mail full mailbox

 

 

 

 

 

 

 

 

 

Unsolicited advice is the junk mail of life (Bern Williams, in Miller & Rollnick)

Compassionate listening – stepping back and allowing learners to individually explore their ambivalence, concerns and ideas about an issue or concept – is at the crux of individual discovery and adult learning.

Here’s the rub: as educators we want to support student success, so when we see someone heading in the wrong direction or struggling, we’re often galvanized into action with all good intentions! This “Righting Reflex” is essentially the imperative to do something…to “fix it”, and often kicks in without any conscious awareness (see Miller and Rollnick’s 2013 text on Motivational Interviewing).

To add clarity: A a quick illustration of the Righting Reflex from a conversation I had on my way in to work this morning (for real):

Me: “I’m thinking that I’d like to buy a Smart Car.” 

Significant other: “Well what about a Honda CR-V? I know someone who has one for sale.” 

Me:   ?   !   ?

O-kayyy…How useful was that unsolicited (albeit well-meaning) advice in helping me think things through? And, to be fair, my own Righting Reflex isn’t hard to activate in both personal and professional spheres. Learner autonomy as being at the heart of constructivist approaches is widely discussed and accepted, yet in practice it’s “simple but not easy”.

In an ideal world, educators validate, explore, question. They evoke and encourage students to critically examine different sides of an issue. This doesn’t negate our roles of teacher, guide or concerned other, but it does place the onus – quite rightly – on the learner’s capacity for decision-making and problem-solving.

A big part of education in health care (and other fields) is less about teaching the correct answer, than in facilitating the process of ethical and nuanced judgment and decision-making. If we can resist the Righting Reflex we’re creating a positive space in which to explore, experiment and make mistakes.

So…as for my own automotive decision-making process…a design endorsement by the MOMA may just tip the balance!

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The brave (not-so-)new world of online learning

I have an online graduate course starting next week – this is my 11th year teaching in the “virtual classroom”, and the new term has put me in mind of some of the most valuable learning I have gained through experience, course evaluations and student feedback. Here are my Top 3:

1. Put out the welcome mat

Universities and organizations generally have a standardized, branded Learning Management System (LMS). The LMS is the platform in which the online course is delivered, so your customization options tend to be fairly limited. In other words, it is your words – versus the overall site design – that are key to a positive first impression.

For example, is the first announcement or discussion posting focused on technical instructions and course requirements? Or on how you will support students’ success in the course, and how enjoyable and inspiring the collective learning journey will be? Time spent crafting a warm and positive welcome helps set the stage for group safety and engagement.

2. Generate controversy

If fostering meaningful critical discourse is challenging in traditional classrooms, it can be even more so online. Students often feel more inhibited when posting messages as opposed to speaking up in face-to-face groups. And online conversation can quickly take on the flavour of a series of rather stilted “mini-essays” unless you model and shape conversational threads.

One effective way I’ve found to stimulate authentic and lively conversation is to post about a controversial topic related to the course content – preferably something that links to a website, video or social media site, or all three. In my addictions course, this might be the way that addiction is portrayed in popular media, and how that connects to broader theories of addiction. Now the class is critiquing theory in a context that highlights real-life applications and relevance.

3. Over-communicate but under-state

Over-communicate because people don’t read. That is to say, they read, but tend to skim or miss points that are buried in the “fine print”. It’s better to make the same points in different ways across the learning platform or course tools in order to ensure that no one gets lost or left behind. This refers to issues that are process-related (like assignment deadlines, accessing technical support or how students will be graded), as well as content-specific (for example key definitions, essential points or important references). In my courses I try to reinforce communication using discussion forums, weekly overviews, course announcements and email to make sure that everyone is on board and on track.

Under-state because there is a phenomenon associated with text-based communication known as “emotional magnification”. Without visual cues, the same content delivered in person with no ill effects can be experienced with greater emotional intensity and negative valence when delivered online. We’ve all experienced this in email and other digital communication modes, and the consequences can adversely impact the positive learning community you’ve worked so hard to foster. Special care in providing corrective feedback is warranted, and this is especially critical in group discussion forums.

There is lots more to online teaching than captured here, but these are my “Top 3” and will be front of mind for me next week as the new term starts.

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What (and who) inspired me in 2012?

As the calendar clicks over to 2013, it’s an opportune time to reflect on some of the inspiring tools and ideas that have engaged me over the past year – and will continue to have traction in the coming year.

Here is a reverse-ordered list with lots of links to explore. Happy New Year!

