Tangles and angles - 50 shades of white

Today was one of those days where I spent the day in bed. I had a shower, got dressed and left the house with no nod towards hair and makeup. When I arrived at work I stripped and donned the gown of no dignity. (Luckily I had a clean out of my underwear drawer yesterday and can vouch for the decency of all my undies.) At the mention of a set of nasal prongs, a sling and a strap on IV, people start to give me funny looks. No, I wasn't filming the sequel to "50 Shades of Grey". I was working as a simulated patient for physiotherapy students today.

I love working with students who are still relatively inexperienced in their profession. It's so interesting to see the problems they encounter and be in a position to give really useful, practical feedback.

It was all about tangles and angles today. My left arm was in a sling after a (simulated) shoulder reconstruction. My right arm had the IV line for my PCA (patient controlled anaesthesia). That was simulated too. No drugs were flowing. Suddenly, a simple action like sitting on the side of the bed becomes a manoeuvre requiring a project manager and a crane booking. Adding to the drama is a very short gown, an educator sitting at the foot of the bed, and sheets that slip and slide and stick to the gown of no dignity. 

"Just swing yourself over and sit on the side of the bed." I hear the instruction and know that even with a simulated post-operative site, I'm not going to ":just swing" myself anywhere. They give detailed instructions about bending my knees, pushing down with my heels and using my right hand to lift and shift towards the edge of the bed. Bending the knees involves giving the educator full view of my nether regions. Lifting and shifting involves all the bed clothes shifting with me. The hospital gown seems intent on moving in the opposite direction to me and soon I am marooned on the very edge of the bed, gasping for air as my windpipe is almost severed by the demon hospital gown. (Who called them "gowns"? They are the least gown like garment I can think of. When I think of a gown, I'm thinking Christian Dior and red carpets, not this white apron masquerading as a functional garment.)

Compounding this is the fact that I'm wearing a sling. I'm then offered another "gown" to cover my back because "we're" going to try walking. They're very focused on the walking, even though it's my shoulder that's had the operation. Obviously, my briefing left out the information that I work as a circus acrobat where I'm regularly walking on my hands. The second gown is tied on the back "like a Superman cape", but of course, is as much like a Superman cape as the first gown is red carpet worthy.

There's a realisation that I've gone one way and my IV and nasal prongs are coming from the other side of the bed. They're also attached to me. We go through a further set of complex movements to reduce the risk that I will be mistaken for a chicken trussed and ready for the oven.

The students were terrific today. They're still at the stage where their thinking processes are slow and deliberate and nothing is really instinctive. I was often left in an unsustainable position while they discussed what needed to happen next.

The one thing I can't simulate is blood pressure and oxygen saturation - it's actually mine they're measuring. My sats were a bit low today - probably because I was holding my breath as I was precariously balanced on the edge of the bed. On the other hand, my blood pressure was a bit higher than usual - again probably because I was being choked by the hospital gown.

Oscar-worthy.
© 2015 divacultura

Angles and tangles seems like an apt description of life as a physiotherapy student.

What did you do today?

How to avoid feedback disasters - what's your purpose?

Giving, receiving, thinking about and teaching feedback occupies a large proportion of my time, both at work and in my private life. I notice how people avoid it, crave it, botch it and do well and wonder at the variability of attitudes and capacity. Part of  my vision for an improved world is doing it better and appreciating the value of feedback.

So I was pleased to recently work with a medical college in trial exams for candidates to practise and receive feedback about all aspects of their performance: medical knowledge, exam technique, communication with me, the simulated patient, and their overall competence.

My case was intense, requiring me to cry and be angry about the situation. As an acting job, it was excellent. I had a really lovely doctor to work with as he conducted the trial exam station.

Candidate after candidate struggled with both the medical knowledge and their capacity to communicate. They often freak out when confronted with a simulated patient who is crying and angry just like a real patient would be in the same situation. Usually they recover. I quickly discovered that the doctor with me had a very different view of good communication. I also learned that many candidates were having significant problems with the medical aspects of the case.

After all candidates had had their trial, we saw them again for two minutes of feedback. After hearing from the doctor how terrible everyone was, I was surprised to hear him start by telling people "you did well". He'd then list - in exhaustive detail - all the areas of failure. He sent them off by saying they "weren't too bad" or "but you did ok".

I was confused. The candidates looked confused. They really wanted to know about their performance. They were participating in this trial exam so that they knew where they had performed well and what they needed to improve. Instead they received a confusing message that left them with no information about what they should do next time. The next time would be when they sit the actual exam.

I took the opportunity to observe and think about what was going wrong and how I would coach the doctor on providing useful, effective feedback.

The first question I would ask would be "what's the purpose of the feedback you're about to deliver?" Then to further clarify, "what do you want to happen as a result of this person receiving your feedback?"

Answering these questions before any feedback conversation will help remove our sometimes overwhelming desire to be liked from the feedback conversation. Interestingly, if your purpose is clear and about helping the other person, they probably will like you because you've taken the time to give them effective feedback that will help them do better in their world.

Listening to the doctor deliver his confusing messages, I tried to discern his purpose; it seemed it was about fulfilling part of the process of the trial exam. Where's the value in that? Feedback is part of the process and there's no doubt there was an obligation on him to provide it, but if the purpose of feedback is merely procedural then no one will benefit. It will be hard to deliver and unhelpful to receive. At its worst, it may also have a negative impact on the relationship between people.

Consistently I find that a lack of clarity around purpose is where people stumble. And it's not just in feedback conversations. Any conversation can benefit from clarity of purpose. Where the conversation is a strategic one (rather than a casual one), it needs to be planned. If you do nothing else, be clear about the answers to these key questions:

1.  what's the purpose of the feedback you're about to deliver?

2. what do you want to happen as a result of this person receiving your feedback?

It can change your life!