods.

Unfortunately, many doctors have never been taught how to do this well. The ability has been taken for granted. Or if they have learned in the past, they have fallen out of love with the practice through over-familiarity. That’s why we’ve now launched our new course Reflective Writing Skills for Appraisal & CPD.

So, rumination, automation, dislocation or facilitation. What’s your current approach to reflective practice?

Stephen McGuire – Managing Director

Civility matters – all year round

Bad behaviour

“Well that’s just brilliant, isn’t it!” “Here we go again!” “How rude!” “How offensive!” “Look what you made me do!” “Who do you think you are?!?” “Are you trying to make it impossible for us?!?” “It’s not me, it’s you!” “What the #@$%!!!” CRASH! BANG! Thump! “………………….. (silence without eye contact).”

The stakes are high in healthcare. High demands equate to high pressure. Things can and do go wrong. Stress is rife. So, it seems inevitable that tempers get frayed and cross words exchanged. But at what cost?

Our festive season is traditionally a time for reflection, peace and making commitments to move on from the past. But civility matters all year round. Rudeness can have serious consequences. Watch Chris Turner’s powerful 15 minute presentation on the matter. It should make us all stop and think.

To say we must all take responsibility for our own behaviour is an obvious point. At the same time, it’s essential to call out bad behaviour of others when we see it or experience it for ourselves. This latter point is often the most difficult part. Every doctor must ensure they have the ability to have tough discussions with colleagues in an appropriate and constructive manner.

We wish you a happy, peaceful time over the festive season and the strength to spread civility all year round.

Stephen McGuire and all the team from Oxford Medical Training

What’s the opposite of giving feedback?

I’m regularly both surprised and delighted by delegates on our courses. Occasionally, someone says or does something which stops me in my tracks – in a good way. An excellent example of this happened to me just recently.

Dr K was one of 16 delegates on a 2-day Teach the Teacher Course that I was leading. Around half-way through the second day, my impression was that he was quietly paying attention. However, it wasn’t easy to gauge what he was learning at this stage. He was happily participating in small group activities. But he preferred doing this with doctors that he knew well and he rarely contributed to discussions in the larger group. That’s ok. After all, we all have our preferences when it comes to learning. As a tutor, though, you always like evidence that your event is having a positive impact.

An important feature of our course structure is that each doctor has the opportunity to design and deliver a teaching session to their fellow delegates. Taking the role of teacher allows them to experiment, put teaching theory into practice and test out new ideas. The other delegates take on the role of learners for these sessions. This gives them the opportunity to experience different teaching styles and then practice giving feedback. Such sessions are always most effective when the doctors combine their personal ideas and creativity with the concepts explored during the course.

A killer question

When it came to Dr K’s turn, his subject was, “The role of feedback in learning.” We always emphasise that giving feedback is an essential skill for teachers to possess. It’s also vital for strong leadership, management and team communication. (For clarity, we are talking about face-to-face verbal feedback, rather than annual, anonymous digital messages). It’s easy to state the obvious with many topics. The real challenge is often bringing this idea to life. How do you take a well worn message, make people really think and make it hit home with relevance?

So, Dr K began with a simple question. “What is feedback? Can you give me a definition?” Delegates thought for a moment and offered their ideas. “Constructive criticism.” “Pointing out errors.” “Recognising what’s gone well.” “Raising awareness.” “Sharing your observations.” He then offered a dictionary definition. It was a reasonable, but unremarkable start. It was the follow up question that stopped everyone in their tracks.

“What’s the opposite of giving feedback?”

Reverse provocation

This curious question is an excellent example of “reverse provocation”. That’s where you approach something from a diametrically opposite stance from the norm. We often visit this idea during our Essentials of Medical Leadership and Management Course as a method to stimulate creative thinking. Consider the question “How can we get more of our patients to turn up on time for their appointments?” It’s probably been discussed so often that any improvement can seem hopeless. We’ve run dry when it comes to new ideas. So, what about reversing it? “How could we ensure that patients always turn up late for their appointments?” This pushes us to think from a fresh perspective. Creating a list of answers starts to generate the solutions. At the same time, it also helps to reinforce the importance of some points.