10. Playlists: Every course (or presentation) needs a good soundtrack. Songza is an auto-playlist-maker recommended by Mary Nisi on NPR’s technology blog

9. Infographics: We can all do a better job at presenting complex ideas visually and elegantly. Here is a List.ly List of infographics tools

8. Presentation Zen: (Re)imagining visual communication – Garr Reynolds has been a big influencer on my own presentation style and content

7. Personal Learning Networks (PLNs): The whole really is greater than the sum of its parts

6. Gaming: Networked learning and simulation can benefit from the principles of successful, immersive and authentic hi-fidelity game environments – and this is progressing in medical simulation in Canada and worldwide.

5. Virality: What is the “replicability factor” intrinsic to certain memes? How can we infuse knowledge products with that same DNA? Check out some emerging research by Berger and Milkman (2012) What Makes Online Content Viral? and Stanford now offers an online course on viral marketing

4. Another MOOC MOOC by Hybrid Pedagogy: Because information wants to be free

3. Motivational Interviewing: A clinical approach that maps equally well to teaching and learning

2. Y Combinator: A model with applications for curricular innovation, education research and student engagement?

1. Social Inclusion: Anyone can learn if they have the tools – like the instrumental support pioneered by the World Braille Foundation: Braille = Equality… Why? Because literacy is the key to opportunity, economic security and freedom. Yet in many countries 95 per cent of blind children don’t even attend school due to lack of skilled teachers and limited access to Braille materials.

This international foundation is dedicated to promoting literacy, independence and empowerment to blind persons, with past and current projects in Kenya, Swaziland, Niger, Burkina Faso, Mali, Liberia and Lesotho. I make a donation every year. Plus, full disclosure, the WBF was started 10 years ago by my dad, Euclid Herie, and my #1 inspiration!

gift wrap

 

 

 

 

 

 

 

 

 

 

 

Wise words from a school principal

Grade 8 graduation – lots of speeches, uncomfortable chairs and a few fleeting moments when my own grade 8 grad is on stage for the bestowing of the diploma. Who knew that a few thoughtful words by the school principal at the end of the ceremony would capture with absolutely perfect clarity the essence of what it is to teach (and learn)?

This principal was moving on to a position at a new school, so it was his final address and farewell. I don’t remember much of that final speech, with the exception of the last sentence:

“Most of all, I want to thank you students; you gave me so much more than I ever gave to you.”

I was struck by those words as a container for everything that’s important in teaching and learning. The stance of attention, humility, curiosity, openness, collaboration, gratitude and honouring the other.

Those words were a gift and an affirmation of the truest meaning of “teacher”.

So in the spirit of the holiday season I’m passing the gift along. Thanks Mr. Beatty.

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It’s not rocket science

In a recent article in the journal Medical Education, Dr. Glenn Regehr champions a radical rethink of education research. Drawing on insights and advances in subatomic and macro physics, he argues against the imperatives of proof, generalizable solutions and simplicity (all drawn from the prevalent theoretical and methodological approaches in medical research broadly). Instead, Regehr suggests that we embrace the construct of uncertainty (“elegant messiness”) in unique education settings (“context is the irreducible covariate”).

Does a narrow focus on the success of medical education initiatives diminish the utility of education research? Here is Regehr’s thinking, with which I’m inclined to agree:

“Rather than dwelling on the questions of what is going on, we jump straight to the issue of whether it worked. We keep tweaking when the answer is ‘No’, but are satisfied as soon as the answer is ‘Yes’. We celebrate and publish our positive results as proof of our rightness and treat the negative results as ‘failures’ to be ignored or even buried. As a result, the information we share with the larger education research community through the talks we give and the studies we publish tends to feel more like a ‘show-and-tell’ exercise than an engaging and challenging contribution to the community’s understanding of learning processes and education practices.”

These are brave words, especially in a field that has historically privileged positivist epistemology over interpretivist approaches (a debate for another day). Yet the parallels between dynamic systems described in chaos theory, and its application to learning contexts and communities, are striking.

Both are highly context-sensitive and characterized by an “exponential growth in perturbation.” In other words, while all education settings have broad similarities, it is their unique and particular differences that matter with respect to learning outcomes and applications. Small contextual variations (perturbation) can lead to massively divergent results (that’s the exponential growth part).

Take-home messages and food for thought:

Competence isn’t contained within an individual practitioner – it emerges via interaction with an always-changing context.

Education research should focus on sharing new and better ways of thinking about clinical teaching/learning problems, issues and assumptions.

We need a shift from showing what we did right, to articulating what we learned along the way.

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How can we bridge the teaching/learning gap?

 

The evidence-based clinical practice model that I use and teach, Motivational Interviewing, is a respectful and collaborative way to talk about change with people who are ambivalent or unwilling.

