The Center for Medical Simulation

Debriefings are often delayed and diminished by questions the asker already knows the answer to. “Wouldn’t it have been better to give epinephrine faster?” “Did it occur to you to have a family meeting?” And when asked why they don’t just share what they clearly think is the answer, the debriefer will often say something like, “It’s better for them to come to the answer themselves.” But we aren’t really asking the learner to come to an answer with these kinds of questions—we’re asking them to read our mind, and then to agree with us once they do. There’s no opportunity for them to understand their own thinking better. Today’s episode will try to get you ready to live with the discomfort of not knowing the answer you’re going to get for long enough to ask a genuinely curious question in debriefing. Workout of the week: Every day, ask one truly open-ended, curious question—one you don’t already know the answer to. Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822 Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/ #healthcaresimulation #medicine #nursing #debriefing #podcast

Dr. Catherine Allan, Director of the Cardiac Care Unit and Inpatient Cardiology at the Cleveland Clinic joins us to talk about readiness for teams to perform pediatric ECMO, a high-risk, high-complexity therapy that staff might only see a third as often as they see patients on ventilators. ECMO can also be called for during CPR, which greatly increases the time pressure and complexity of the procedure. During ECPR, there is not only the ICU resuscitation microteam but also the surgical team and the perfusion team, leading to potentially having up to 20 people working in the room when running an ECPR case. We discuss how leaders can help connect seemingly imposed efforts like checklists and huddles to what it is that frontline workers are trying to achieve and are meaningful to them, and how simulation program designers must do the same in order to make sure that training is not a top-down checklist but rather a mutually owned process that gets teams where they believe they need to go. Host & Co-Producer: Chris Roussin, PhD, Senior Director, CMS-ALPS (https://harvardmedsim.org/chris-roussin/) Producer: James Lipshaw, MFA, EdM, Assistant Director, Media (https://harvardmedsim.org/james-lipshaw/) Consulting and readiness with CMS-ALPS: https://harvardmedsim.org/alps-applied-learning-for-performance-and-safety Dare to Be Ready on Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP Dare to Be Ready on Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Just in time for the Thanksgiving Holiday— the CMS Book Club reviews “How to Avoid Awkward Silences” by Patrick King! “You set the tone for how people react to this… when you act awkward and diffident, people feel awkward and diffident.” Join us as eight learning conversation experts debate the value of silence, and how we can get the conversation back to flowing when we feel like we’ve lost touch with what’s happening in the debriefing room, classroom, or around the family dinner table. Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Why is it so hard for healthcare educators to share what they actually think in a debriefing or feedback situation? Jenny shares the story of a participant in an anesthesia clinical simulation who helped guide her to be more transparent: “I’m often talking to providers on the worst day of their career, after a medical error has occurred. If I’m going to ask them to be honest with me about what they were thinking, the least I can do is be honest about what I’m thinking.” Over the years training faculty in feedback conversations, we’ve run into many who ask, how is it helpful to tell my learner that I think they’re an idiot? But telling the person what you think honestly should not be your feelings or attributions about their character. It should be the impact of their actions, which exist at the level of concrete data. Workout of the Week: Practice saying to people, “When you did x, it led to y.” One great feature about this workout is that you can use it for positive things! “When you stayed late to help me with that report, it lowered my stress level.” Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822 Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

When we lead a conversation where we only bring our conclusions and inferences to the table, rather than the concrete data that helped lead us there, we are influencing (sometimes unjustly) what is even discussable among our teams. By going back down to discussing the data that helped us shape those conclusions, we can make conversations and meetings more fair, more equal, and more productive. Workout of the week: Note when you have gone up the ladder of inference to a conclusion about a person and perhaps lost track of the data that led you there. Then, go back down and incorporate the data into an observation. Example: “She was defensive” is an inference or conclusion. Go back down the ladder to the data and turn it into an observation: “I observed that she crossed her arms and said, ‘I don’t know,’ twice.” Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822 Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/