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00:00:01
Can you have too much Psychological Safety?
25 Plays5 months ago
VIP Lounge session with our VIP's:
Jenny Rudolph - Senior director of Innovation, Center for Medical Simulation
Mary Fey - Associate Director, Applied Learning for Performance & Safety, Center for Medical Simulation
Kate Morse - Assistant Dean for Experiential Learning and Innovation, Associate Clinical Professor at Drexel University, College of Nursing and Health Professions.
In this session we discuss psychological safety, prebriefing and the differences in prebriefing between higher education and health-based sim centres and the possibility that were are focusing so much on 'psychological safety' that potentially we are doing our learners a disservice and not preparing them for the realities of clinical practice.
Recommended
Transcript
Intro
Introduction of VIP Guests
00:00:41
Melanie Barlow
right Welcome to another VIP lounge session and we certainly have some VIPs in the house today. We have with us today all our Simulation Happy Hour hosts, Jenny Bassett, Jane Frost, Kerry Reid-Searl and I'm Mel Barlow.
00:00:53
Jenny
I love it.
00:00:55
Jane Frost
Hi.
00:01:01
Melanie Barlow
So we have three VIP lounge guests today. the first up is Professor Jenny Rudolph, who I am sure for many needs no introduction. She's currently the Senior Director of Innovation at the Centre for Medical Simulation and was previously the Executive Director of CMS.
00:01:19
Melanie Barlow
She is the lead author on the phenomenon that is with good judgment, debriefing and conversations. She's an organisational psychologist and...
00:01:31
Melanie Barlow
Proudly my long-term mentor, so welcome, Jenny
00:01:36
Jenny Rudolph
Thank you, mel Such a pleasure to be here.
00:01:38
Melanie Barlow
Next, we have Professor Kate Morse, who is a nurse practitioner by trade, but is now the Assistant Dean for Experiential Learning and Innovation and Associate Clinical Professor at Drexel University in the College of Nursing and Health Professions in Philadelphia.
00:01:55
Melanie Barlow
Previously worked at CMS where she supported faculty development, strategy and debriefing with simulation centres around the world, of which I personally benefited from her expertise and her friendship. So welcome, Kate.
00:02:10
Kate
Thanks, Mel. Happy to be here.
00:02:13
Melanie Barlow
And last but not least, Dr. Mary Fay is a Senior Director for Teaching and Learning at CMS, an adjunct faculty at Drexel University. She's previously held many academic appointments in both community colleges and universities.
00:02:31
Melanie Barlow
Mary's expertise is in faculty development, curriculum, brain-based teaching strategies, simulation and debriefing and feedback. And in her spare time, she's also a CrossFit coach.
00:02:45
Mary
ah
00:02:46
Melanie Barlow
Welcome, Mary.
00:02:49
Mary
Thank you, Mel.
What is Psychological Safety in Teams?
00:02:52
Melanie Barlow
So great group today, we're going to be discussing psychological safety, which I know has been discussed a lot before. But I guess from our perspective, we really want to understand and use your expertise to kind of ascertain, can we have too much psychological safety and can it be at the disservice for our learners and for the realities of clinical practice?
00:03:17
Melanie Barlow
So just so we're on the same page, I guess I'm going to throw it to Jenny And can you just, from your perspective, just explain like what is psychological safety and why is it so important in SIM?
00:03:31
Kate
you
00:03:32
Jenny Rudolph
Sure. Thank you, Mel. So psychological safety is a construct that emerged from my field, organizational behavior, and it was actually really expanded and explained by Harvard Business School professor Amy Edmondson.
00:03:50
Jenny Rudolph
And what was really interesting is Amy was actually a student of Richard Hackman, who was the leading teamwork researcher in our field for several decades. And Richard Hackman found that the teams that did best had certain inputs going into them, like fantastic structure, clear goals, adequate support, all that stuff.
00:04:14
Jenny Rudolph
But Amy Edmondson found there was this conundrum, which is teams could have all those amazing inputs, but they could still sort of flounder if people didn't feel comfortable with each other.
00:04:30
Jenny Rudolph
And I think that kind of intrigued her. So for her doctoral dissertation, she studied what was going on with teams and she started exploring this construct of psychological safety.
00:04:42
Mary
Thank you.