So, what is the opposite of giving feedback?

Well, I’m not sure I have one clear, simple answer to this question. Delegates on the course thought long and hard, then offered a few suggestions: “Silence.” “Holding back.” “Acceptance.” “Avoidance.” “Apathy.” “Reinforcement of unconscious incompetence.” Maybe the most insightful response was,”What I usually do!”

In many ways, the answer is less important than the thinking which the question generates. Ultimately, it leads us to think about why giving feedback is so important and why it’s essential that a great teacher can do it well.

So how would you describe the opposite of giving feedback? What are you doing to improve your skills?

Stephen McGuire – Managing Director

Want to start an epidemic?

It would seem reasonable to think that being responsible for starting an epidemic would be the last thing any doctor would want. We usually consider epidemics in the physical sense. But we also see behavioural epidemics infecting a population. The recent escalation of parents not ensuring their kids are vaccinated is a good example. And we typically think of epidemics in the negative sense. We flip this idea round during our Essentials of Medical Leadership and Management Courses. Being responsible for spreading positive behaviour, ensuring improved working practices take a grip across your team and then beyond is a wonderful thing.

We often know what we want to achieve when it comes to leading quality improvement, championing new techniques or transforming attitudes. But how often do initial changes in team behaviour really stick. How often do initially well received ideas slowly evaporate and fail to take a grip? This happens for a broad range of reasons.

The tipping point

Malcolm Gladwell came to prominence through his book Tipping Point: How Little Things Can Make a Big Difference.  He begins by exploring the factors which contribute to a major outbreak of infectious disease.  He then goes on to look at historical events, cultural phenomena and human behavioural trends. His focus is on how things spread through human populations. Along the way, he aims to identify the key factors which contribute towards the reaching a ‘tipping point’. That’s the point when something moves from being small and contained to a few, to become an outbreak which impacts on the many.  These key forces can be applied to the deliberate spread of ideas and behaviours. They can be utilised to start a positive epidemic.

Gladwell proposed that reaching a tipping point requires three active agents:

  • The right people
  • A fertile context and
  • ‘Stickiness’

The right people

Leadership is often a ‘team sport’. We rarely achieve sustained behavioural change with a group of people on our own via one single act of influence. Change requires maintaining contact with our team members. Shift patterns, busy workloads and people working in different locations are just a few factors which make this challenging. So it helps to involve colleagues who are natural connectors, who are good at networking with people. It’s also useful to involve people with credible expertise who have the ability to distill any complexity or confusion into simple concepts. And support from people who can ‘sell’ an idea, who make it directly relevant to individuals will help ensure that everyone is onboard.

Fertile context

Epidemics require the correct ‘breeding ground’.  An infective agent may have a major impact in one situation.  Yet transferring the same agent to a different time, place or culture may mean that it has no impact at all. Timing is essential. People need to be ready for change. This might mean taking an opportunity as it arises, waiting for the right time or taking steps to ensure your team are going to be receptive to your initiative. As well as there being a ‘right time’ there’s also usually a ‘right place’. These two elements can be guided by understanding the prevailing culture which also informs what is expected, respected and accepted.

Stickiness

You have to genuinely engage people if you want them to follow your ideas. You need them to pay attention to receive your message clearly and unambiguously. So the way that you communicate is important. It needs to be personally relevant to people for them to commit. This works best when they understand ‘why’ and “what’s in it for me or the things I care about” is apparent. But one single instance of relevant engagement rarely has a lasting impact. So follow-up is an essential element of making your message or need for change sticky.

What do you want to change and how will you start your epidemic to make sure your ideas spread?

Stephen McGuire – Managing Director

A perfect recipe for breaking bad news

Healthcare often involves having life-changing discussions. You may need to recommend an unwanted procedure. It could be advising there’s been permanent loss of function. Sometimes you may need to inform that an error has occurred. And, potentially the most challenging, there are conversations about death and dying.

