Assessing teams instead of individuals

Patient outcomes are almost always influenced by how well the team works together, yet all of the disciplines conduct assessments of individual students. Yes, we might ask students who they would refer to, or who else is important in the management of the patient, but do we ever actually watch a student talk to a nurse, for example? We assess communication skills based on how they interact with the patient, but why don’t we make observations of how students communicate with other members of the team when it comes to preparing a management plan for the patient?

What would an assessment task look like if we assessed teams, rather than individuals. What if we we asked an OT, physio and SALT student to sit down and discuss the management of a patient? Imagine how much insight this would give us in terms of students’ 1) interdisciplinary knowledge, 2) teamwork, 3) communication skills, 4) complex clinical reasoning, and 5) patient-centred practice? What else could we learn in such an assessment? I propose that we would learn a lot more about power relations between the students in different disciplines. We might even get some idea of students’ levels of empathy for peers and colleagues, and not just patients.

What are the challenges to such an assessment task? There would be logistical issues around when the students would be available together, setting concurrent clinical practice exams, getting 2-3 examiners together (if the students are going to be working together, so should the examiners). What else? Maybe the examiners would realise that we have different expectations of what constitutes “good” student performance. Maybe we would realise that our curricula are not aligned i.e. that we think about communication differently? Maybe even – horror – that we’re teaching the “wrong” stuff. How would we respond to these challenges?

What would the benefits be to our curricula? How much would we learn about how we teach? We say that our students graduate with skills in communication, teamwork, conflict resolution, etc? But how do we know? With the increasing trend of institutions talking about interprofessional education, I would love to hear what they have to say about interprofessional assessment in the hospital with real patients (And no, having students from the different disciplines do a slideshow presentation on their research project doesn’t count). Or, assessment of the students working together with community members in rural areas, where we actually watch them sit down with real people and observe their interactions.

If you have any thoughts on how to go about doing something like this, please get in touch. I’d love to talk about some kind of collaborative research project.

SAFRI: conflict resolution

Someone told me that the SAFRI programme had changed their life, and I remember thinking that that might be taking it a bit far. But today brought me closer to thinking that it might not be that far from the truth. It wasn’t so much the content of the session, but the reflection and discussion that happened as a result of an exercise on conflict management. During the session, I was able to confront a part of me that isn’t the rational, logical person I usually think I am, and gave me a greater appreciation for the poor souls who have to try and understand why I think and do things so differently to them.

We spent a lot of time talking about the different approaches to managing conflict, with people who share similar psychological attributes identifying with certain approaches. I realised that I have ways of dealing with difficult situations that aren’t shared by most other people (I was the only person in my group, besides the facilitator, as opposed to 3 other groups of almost 10 in each group). My MBTI type is:

  • Introvert – draw energy by looking internally, prefer reflection over action, prefer written communication
  • iNtuitive – prefer theory and abstraction, imaginative, desire change
  • Thinker – use logic and objectivity to make decisions, remain detached, truthful rather than tactful
  • Perceiver – remain open and adapt to new information, be flexible, enjoy surprises, routines are limiting

The exercise I got the most out of today was to analyse a conflict and reflect on my own responses, as well as how I respond to the responses of others. Here’s the short reflection I put together after a few minutes of discussion with the facilitator:

I approach conflict logically, which is good for mediating the conflict of 3rd parties, but not so good when I’m personally involved. While other personality types might avoid conflict, I will sometimes create it by playing devil’s advocate. I’ll probe and push buttons to get a reaction and will sometimes take an opposing viewpoint just to have an interesting discussion (I’ll also not understand when the other party doesn’t appreciate this attempt to engage with them).

When I am involved in a conflict, I experience a rapid escalation of my own emotional response if I feel that those emotions aren’t being acknowledged, yet I have no natural tendency to acknowledge the emotions of other’s (“I’m right, so you must be wrong”). If my emotions are not acknowledged, I tend to withdraw and switch off emotionally. In those cases I find it difficult to let go and will definitely refuse to acknowledge the other person’s emotion…as a form of retribution (when I write it down like this, it seems insane, but in the moment, it’ perfectly clear to me).

On the other hand, if my emotions are acknowledged, there is a complete collapse of my resistance and I’m able to move towards resolution. However, I struggle to close the issue and will often find myself prolonging an argument to make the point that “I’m right”. When I do manage to avoid that and the conflict is resolved, I forget about it in minutes.

This experience,  and the wonderful conversations it generated afterwards, really gave me a greater insight into who I am, as well as how I relate to others. For the rest of the day I was acutely aware that almost everyone else in the room sees, and responds to the world differently to me, which I found both sobering (“I’m alone”) and inspiring (“I’m special”).