00:04:45
Jenny Rudolph
And what she found is that psychological safety is the feeling that you have that this environment is safe for interpersonal risk-taking.
00:04:56
Jenny Rudolph
And I think in the healthcare care context, we could think about that as safe for interprofessional risk-taking. And what's really important about that in my view is when you're communicating across difference or you're interacting with other people who don't necessarily think the same way you do,
00:05:15
Jenny Rudolph
What are the things that make you feel afraid, like you're going to be humiliated or you're going to be put down, or if you admit that you don't know, that will be held against you, versus situation where you could do any of those things, speak up, say you don't know, ask for help, and be supported.
00:05:35
Jenny Rudolph
And so that latter situation is the thing that Amy Edmondson found was most important. indicative of psychological safety being present.
Creating Psychological Safety for Nursing Students
00:05:47
Jenny Rudolph
The last thing I just want to say, Mel, is for us thinking about psychological safety in healthcare teams, which is another aspect of this, there's a very distinctive study that came out of Google and studied tens of their teams.
00:06:07
Jenny Rudolph
And the most important predictor of team success was psychological safety. So how we think about creating teams where people can feel safe to learn at the edge of their expertise, I think is one of the things we could explore today together.
00:06:24
Melanie Barlow
oh Thank you, Jenny. Mary, can throw over to you How do we then, if that is psychological safety, like how do we establish it?
00:06:37
Mary
Great question, Mel. And just for context, you know much of the work that I do traditionally and still is with undergraduate nursing students and undergraduate nursing faculty. And so I love the part of Jenny's description of psychological safety where she discusses being willing to take some risks without fear of being shamed or humiliated. And I think that for you know, anyone who's learning a new skill, but especially for undergraduate nursing students, that is a real motivator or a driver,
00:07:12
Mary
a real driver for their actions and the choices they make in simulation. And by that, I mean, if psychological safety is present, they're willing to dive in, give it a try, see what happens and debrief it. If psychological safety is not, then they're defensive, they're withdrawn and they don't want to participate.
00:07:29
Mary
And so when I think about what do I need to do to create psychological safety in a setting like that, ultimately what I think is when I'm done with my pre-briefing and we're walking down to that simulation, I want them thinking, okay, i'm a little bit nervous, but I trust Mary. She's not out to get me. Nothing bad is going to happen to me.
00:07:47
Mary
And so It's all those little things we do to build trust, which is relate to people on a personal basis, have a positive attitude, be welcoming, explicitly say to them, I do not expect you to be perfect today.
00:08:01
Mary
Perfection is not expected here. This is about trying on the role of the nurse and seeing what it feels like. And then when we get to debriefing, we'll put all the pieces together. And so it's letting them know what's going to happen to them, letting them know that you're on their side, letting them know that you don't expect perfection, I think, or some of the big bucket items that I think about when I think about creating psychological safety in the context of nursing students.
00:08:26
Melanie Barlow
That's so good. Thanks, Mary. Kate, how do you establish psychological safety with your learners?
Is Discomfort Necessary for Learning?
00:08:35
Melanie Barlow
What are some moves you do?
00:08:37
Kate
Sure. i think ah contextually, and we've been talking about this a lot of late with some of our learners, is sort of this idea of the the value of discomfort in the service of learning. Because I think if you lined up lot of our current both undergrad and graduate students, because we just had a whole slew of graduate students with us and we had this similar conversation,
00:09:04
Kate
that Oftentimes, I think people define discomfort as bad. You know, that's not a safe space for me. If you sort of you know, went around and said, hey, what would it mean to you as a learner to be in a space where you could take those risks and appear like you don't know things and make mistakes?
00:09:22
Kate
And increasingly, the theme of like discomfort is bad. yeah It comes up and that they want to learn without feeling uncomfortable.
00:09:36
Kate
So I think a lot of the moves that have changed for me beyond the the lovely structure that we all use and we think about in pre-briefing and the moves that Mary described underpinning the theory that Jenny described is just sitting and naming that. Like, I expect that you will feel discomfort today.
00:09:58
Kate
And that's actually good because that's in the service of learning. It shouldn't be the kind of discomfort where you want to leave, but it's enough that, you know, it's a little uncomfortable because you can't change without discomfort. You can't challenge your thinking without discomfort.