These can be traumatic experiences for all concerned. Traumatic for the patient. Traumatic for the family members or carers . And, of course, traumatic for the doctors themselves. So, it’s little surprise that delegates on our Advanced Patient Communication Skills Courses want to improve their ability to manage these situations and to manage them well. A significant percentage of them are looking for an effective process that they can use. And we do conclude our course by exploring a structured framework which has been proven to help. However, before we think about how to do this, there is a fundamental question to consider.

What do we mean by “breaking bad news well?”

When we delve into this question, there are always a number of doctors with a clear aim. Deep down, what they really want, is to communicate their message in a way that avoids any uncomfortable openly-emotional upset. Desire to prevent unnecessary distress is admirable. But can a lack of emotional disturbance really be considered as a useful indicator of success here?

At Oxford Medical, our definition of good communication is: To ensure that all concerned hear what needs to be heard.

So, an essential element of communicating any type of news is that your message is received and understood. If that message is truly life changing then an emotional reaction should not be surprising. But neither should it be considered inevitable. The initial reaction may well be one of silent shock or questioning denial. Alternatively, it may be calm factual discussion when the message has been heard but the unimaginable full consequences have not yet registered.

And good communication cannot purely be about transmission of a message. You need to be sure that the message has been received and understood. “Hearing what needs to be heard” goes well beyond simple sharing of words. Expressions of emotion are a very powerful form of human communication. They can help you know what message has been heard and understood, what the impact may be and how you should adapt.

It’s likely that you have experienced numerous instances of hearing bad news yourself at various points in your personal life. You may have experienced health issues of your own. You may have lost colleagues, friends and/or family members. Take a moment to think about the reactions you felt in some of these instances.

Process versus comprehension

Chances are, as each set of circumstances was in some way unique, that you experienced a unique range of feelings in response to each event. Patients and their families are no different. They all have unique personalities, unique circumstances and unique relationships with the people around them. So, their reactions are often difficult to predict, sometimes surprising. In fact, approaching the task of breaking bad news with fixed expectations will limit your ability to react to the events as they unfold. The problem with frameworks and processes is that, on their own, they lead to cold, unresponsive communication.

If your role includes regularly delivering life-changing messages then it is likely that these acts of communication will typically be remembered in far greater detail and for much longer by the receiver than by yourself. And they will remember you as a person every bit as much as the message itself. Their memories and emotions are forever interconnected with the way the message was delivered and your reactions to their situation.

Our approach on our courses is to begin by thoroughly exploring the human condition and principles of good communication. What drives our feelings, thoughts and actions. What we need and want. The nuts and bolts of communication. How we react to different circumstances. And we consider this from the aspect of patients, family members and doctors. We then take this deeper understanding and relate it to the various communication models that can be helpful in healthcare.

Comprehension enables intelligent application of frame works or processes. This in turn leads to caring, effective communication with benefits of all concerned.

What steps are you taking to improve you abilities with break bad news?

Stephen McGuire – Managing Director

Sustain the fire, prevent burnout

Hands holding fire

It’s almost two months since the latest wave of medical school graduates joined the NHS. The vast majority are brim full with altruism, idealism and enthusiasm. It’s also highly likely they are feeling significant levels of trepidation. Uncertainty, conscious-incompetence and unfamiliarity can lead to real pressures. And that’s normal for anyone taking up a new role. But there’s an additional problem which is being discussed a lot. The prospect of burnout.

A self-fulfilling prophecy?

If you start to type ‘burnout‘ into your online search-engine and it’s likely to give you ‘burnout nhs‘ as the lead prompt. Medical press, conferences and NHS communications regularly dedicate space and time to the problem. Recently, I had a conversation with a senior doctor who was despairing that the issue seemed to be getting worse. “We’re in a spiral. It must be something we’re doing. It’s becoming almost inevitable.”

Can that be true? Should bright young doctors actually expect to gradually be beaten by constant chronic stress to the point that they become hollowed out, emotionally-blunted, empty shells? Burnout feeds on feelings of self-doubt, inevitable failure and hopelessness. So, is there a risk that both leaders and these junior doctors can be reinforcing a self-fulfilling prophecy which will spread and accelerate the problem?