In fact, conversations about change are clearly relevant beyond counselling, therapy or health care. The new edition of Motivational Interviewing by William Miller and Stephen Rollnick outlines four essential processes that map well onto processes of adult education, particularly in contexts where learners may be less than enthusiastic. These processes are somewhat linear but also recursive –  one naturally leads to (and provides a foundation for) the next, but we may also circle backwards and forwards as needed.

1. Engaging:

This is about establishing a relationship with the group and creating a positive learning community. Is it safe to speak up, disagree, critique and explore? Meaningful discourse hinges on successful engagement.

2. Focusing:

Engagement comes first, but it is also important to understand and highlight the relevance of the topic/learning objectives to real world problems and issues. What will I learn, and why should I care? How will mastering new knowledge and skills make my work easier and better? Individuals may raise topics or issues that instructors hadn’t anticipated. These are the burning questions that need to be resolved through successful focusing. Optimally, adult learners are engaged in co-creating curricula.

3. Evoking:

Learning is 100% volitional. Constructivism and paragogy mark a shift from installing knowledge and solutions towards evoking these. Although faculty bring expertise to the table – and we shouldn’t shy away from sharing this – a motivational approach presupposes doing so in partnership with learners, and with a spirit of nonjudgmental acceptance and compassionate empathy.

4. Planning:

We’ve engaged learners in an active partnership, linked curricula to real-world issues, and evoked new connections, insights, ideas and approaches. Now what? Identifying implications for practice and committing to an action plan are key. The planning process helps bridge the gap between learning and life. If new learning has no real-world implications, then we’ve missed the boat somewhere along the way.

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Just how important are your academic references for grad school admission?

I’ve written my share of academic references – never more so than the last couple of months, where one candidate requested a record of twelve (yes, that’s 12) separate letters – but I’ve never served on a university admissions committee. I’ve always been curious about their importance relative to other factors like grades, personal/research statement, publications and relevant experience. My curiosity was finally satisfied when I found myself sitting next to just such a person on a train (currently reviewing candidates for a competitive university program) and we got to talking.

The short answer is VERY IMPORTANT – and although I always knew that excellent references are key, I didn’t appreciate the full extent of their influence.

So, in the interests of supporting would-be grad students everywhere, here are some tips from the perspective of a referee:

1. Be strategic. Is it better to ask a more junior instructor from a small class you loved where you got an A-, versus a tenured, senior faculty member where you got the same grade in a large class you weren’t so enthusiastic about (and not sure the prof remembered anyone’s names)? Rest assured that the sessional might not remember individual students very well either, and the answer should depend on…

2. How will this person rank me relative to what comparison group? In my 10 years of writing reference letters, I have never been asked this question directly – yet this is the most crucial question you need to ask your referee. You are looking for someone who is going to rank you in the top tier, across all categories if possible. Let’s look at the previous example: Is it the junior prof’s first year of university teaching? If so, even a ranking in the top 1% of 20 students probably carries less weight than the seasoned, tenured prof’s ranking in the top 5% of 5000 students. Ask the question – if you don’t like the answer maybe it isn’t the right person.

3. Send your referee a summary of the personal accomplishments and key points you want to emphasize in your application. And can I add that writing clearly and concisely, without errors in spelling, punctuation, grammar and syntax should be a given. Trust me, if I disagree with you I will edit. If I agree I will amplify. I will also add my own content. Sending me only your CV and personal or research statement makes it harder to write the best letter I can for you.

4. Follow up and say thank you – whatever the outcome. This obvious courtesy is not always observed, and you might need me again when you decide to apply for your next degree.

5. Don’t give up! This isn’t really a tip about reference letters but I am adding it because grad school applications are a lot of work, and so discouraging when there is no offer. Keep applying and consider spreading your net a little wider next time.

Just please don’t ask me for all twelve letters at once?

 

 

 

 

 

 

 

 

 

 

 

 

 

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

Empathy

Respect

Trust

Compassion

Listening

Care

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 

 

 

 

 

 

 

Network of networks = your very own PLN

 

Today, there’s no problem finding information – the challenge is sifting through and locating the right information at the right time. And not just the right information at the right time – it’s also about access to tools and ideas that you never even knew you needed until you saw them. That’s where PLNs come in.

In the olden days before the advent of online academic journals and research databases, I always made at least one serendipitous discovery while browsing library holdings or leafing through print materials. I would be scanning a row of books looking for a particular call number, and suddenly notice a different book that was a great fit for some other topic I was researching. It’s hard to replicate that kind of happenstance when digital searches yield a specific document or information source with laser-like precision.

Plus, learning is not just about acquiring information – paragogy (a.k.a. the new andragogy) views learning as inherently non-linear and socially constructed via networks/peers. So PLNs – because they’re naturally hyper-textual and social – fit beautifully within a paragogical frame.