00:10:15
Kate
And Discomfort in the service of learning, not discomfort in order to, as Mary described, you know, shame, blame, humiliate learners, but understanding that if they go in with, that hey, it's okay because I'm a learner and I'm going to feel uncomfortable and I'm trying something new and it's going to be potentially hard, changes, I think, their perception.
00:10:43
Kate
And look, you can go around a circle because we had, you know
00:10:43
Mary
Thank you.
00:10:46
Kate
20 people in um and they will have very different descriptions about what that means for them.
00:10:53
Melanie Barlow
Sigh.
00:10:53
Kate
But I think we spend, i spend a way more time in pre-briefing, particularly if people are new to being in simulation, talking about like, what is it that we all have to do in this to ah ah order to engage in learning?
00:11:10
Kate
And that, what does that mean to you? Like, what's your tolerance for that? How can, you know, what can we do to support that? What we're not going to do is not give you feedback because that's not going to help you.
00:11:25
Kate
ah You know, that's not going to help you grow and develop. And if that's the expectation, like how can we sort of reset that before we go through that experience versus you coming to debriefing and being super surprised that there's clear, hopefully actionable feedback that might feel a little uncomfortable.
00:11:47
Kate
So I think I spend way more time talking about that because I find a lot of learners labeling behaviors that I would look at and go, wow, that's super clear. That's great.
00:12:00
Kate
And they're like aggressive, assertive. And I'm like, really? Wow. We come at that from such different perspectives. we try and And I'm not saying it works all the time, but try and just sort of scale that to what are we doing here in the service of learning? What can you expect? Not only just the fundamentals of the sim and things about who they are and where they are and what they're supposed to do, but also managing their own emotions around that.
00:12:31
Melanie Barlow
Thank you. I want to dive shortly deeper into that concept of discomfort.
Pre-briefing: Hospital vs. Education Settings
00:12:39
Melanie Barlow
Before we get there, so you talked about pre-briefing.
00:12:44
Kate
Mm.
00:12:45
Melanie Barlow
So I've worked both in hospital-based sim centres and in higher education. Pre-briefing is clearly important in both contexts, but is there a difference logistically in how you do it. So you, versus like hospital based, you might see people once a year, they come to the Sim Centre versus you have a class for 10 weeks straight in the same environment.
00:13:12
Melanie Barlow
And so often with kind of more novice academics, they they look at the standards and they see, you know, they need to do this full you know, half hour long pre-brief when you've only got them two hours in a lab a week.
00:13:30
Melanie Barlow
I guess I'm throwing this out to everyone, like how are the differences in how we pre-brief and why?
00:13:38
Mary
Mm-hmm.
00:13:39
Kate
Sure. I mean, I would say for my, for people that come back all the time and, you know, are regular and know the flow, they can practically pre-brief themselves.
00:13:51
Kate
And that's great. To my mind, that's like fantastic. You're already down the path. So I don't feel the need to, like I might do the same structure for, I don't know, two to three times till I know they're comfortable and they're hearing and they're listening, you know, they're able to listen to things and they know us.
00:14:09
Kate
And then I'm going to refresh, like refreshing the basic assumption, refresh it, you know, the same principles of who you are, where you are and what you're supposed to be doing is really important.
00:14:19
Kate
Is this, you know, count for a grade as this formative, who's going to know about it, like all those things, I feel like you got to say every single time, because it might be different based on what they're there to do that day.
00:14:31
Kate
But I might not do a third, I wouldn't do a 30 minute pre briefing, because they know it off by heart
00:14:36
Melanie Barlow
Yeah.
00:14:39
Melanie Barlow
So Jane, Kerry and Jenny B, do you guys have a script for your academics to say each time? Do you just rely on people knowing how pre-brief to help establish psychological safety?
Facilitators' Psychological Safety: An Overlooked Aspect?
00:14:57
Kate
Thank
00:15:03
Jane Frost
I am happy to go next, if that's all right, Jenny. We do have some training, it has struck me listening to our experts today, and and thank you very much, it's been really interesting, that maybe we also need to be looking at the psychological safety of the facilitators because we do have this reluctance of people to actually do SIM and to do SIM properly.
00:15:28
Jane Frost
And perhaps that's because they're shown or they're worried about their being shown up or not doing it correctly.
00:15:29
Kate
Mm-hmm.
00:15:36
Jane Frost
And maybe there's something around the educator and looking at how we prepare them and give them that psychological safety to take risks and to actually implement simulation that they might not be comfortable in.