It’s not just the NHS

We cannot and must not ignore the high prevalence of burnout in young doctors. At the same time, it’s important to recognise that the problem isn’t confined to the NHS. Look out from the UK and we see the issue being discussed by doctors all the way from America to New Zealand and around the globe. Nor is it limited to doctors or even healthcare. Some commentators are, rightly or wrongly, labeling millenials as being the ‘burnout generation‘.

Feelings of isolation are further drivers/symptoms of the burnout spiral. It therefore makes sense that, at the same time as looking at the specific experience of being a doctor,we pay attention to discussions away from the medical arena. So what’s the way forward?

Prevention is better than cure

Burnout is the reaction to chronic stress. But what causes stress to one person can be somethings that others have learned to take in their stride. The requirements for junior doctors to learn cause, diagnosis and treatment of disease and how to interact with patients are obvious. But we must also remember that the earlier that they learn good coping mechanisms, the more likely we are to retain beliefs, energy and enthusiasm. So dedicated efforts to gain planning/organisation skills, the ability to have difficult conversations with colleagues and understand the UK healthcare system are also essential.

Leaders have a responsibility to encourage and facilitate such development. In addition, this quote should provide some nourishing food for thought:

What we call burnout, that sense of despair, hopelessness and loss of joy is not due to a failure of the individual. It is a failure of the environment they work in, the culture of the workplace, the workload imposed on this.

Professor Andrew Goddard, RCP president

Leaders have a duty of care for those who work for them. So, it follows that leaders also have a duty to develop their own abilities in creating real teams, becoming more organised, addressing bullying and the problematic subcultures and delivering change via positive behaviours.

What steps are you taking to sustain the fire and prevent burnout?

Stephen McGuire – Managing Director

It’s official. We’re Excellent!

Excellent rating from TrustPilot

We’re delighted to see that TrustPilot now rate us as Excellent. That’s based on a total of 849 reviews from doctors who have used our CPD accredited courses over the past few years.

We invite every single doctor who attends one of our courses to post a review if they wish. They don’t have to. So we’d like to thank each and every doctor who chose to take the time to write a review and make your thoughts public.

All of these comments are available unedited and publicly visible and we respond to each and every one. So you won’t just see the numerous excellent five-star ratings that make us so proud. No-one is perfect. The good, the occasionally bad and the rare ugly comments are out there in the open for all to see.

The value of feedback

We build the topic of feedback into many of our courses. It’s a fundamental element of good team-communication. It’s essential for teaching, leadership and management alike. So we regularly explore the need for doctors to talk to each other about their concerns, the impact that actions have had on them or others and what needs to change. They also need to reinforce what is going well. And this cannot simply be limited to annual, anonymous, digital form filling. There needs to be conversation. Unfortunately, there is plenty evidence that there are major shortfalls across the medical profession in this respect, which is why feedback is a regular topic for my blog posts.

We don’t just rely on our TrustPilot reviews. We also ask every delegate to provide us with written feedback at the end of each course. This let’s us identify what we’re doing well. That let’s us spread best practice across our Faculty of Tutors. It also let’s us know where we’ve fallen short, what’s got in the way of our learner’s progress and what else our doctors would like. That means we can continually address issues and build on our strengths.

Openness

The importance of privacy and confidentiality is regularly discussed in relation to feedback. However, the TrustPilot website reviews go beyond regular feedback as the comments are out in public. That’s our choice. Such openness provides added incentive for us to tackle issues as and when they arise. The reviews also help us to celebrate our successes. The desire for improving our trends and our overall rating gives us motivational targets to aim for.

There are some similarities here to the public ratings which providers receive from healthcare regulators, such as CQC. It’s all too easy to feel under attack and disagree with some reviewers opinions when a poor rating is received.

How effectively are you channeling feedback, reviews and ratings into performance improvement?

Stephen McGuire – Managing Director

Ready Doctor? Er… No!

Traffic lights at amber

New junior doctors feel unprepared for work. That’s the stark headline in HSJ where they report on an interview with Professor Wendy Reid, Medical Director and Executive Director of Education, Health Education England. Dr Reid goes on to describe the problems being encountered by new doctors as they leave medical school and take up their first roles in hospital.

