Monthly Archives: November 2012














Will it be on the exam?

In-class exams may well be one of the most stressful – and for some, traumatic – experiences in a student’s life. This truism came front and centre last week at a certificate program I was teaching, geared to seasoned interprofessional practitioners. The varying responses to our in-class, summative, multiple-choice exam tended to cluster around the less enthusiastic end of the spectrum.

Why are exams so aversive?

One obvious reason is that they can be high stakes, as in this (admittedly oversimplified) equation:

high grades = approval + scholarship $$$ + grad school admission

Another reason may have to do with lack of autonomy: we didn’t write the exam questions, and we generally can’t know – or in many cases – anticipate – them in advance. And people inherently strive towards personal autonomy.

But I think that radical pedagogical analyses get closest to the crux of the matter, in their critical interrogation of power dynamics in the classroom, the stance of the professor as “expert”, and framing of “curricular content” (for example, Laura Béres 2008 article).

Constructivism frames learning as socially constructed by learners, where learning is meaningful and relevant to real life. In-class exams are, by nature, removed from real life and focus on content domains that the instructor sees as key.

This can be an uneasy alliance in progressive classrooms, and one that I am still struggling to reconcile… Especially in a knowledge landscape where locating information should take precedence over memorizing information (see Julio Frenk’s influential report in the Lancet, “Health professionals for a new century: transforming education to strengthen health systems in an interdependent world”).

Closing thought:

Exams do stimulate affective arousal, which is associated with enhanced memory retention. I’m just not sure that those memories correlate well with the exam content!











What to do when it’s just you and several hundred people

Big room, big crowd, big sound system. It’s all about a big performance, right? In fact, the opposite is true. In my experience, larger audiences mean that it’s even more essential to take the approach of a one-on-one conversation.

What does that look like in the context of one presenter and hundreds of participants? Here are a few tips to keep in mind:

Talk to the audience as if you were at a really great social event with a group of professionals. In other words, you are kind of on your best behavior, but you can still be spontaneous, authentic and funny.

Tell stories – lots of stories. People are hard-wired to respond to, and remember, stories, so come prepared with anecdotes and examples. These can be some combination of work, practice or personal illustrations of key points. Just keep things brief and to the point.

If you’re using slideware rely on images versus text. This is a good principle for presenting to any size group, but it’s even more relevant with larger audiences where the sightlines may not be as good from every vantage point in the room.

Audit your presentation with a non-expert who has a really short attention span (I suggest a teen-ager). What parts of the talk do they like? Where are they bored? Adjust accordingly.

Promote direct interaction using methods such as: Individual reflection (“Write down the first thing that comes to your mind in response to the following statement…”); Peer-to-peer conversation (“take two minutes and turn to the person next to you and talk about…”); Rhetorical questions (“What would you do in the following situation?”); Video or audio clips with direction (“As you’re looking at this video, here’s what to watch for…”); A call to action (“What’s one thing you will commit to practicing after this session?”).

Reflect what’s happening in the here-and now. Is the room too cold or too warm? Are people tired or hungry? Is there an interesting event that’s all over the news? Acknowledge the “meta-context” in which the session is taking place.

I love giving talks to large audiences: the dynamic energy that happens when lots of people come together is socially infectious. It’s not you versus them – you’re all in it together.








Utility + ease of use are what really matter


Recently, I was asked to give a Keynote Address  at the 2012 Ontario Association of Social Work annual conference outlining the “digital communication power tools” for social workers and other practitioners. Although I’ve taught an online graduate course for the past 10 years and have a longstanding interest in digital communication and online applications, I’m nowhere near as expert as the teenagers in my life.

However, the beauty of a “beginner’s mind” means that I can comfortably NOT be an expert – in anything – and still have something to share, in a spirit of exploration and adventure. And that is precisely the stance from which I developed the talk.

The three areas I covered (social media, online collaboration and e-therapy) are roughly overlapping, and provided a pretty broad terrain in which to navigate. The 250 or so practitioners at the conference included super-users, newbies, young and not-so-young, and all of us keen to better understand the ways in which these tools (because they really are just tools) can contribute to professional practice.

I think the most important take-away comes from the Technology Acceptance Model, where in one study, age and busyness of practitioners were not associated with uptake of social media in medical practice – rather, ease of use and utility of the applications influence attitudes, acceptance and behaviour. In other words, busy, old practitioners can and will use social media tools if they are accessible and relevant!

Here are the annotated slides (with Speakers’ Notes):  Digital Communication Power Tools

Also on Slideshare if you’d like to experience the session via social media.










Are the most important health care competencies the ones that can’t be taught?

 What, in your opinion, are the core competencies for practitioners working with women and girls who have concurrent mental health and substance use problems?

This was the question that I posed to a group of about 100 interprofessional clinicians at a recent conference session titled “Women and Concurrent Disorders (Addiction and Mental Health)”.

I posed the question before referencing the core competency domains identified by the Substance Abuse and Mental Health Service Administration’s 2011 document Addressing the needs of women and girls: Developing core competencies for mental health and substance abuse service professionals:

 SAMHSA Core Competency Domains

Sex and gender differences

Relational approaches in working with women and girls

Family-centred needs

Special considerations during pregnancy

Women’s health and health care

Interprofessional collaboration

I was curious to hear what this group of experienced and seasoned health care providers had to say about the core competencies that were top of mind. Without hesitation, hands went up and people called out examples: 

Practitioner-Identified Core Competency Domains







It’s striking that no one mentioned any of the SAMHSA competencies, which focus on domain-specific knowledge and skills. Rather, the areas addressed by the audience emphasized process over content. Now, this is not to minimize the centrality of scientific and clinical knowledge and skills. Healthcare consumers expect this of us, and we as professionals expect it of ourselves.

But in those moments when the group named these key areas as most important, we collectively moved to the tacit underpinnings of excellence in healthcare: the human interactions that form the basis of helping. The things that are much harder to teach – if we can teach them at all.

View the full presentation on slideshare 

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