00:15:45
Mary
you
00:15:53
Jane Frost
Do you have any thoughts about that?
00:15:54
Kate
Mm-hmm.
00:15:56
Jane Frost
Is that work that you've done?
00:15:58
Jenny Rudolph
I think that's a wonderful topic, Jane, and it's something I happen to be very passionate about. One of the things I've been thinking about a lot is the place from which I come as a faculty member internally.
00:16:22
Jenny Rudolph
And what I mean by that is, do I feel at peace with what is giving me credibility or what is giving me a sense of authority?
00:16:33
Jenny Rudolph
And I don't mean authority over, but I mean, am I seen as an authority by my peers?
00:16:35
Kate
Thank you.
00:16:41
Jenny Rudolph
Am I seen as an authority by my learners? And in my opinion, that authority can come from various things. It doesn't just have to come from, i know the most about how to manage this particular kind of anaphylaxis.
00:16:58
Jenny Rudolph
It could come from, I am an expert in helping people learn in this team context. So Jane, the piece, there's so much to say there, but the thing that I try to work with people most on and with myself on is do I feel entitled to be sitting here?
00:17:16
Kate
Hmm.
00:17:19
Jenny Rudolph
Do I feel um i belong? Or am I auditioning to be approved of by my students and by my colleagues? Because when I feel like I'm auditioning, when I feel like I'm not accepted,
00:17:35
Jenny Rudolph
And then that drives up my autonomic nervous system. I am not safe and social. And when I don't feel safe and social, that leaks.
00:17:47
Jenny Rudolph
And so then that social, sorry, that psychological, that emotional contagion degrades the environment for all. So I love that you brought that up. I think we need to do more about it.
00:17:59
Jenny Rudolph
Anyway, those are some initial thoughts. I'm sure others might have interesting things to say.
00:18:02
Melanie Barlow
yeah
00:18:04
Melanie Barlow
That's super interesting.
00:18:04
Mary
Thank you.
00:18:07
Kate
Can I chime in for a second, Mel?
00:18:09
Melanie Barlow
Go.
00:18:10
Kate
So i I think I did put my, I'll put my hand back down. High level performance online. I think it's such an interesting, and I don't think Jane, I approached it in the thoughtful way that you brought it up.
00:18:24
Kate
But one of the things that we did is we created, like we have a number of sort of standard pre-briefing videos that go in their online shell.
00:18:30
Jenny
Thanks.
00:18:33
Kate
We have one 10 minutes, and then we have a five minute one that when they come both for high fidelity and our we have a standardized patient lab. So, the sort of that nuts and bolts of the basic assumption, the lab, how you're going to interact, the, the, like those elements, the standard elements, they don't, the faculty don't have to worry about because they were, I think, very concerned. They might come once a year. So they never felt really comfortable with that material.
00:19:03
Kate
And then they partner with that and talk about why the students, because they were the course faculty, like, what are we here today? And what are my expectations of you?
00:19:13
Kate
And what are we going to do? So they sort of get to do the faculty piece with married with it because people were, I think, for the reason that you outlined is they didn't feel good about doing it because they didn't do it enough for it to be comfortable for them.
00:19:19
Jenny
Thank you.
00:19:35
Kate
So when you say that, I think that
00:19:36
Melanie Barlow
Yeah.
00:19:39
Kate
is probably why we did that, but I didn't think about it at the time.
00:19:43
Melanie Barlow
Yeah, I think what I try and encourage people in higher education to think about is pre-briefing is not just the bit you say before they head into the sim.
00:19:48
Jenny
Thank you.
00:19:53
Melanie Barlow
Every bit of information you have shared with the learners about that activity before going in from the learning management system to the unit outline to the is all the pre-briefing and if you have inconsistent information across those different platforms because you've changed the activity but you forgot to change the information about it in other areas is it going to lead to feeling uncomfortable and impact trust and they don't know how to engage so that consistency and I think to Jane like
00:20:31
Melanie Barlow
How do we prepare our facilitators? I don't think we put in the same thought. You know, like often we're still creating activities the week before and then hand out the session plans to faculty like days before.
00:20:41
Jenny
I see.
00:20:47
Melanie Barlow
Like that's inadequate pre-briefing and preparation for them. And so no wonder they're feeling uncomfortable. Carrie, Carrie.