It’s more than just finding themselves in a new hospital environment. It’s more than finding themselves working with new people they have never met before. It goes well beyond just moving to a new town or city away from family and friends – and that’s a major life transition if ever there was one. Professor Reid is making a point about how well medical schools are preparing students to actually work as doctors.

But let’s concentrate on the human aspects of the new doctors’ experience. Let’s consider the culture they discover when they arrive in their new placement.

Problematic subcultures

The General Medical Council recently published a report titled, “How doctors in senior leadership roles establish and maintain a positive patient-centred culture.” This document describes five problematic subcultures which exist in many areas of the NHS. It includes:

  • Diva subcultures where self-centred dominant people are allowed to get away with inappropriate behaviour while everyone else make adjustments to avoid confrontation.
  • Factional subcultures where mismanagement of disagreements lead to people choosing sides and organising themselves around the conflict.
  • Patronage subcultures where there is reluctance to challenge highly respected, well-liked and/or supportive individuals through dependence or loyalty.
  • Embattled subcultures where the constant pressures have led to collective feelings of being under attack and/or hopelessness.
  • Insular subcultures where people have become isolated from the mainstream, either geographically or psychologically, leading to deviations from accepted standards.

Any of those sound familiar? It’s worth thinking of this list as a Venn Diagram because it’s not unusual to find more than one of these subcultures existing within one single group of people.

Now pause and think. What impact are these subcultures having on the latest cohort of new junior doctors? In the short term, will they simply join in and participate in these problem groups? Long term, what will they “learn” from experiencing bad examples? Some of them may recognise this is not how things should be and take positive action. Unfortunately, many may simply learn how to become part of the problems. If this is the case, then the subcultures will not only persist. They will grow. The cycle goes on. Year after year after year.

Breaking the cycle

Let’s return to that HSJ interview with Professor Reid. “Positive investment [in education] and training is how you get the workforce you need.” “It’s not just about recruiting more medics but also how they can be used differently in the system.”

Healthcare workforce education and training has to go beyond the natural sciences and technical sciences. There is a wealth of social scientific development which has great benefit to patients, workforce and organisations alike.

There’s a popular drive toward development of leadership skills for doctors. This should be applauded. But are we developing people to lead individuals or to lead teams? If the toxic subcultures are to be addressed, then there’s a need for both. Leading people requires you to develop clear understanding of them as individuals. Leading teams requires you to develop clear understanding of team dynamics.

You have to learn the differences between healthy teams and dysfunctional teams. You have to learn how teams develop and why they can go wrong. And you have to learn how to resolve problems when they occur.

The best leaders don’t just strive to develop both their individuals and their teams. They recognise that they are not alone. So, they recognise they must form and participate in leadership teams. Team communication skills are therefore a fundamental building block of great leadership skills.

What steps are you taking to develop your team communication skills?

Stephen McGuire – Managing Director

How to make something invisible

Someone invisible through camouflage

Think about your most recent journey to work. You might have driven, used public transport or walked. From the moment we left our front doors until we said hello to our colleagues our individual journeys will, in many ways, have been unique. But we all have at least one thing in common. We were constantly being bombarded with information.

There were information signs, warning signs and advertisements. There were words, symbols and pictures. Bleeps, bells and dimpled paving stones. But how many did you pay attention to?

There are two main points to consider here and they have direct relevance to leadership and management.

Overload and familiarity

The first problem is that there’s just too much information around. If we all took the time to read or interpret everything available then we would grind to a halt. We can’t possibly pay attention to everything. So, we have to be selective. And that’s where the second problem comes in – familiarity. Why should we pay attention to anything we’ve seen repeatedly again and again and unchanged when there’s so much information vying for our attention?

Quite simply, the easiest way to make something invisible is to leave it unchanged.

We have a sign on the door of our office which says, “Please check that all windows are closed before leaving.” We put it there as a reminder after forgetting twice within a two week period. But, two years on, how often does anyone take any notice of it now? Well, the recent early morning incident with the pigeon should be a clue…

Have a look at any notice board in your workplace. How long have the various posters and messages been there? How many are still relevant? Are any of them out of date? And how many of them would you have noticed if you hadn’t made the conscious decision to go and look at them.