This article about PLNs at edudemic.com gives a great overview and rationale for the functions of various social media tools in building, customizing and contributing to your own composite, ongoing knowledge stream. Your very own PLN.

3 tips for success

 

Students want to know: “What do I need to do to succeed in this course?”

 

As in many things, the answer is simple (but not always easy). At the start of each semester I share the following three elements that, in my experience in university teaching, almost always translate into academic success.

  1. Show up: If you don’t actually come to class you miss important stuff.
  2. Be 100% present: If you show up and spend the class on your smartphone, you’re not really present.
  3. Do your homework: The real learning happens outside the classroom.

BUT here’s the caveat: It’s a three-legged stool. You need all three elements or you “fall off” (and if you start shaving away any of the legs, it gets a bit wobbly).

And I’ve found that these are pretty good rules to live by in life generally, whether in work, relationships, travel, and so on. When things get complicated it’s nice to take it back to the basics!

 

 

 

 

 

 

 

 

Your USB key is corrupted, and by the way the handouts weren’t printed

 

Bad deam? Worst nightmare? Or maybe the best and most productive 90 minutes possible. I’ve read that the Chinese character for crisis represents danger + opportunity, and nothing could be truer. This unwelcome scenario happened to me today when presenting to a small group of Medical Residents on the topic of Motivational Interviewing.

The moment I realized that “Plan B” (the handouts) was not an option, I decided to use (and trust!) the principles of Motivational Interviewing (captured by the acronym “A-C-E”, Autonomy, Collaboration and Evocation) as the foundation spirit for my approach. In other words, it’s all about relationships, and my primary goal was establishing a relationship with the group to help facilitate meaningful practice and learning.

So…what did we actually do? I demonstrated Motivational Interviewing skills with a volunteer who agreed to talk about physical activity and exercise as a hypothetical change goal  (a “real play” versus a “role play”). Frequent pauses, critical reflection and discussion allowed key points and clinical skills to emerge organically. In the second half of the session, the whole group participated in another activity focused on practicing – and again critically interrogating – reflective listening skills. We closed with each person articulating a specific practice goal based on their learning.

It’s all too easy to fall into the trap and habit of teaching as performing. In Motivational Interviewing I often talk about a “red flag” being when the practitioner is working harder than his or her patient; and today I was reminded that it’s energizing and affirming when the learners work harder than the instructor.

Maybe next time “Plan C” gets promoted to “Plan A”. That 90 minutes felt like freedom.

 

 

 

 

 

 

 

 

 

The good, the bad and the ugly

Over the last few years there’s been an explosion and widespread adoption of webinars as (in many cases) the primary or preferred strategy for delivering continuing education to large groups of geographically disparate people. It makes sense: education can be delivered in a brief, cheap and convenient form that has minimal impact on busy practitioners’ time.

But, just like classroom-based learning, there is huge variation in the quality, interactivity and utility of web-based learning. At their best, webinars are a model of multi-modal learning, with a dynamic and engaging facilitator, lots of interactive sidebar chat, and great use of visuals and reflective activities. At their worst, webinars are the workplace equivalent of a really boring TV show.

Here are a few tips culled from my own experience as facilitator and participant:

  1. It might not be a webinar: Sometimes network connections fail, either at your end or for participants. Send out a complete slide deck ahead of time and have a teleconference line just in case.
  2. I like text chat better than voice: In webinars, text chat is really seamless, especially with large groups (e.g., 100 or more). Encourage people to chat with each-other as well as the facilitator throughout the webinar. This brings me to two more points:
  3. Prime participants to participate: Most people regard online, text-based communication as more an act of publishing than as an act of speech. This cognition tends to constrain spontaneous conversation, so I ask participants to write down at least one question ahead of time. That way people are “primed” to participate, and once the ice is broken the group can really take off.
  4. You can’t do it all: With lots of sidebar chat it’s pretty much impossible to present AND read comments/questions at the same time. Having a moderator to help cue the presenter with key questions or pauses is essential.
  5. Ready for your close-up: Built-in computer webcams tend not to give the most flattering angle. Use a separate webcam for better camera postioning, add extra light, and talk to the camera. Participants want to feel connected to the facilitator.
  6. Less text more pictures: If text-heavy presentations are boring in person, they are even more deadly by webinar. (Plus, disengaged participants will toggle back and forth between a boring webinar and another, more interesting, website). Keep people engaged with well-designed content and activities.

I love the convenience of webinars, and done well they can really add value to an organization’s staff training and development strategy. The key phrase is “done well” – watching bad TV in the middle of the day is best kept for when you’re home in bed with a cold.