00:20:56
Melanie Barlow
Thank you, Kerry. Jenny.
00:20:58
Jenny
And can I just add to that? I think one of the differences here is that we don't have an accreditation process within Australia and there are probably other countries in the world that don't have accredited facilitators, whereas, you know, there are many countries that now have accredited facilitations as a specific training program.
00:21:18
Jenny
And so I think that's something that's really important. When Kerry said, you know, we need a template. Well, if i if I've walked in as a casual staff member, to facilitate simulation, want to know what this organisation is doing. So I think that is important.
00:21:33
Jenny
And when you're teaching across many sites, you know, a lot of universities don't just teach from one central site. We, you know, we have a footprint that's quite large. So I think there are other really important aspects to think about to ensure that we are providing psychological safety for our learners and for our staff across all of those spaces.
00:21:57
Melanie Barlow
Thank you. Can I change tack slightly?
00:21:58
Kate
Thank you.
Psychological Safety in VR and Digital Simulations
00:22:01
Melanie Barlow
So years ago when, i don't know, a decade ago, when we had all these or more, fancy mannequins all came out, they're high technology, and everyone was kind of focused on the sexiness of the technology and kind of forgot about the underpinning pedagogy and importance of, you know, pre-brief and debrief or feedback.
00:22:29
Melanie Barlow
And in some aspects, I'm kind of seeing this again with the advent of VR and digital simulations. How do pre-brief then and establish psychological safety with those technologies if students are doing this asynchronously or like how do we How do we do that? Any thoughts?
00:22:55
Kate
It's very complex no i yeah you know, I'll say, i think the value of pre-briefing shouldn't just happen, as you were saying, related it to that individual learning activity.
00:23:11
Kate
i mean, i think of all the things I've taken from simulation to put in to my course orientation. And, yeah you know,
00:23:23
Kate
Some of it's in my core syllabus, like the basic assumption. And those, so it has, I think as you were saying, like it has to start at the very beginning. And if it's not there in the classroom, then it's not going to be there in VR, whether that's asynchronous VR or, you know, everybody's in a, in a shared space.
00:23:44
Kate
And I think it's equally important to still talk about it because with, out it, then we distance the students. We're modeling, and this is in my mind, we're modeling for the students that the conversation and the relational aspect, which Mary often talks about, is less important than the you know stuff, your avatar or whatever.
00:24:11
Kate
i think they're learning modalities that can appeal to a lot of people, and they may be really, really helpful. And I think they still have to be bookended by pre-briefing and debriefing of entering in and you know synthesizing learning.
00:24:27
Melanie Barlow
Yeah. Jenny
00:24:31
Jenny Rudolph
Yeah, thanks for this question, Mel.
00:24:35
Jenny Rudolph
I think we need to consider the cognitive load posed by any technology. And in my opinion, really excellent pre-briefing of anything involves the faculty having experienced that anything.
00:24:57
Jenny Rudolph
So whether it's a mannequin-based simulation, an actor-based simulation, a Oculus Rift facilitated full VR, a flat screen VR, the instructor needs to know themselves what that feels like.
00:25:06
Kate
you
00:25:18
Jenny Rudolph
And I think that is one of the biggest things missings across all of our faculty. you know So many of us don't put ourselves in SIMS enough to know what it actually feels like. And I'm just going to give a really concrete example.
00:25:37
Jenny Rudolph
I've been working with a group that uses voice and avatars to practice difficult conversations like de-escalation of a combative patient or things like that.
00:25:50
Jenny Rudolph
And just like when I'm pre-briefing somebody around mannequin sim that, you know, you're not going to get the breath sounds you might expect or the patient isn't going to diaphorese or you're not going to necessarily see cyanosis and whatever.
00:26:05
Jenny Rudolph
Similarly, when pre-brief working with an avatar, i'm going to say there's a latency sometimes when you say something to them, they don't respond as quickly as a human. But if you can solve the problem in front of you, just like you would if you were facing a combative patient, I think the simulation will gradually draw you in.
00:26:27
Jenny Rudolph
And If I do a good job of that, then when these funky, weird things happen that could break the fiction contract or break reality, it doesn't distract them because they they they remember and they were it was expected.