An issue for leadership

How clearly and explicitly do you feel your teams goals are defined? When we asked over 200 doctors this question 21% of them responded either “Not at all” or “Not enough”. Our study was published in BMJ Leader. You might be puzzled by that response. After all, aren’t the team goals clearly defined on the notice board?

We also asked the same participants, “How effectively do you discuss progress towards these goals with your fellow team members?” In this case, 40% responded either “Not at all” or “Not enough”.

What are the chances of success if one fifth of a team are unsure what they are trying to achieve and two fifths are unsure if they are making progress or not? And how well are all those new team members who are joining fresh from medical school or latest training rotations being briefed? What about the locums who are covering holidays?

Learning from advertising

The numerous marketeers who place advertisements on radio, billboards and television are experts in grabbing our attention. They know all about invisibility phenomenon. So they change things regularly. They make sure that we are exposed to their message in different ways, in different places and at different times. And they make sure that we see, hear and feel their message in a manner that that is relevant to us.

What are you trying to change or achieve?

How visible or invisible are your goals to your team?

Stephen McGuire – Managing Director

A steep ‘forgetting’ curve?

There are likely to be a lot of unfamiliar new faces around you at the moment. FY1’s are taking their first steps after completing Medical School. FY2’s are starting their next rotations. The latest recruits are beginning their various specialist and core training programmes. And it won’t be long before the newest batch of university students turn up. We’ll often say that they are on a steep learning curve. But, if you are involved in supporting their development, whether formally or informally, then there’s another important question to consider.

How steep is their forgetting curve?

It happens to us all. You’re a qualified doctor. So, you must have passed your university exams in a broad range of subjects. How well would you get on if you were to re-take these exams today? Would you pass with flying colours as you once did? Or would there be fundamental gaps in your knowledge or skills?

Our initial learning curve is quickly followed by a forgetting curve. This was described by Hermann Ebbinghaus way back in the 1880s. He even proposed algorithms to describe the curve’s decay rate.

We see this forgetting curve played out over short time-scales with regular frequency during our Teach the Teacher Courses. Our delegates each have several opportunities to practise teaching their fellow delegates. So they also have numerous experiences of being taught, learning new skills or new information. It can be remarkable to see what they manage to achieve in just 10 minutes. And it can be surprising how little they have retained just half an hour later.

Optimise learning. Minimise forgetting.

Without doubt, there’s a lot to be learned. So, you have a lot to teach. All too often, this means we go too fast. We try to ‘maximise’ learning, to get as much done as quickly as possible.

Let’s consider the idea of “See one. Do one. Teach one.” It’s a fairly common phrase in the medical world. But is it really a good recipe for the consistent transfer of skills? The forgetting curve means the output of this approach is more likely to be, “See one. Do one. Forget one.” Even worse, it could turn out to be, “See one. Do one. Teach something that isn’t actually correct.” And the consequences of that should immediately set alarm bells ringing.

Clearly, the learner has a significant responsibility here. The teacher can’t actually do the learning for them. But, at the same time, the teacher’s approach can make a significant difference.

Think of the last time you were teaching someone something. How would you describe the balance of your focus in the following two domains:

  1. Acquiring knowledge or skill
  2. Retaining the knowledge or skill

We’re wasting our time if what we teach isn’t going to be retained. So, it makes more sense to try to ‘optimise’, rather than rushing to ‘maximise’ learning. At the same time, it’s important to take steps to minimise forgetting. A well judged pace for initial acquisition, combined with an appropriate degree of repetition and assessment over a period of time is always going to be more effective than “See one. Do one.”

But you might think, “Doesn’t this idea of minimising forgetting sound negative?”

A positive alternative

Understanding the realities and reasons for the forgetting curve helps to clarify the issue. The positive alternative to ‘minimise forgetting’ is to ‘maximise retention’. Focus on pace, repetition and assessment is just one consideration in achieving this. A teacher whose approach is firmly grounded in all the theories of adult learning will aim to facilitate efficient acquisition and help to maximise retention.

What steps are you taking to manage both learning and forgetting curves of the doctors you are supporting?

Stephen McGuire – Managing Director