00:26:42
Jenny Rudolph
So I think the foundational principle of thinking about their lived experience in the sim and helping them get into it and offload anything that's distracting is sort of the same as we've always done, but requires us to know the experience.
00:27:00
Melanie Barlow
I love that because often academics or educators are too scared to be put themselves in the sim because they think they need to be the expert, yet we kind of tell our learners, go in you know, embrace it.
00:27:01
Kate
you
00:27:17
Melanie Barlow
And yeah, it's a bit...
00:27:19
Mary
Yeah. Yeah. go Go in there and do the thing that I won't do.
00:27:26
Melanie Barlow
That's so true. Yeah, that's great. Thank you for that. I want to get to, I guess, the the conversation.
Are Simulation Practices Hindering Real-world Readiness?
00:27:35
Melanie Barlow
So for me, i think potentially when you look at, and I'm going to talk about nursing, but I think this relates to anyone, but I just, as a nurse,
00:27:36
Kate
you
00:27:45
Melanie Barlow
see nurse graduates come out, their resilience levels are less, you know, than in our day. And the attrition rates in that first, you know, one to two years is is really high. And and i look at how we do sim now in undergraduate. It's predominantly skills-based.
00:28:09
Melanie Barlow
We're not putting our learners in these areas kind of difficult situations of dying patients or cultural complexities or like and then we wonder why they struggle with the realities of practice and so my question to you is is are we potentially now is the pendulum gone too far the other way are we being too psychologically safe and doing our learners a disservice jenny r what do you think
00:28:42
Jenny Rudolph
So I think this is a super important topic, and I'd love to hear from others in a moment about kind of inoculating learners and potentially the role of micro debriefing and knowing how to reflect on your own practice is a really important topic.
00:28:58
Jenny Rudolph
thing once you get into practice. So I don't want to miss the opportunity to hear about that if people want to talk about it. But to your question, Mel, can we be too psychologically safe?
00:29:11
Jenny Rudolph
So I think what I would say, going back to Kate Morse's comment about tolerating discomfort in the service of learning,
00:29:12
Kate
you
00:29:22
Jenny Rudolph
When we say we're being too psychologically safe, generally what that means is we are being nice and we are sugarcoating and we are deflecting and we are not providing advice.
00:29:34
Jenny Rudolph
safe but direct feedback about performance. And what I think is paradoxical, Mel, is when we get too nice, if you think of psychological, well, let's talk about it as niceness rather than psychological safety, a certain amount of could meeting learners where they are, accepting that they feel risky, feel risk, and we're helping them with that is really important.
00:30:03
Jenny Rudolph
And I'm drawing an inverted U with my hand here
00:30:06
Mary
Yeah.
00:30:06
Jenny Rudolph
But once we get into sugarcoating, covering up, not giving clear feedback, what I think happens there is the learners discern it. And they when they feel that it's about them guessing what you're thinking, or they recognize that you're protecting them from what's really happening, it causes a degradation in psychological safety in another way, because people recognize people aren't talking about what's really going on.
00:30:35
Jenny Rudolph
So I really liked Vic Brazel and Eve Purdy's piece on the IceNet blog maybe two years ago where they talked about safe, not soft.
00:30:46
Jenny Rudolph
And so I'm just thinking maybe that's something for us to explore.
00:30:51
Melanie Barlow
Great. Thank you, Jenny. Mary.
Teaching Stress Management in Simulations
00:30:55
Mary
So Jenny spoke to sort of being nice with regard to the feedback and debriefing part of it. There's another phenomenon that I see happening a lot in simulation, in especially undergraduate programs, which is during the simulation itself, students being told, if you get too stressed during the sim, you can just step out.
00:31:13
Kate
Thank you.
00:31:20
Mary
And that's something that I think we need to be talking about because I think that that is not the right thing to do. Because in real practice, if they get too stressed, they're not allowed to step away from the bedside.
00:31:34
Mary
And in real practice, if they have to take care of someone who had breast cancer and their beloved grandmother died of breast cancer and it's bringing up bad memories, they still have to take care of the patient with breast cancer. And so I think rather than us saying to undergraduate nursing students, if you get too stressed, you can leave, we should actually be, number one, bringing them along in simulation using a framework like the SIM zones where they gradually get used to the intensity of simulation in small doses, and we can support them through it, through things like micro debriefing, pause and discuss.
00:32:08
Mary
And I think we should have specific learning objectives related to some simulations that are specifically about decision-making under duress, because that's what we're missing.
00:32:19
Mary
And that's what they need more than anything is how do i manage stress and still get my drug calculations right and still communicate therapeutically with the patient and still put together a good S-bar.
00:32:31
Mary
And so when we constantly give them the, you can step out anytime you want to, I think we're doing them a grave disservice. Now, I also want to say, i do think it's okay that if we say to the students, if you become so distressed that you cannot function,
00:32:44
Mary
then it's okay to step out, but we need to put some parameters around that.
00:32:49
Melanie Barlow
Yeah, so true. Very interesting. kate
00:32:53
Kate
So I love what Mary said around the micro debriefing and the pause and discuss as sort of scaffolding it through. Because early on, it's if you think a fundamental first year nursing student or brand spanking new nurse practitioner, you're not going to say to them, so today but your patient's going to die and you have to manage this.
00:33:13
Kate
Because that's not fair enough. And that's not creating a safe learning environment. But to say, listen, you're going to start this. I'm going to come in at, you know, predefined times or you can, you you know, call for help and I'll come in and help you.
00:33:27
Kate
All the way up to, yeah by the end of this, you will be managing whatever is appropriate for their level of training. But I agree, you have to give them those opportunities. And those micro debriefings aren't just about, as Mary said, not just about like what are you thinking? What are you noticing if you're working on the nursing process or differential diagnoses?
00:33:50
Kate
But it's talking about notice how you weren't able to access your thinking before I came in. Now, you know, the beeping has stopped and we're just chatting here at the bedside.
00:34:04
Kate
And now you're looking at me and you know the answer. That's because here your emotions were driving you here.
00:34:09
Melanie Barlow
Bye.
00:34:11
Kate
They're not. Your cognitive load came down. So how can we, what can you do yourself at the bedside in hard conversations to manage that?
00:34:22
Kate
So we start to incorporate like those, whether, or what do you normally do? Like when you're in an argument or when you're in a stressful situation, well, how can you bring that here? So yeah they can start to practice those self moves and to manage that because i am a hundred percent in agreement with you.
00:34:36
Mary
Yeah. Right.
00:34:41
Kate
We must prepare them. it is not, it's not, we still at the United States have upwards of 40% attrition rate for new nurses and nurse practitioners are taking more and more responsibility.
00:34:55
Kate
It is not always easy.
00:34:58
Melanie Barlow
Yeah, and I'd love to hear from an Australian perspective, guys. In speaking with paramedics, days they do this training.
00:35:09
Melanie Barlow
They actually have, sim I've heard of simulations where, because it's very male-dominated and, you know, often the juniors struggle when they go out on placement with senior male paramedics and as a generalization but they have these simulations about how to manage those dynamics in the tea rooms and things like that like they put their learners in those situations and context to prepare them I think look I don't have insight into a lot of higher eds in Australia but Jenny, Kerry and Jane like
00:35:38
Mary
Yeah.
00:35:41
Mary
yeah
00:35:52
Melanie Barlow
What are your thoughts? Because when you're predominantly skills focus, it doesn't give you really the opportunities to have these micro pauses and discussions when you've got a room of 30 students doing deliberate practice on skills. Like, how do you guys manage it?
00:36:11
Melanie Barlow
Or is there a gap?
00:36:14
Melanie Barlow
And I think this comes back to that concept of organisations investing in faculty development to facilitate those conversations.
00:36:21
Mary
Mm-hmm.
00:36:26
Melanie Barlow
I'm just conscious of time, but Jane and Jenny, thoughts?
00:36:26
Kate
you
00:36:34
Jane Frost
Well, I think it's a problem. I think it's something that we need to develop the staff and I think just talking today, and talking through the psychological safety of the staff, maybe if we can invest in that, then we'll be able to get them to actually be, as Jenny R was talking about, confident and and knowing who they are in the classroom so that they're able to facilitate simulations.
00:36:45
Melanie Barlow
Uh-huh.
00:37:03
Jane Frost
More consistently, we have large amounts of numbers in nursing, so trying to get that consistency and getting everybody trained to do it is really difficult.
00:37:17
Melanie Barlow
Carrie.
00:37:19
Melanie Barlow
no Kate.
Building Resilience Through Feedback Literacy
00:37:21
Kate
ah Mel, while you were speaking, it was making me sort of think about there's probably some connection to to feedback literacy here. And yeah because in real clinical practice, you know, I've had a variety of good feedback, bad feedback, horrible feedback, great feedback.
00:37:34
Jenny
Thank you.
00:37:42
Kate
ah ah yeah And, you know, you're, you don't, you can't control that piece, but you can, I think, teaching students how to build the skill of receiving feedback. And that's to discern, you know, when it's,
00:37:56
Kate
feedback that you're like, okay, thanks so much. um um ah and And feedback that's really going to help you or feedback you need to rely on. i I think that doing simulations with learners focus on building the skill of receiving feedback may have, and this would you know be a long-term connection, but because there's so many other variables, may have some connection to
00:38:12
Jenny
Thank you.
00:38:23
Kate
sort of their resilience in that first year in clinical practice where it sort of feels like an assault on the census on a daily basis because you're not an expert. So you're doing at a lot of things that are getting feedback might help.
00:38:40
Melanie Barlow
I love that. You're talking my language.
00:38:45
Melanie Barlow
I think, yeah, we we wonder why our students aren't listening to us or or listening to our feedback yet. We never, ever teach them how to receive feedback.
00:38:53
Kate
Thank you.
00:38:54
Mary
Never ever.
00:38:56
Melanie Barlow
So, excellent.
00:38:56
Jenny
Mm-hmm.
00:38:58
Melanie Barlow
Oh, such an amazing discussion. I could talk about this for hours, but I'm conscious of everyone's time. So, thank you, Mary, Jenny and Kate for your really thoughtful insights.
00:39:12
Melanie Barlow
I know Jenny B has a final question for you.
00:39:16
Jenny
So one of the questions we ask all of our lovely guests in our VIP room is if you could be anywhere in the world having a drink, where would you be and what would it be?
00:39:27
Melanie Barlow
It's happy hour anywhere.
00:39:32
Jenny Rudolph
All right, I'll take it. I'm sitting on the shores of Silver Lake in Barnard, Vermont right now. And i would be loving to have a cool India pale ale on the dock right looking over the lake here.
00:39:49
Jenny
Can't wait to join you for one of those, Jenny, huh?
00:39:51
Mary
No, I'm on my way.
00:39:51
Jenny Rudolph
Absolutely. Can't wait to have you.
00:39:55
Mary
All right, well, I'm gonna second Jenny's beer idea, but I would be drinking a Scheinerbach beer, which is brewed in Scheiner, Texas. And you know in honor of my Australian friends, I would be drinking it in Melbourne.
00:40:08
Melanie Barlow
right, come on down.
00:40:08
Jenny
Thank you, Mary.
00:40:09
Kate
Oh, Mary, well done. Well, I have to depart from the beer trio because I don't like beer.
00:40:12
Jenny
Can you buy that in, Mary?
00:40:18
Kate
It would be a glass of Prosecco. Mel, just for you.
00:40:22
Melanie Barlow
yeah
00:40:22
Kate
And I think one of my favorite places I've had a glass of Prosecco was sitting in the little tiny town of Mirren in Switzerland, overlooking um an amazing, incredible place Valley and watching the sun come down on the mountains and just enjoying myself.
00:40:45
Melanie Barlow
How amazing.
00:40:45
Jenny
both.
00:40:47
Mary
wow
00:40:47
Melanie Barlow
Amazing.
00:40:48
Jenny Rudolph
I felt so psychologically safe when you asked me that question, Jenny B.
00:40:48
Mary
it
00:40:54
Melanie Barlow
Very good.
00:40:57
Mary
oh
00:40:57
Melanie Barlow
Our job is done.
00:40:58
Kate
Because Mel prepped us.
00:41:02
Melanie Barlow
So thank you so much for joining us today. And just for our listeners, if you have a topic you want us to discuss, you can go to our website at www.simulationhappyhour.com
00:41:10
Kate
Thank
00:41:14
Melanie Barlow
and send us a message. And we look forward to having you join us for our next Simulation Happy Hour. Thank you, everyone, for joining
00:41:23
Mary
Thank you, Mel
00:41:24
Jane Frost
Thanks.
00:41:24
Jenny Rudolph
Thank Mel.
00:41:25
Kate
thank you mel
00:41:25
Melanie Barlow
Bye. bye