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SEL in Action
SEL in Action
SECs in Distance Leadership Series: Episode 2 w/ Eric Wooltorton
I speak with Eric Wooltorton, a family physician and medical educator, about the social & emotional competencies needed for online medical practice, teaching, and learning. Eric provides an energetic and humorous perspective on the shift to practicing medicine and leading medical students as they begin their residency during the pandemic.
The SECs in Distance Leadership Series was created for the SECs in Distance Leadership Graduate Course that I taught in the Spring/Summer of 2020. The interviews were conducted with educators and leaders about the changes they've seen and what they think will be pivotal as we move forward from the COVID work-from-home and emergency online teaching/learning mandates.
For full transcript and show notes, please visit https://sel-in-action.com/podcast-ep-2.
You're listening to the SEL in Action podcast, the podcast where we explore what social and emotional learning looks like in educational and professional settings. I'm your host Heather Woods. And today on episode two, we will be speaking with Dr. Eric Wooltorton, about what social and emotional competencies are required in medical education, particularly when we're learning online. This episode is part of the social and emotional competencies and distance leadership series. So today I am speaking with Eric Wooltorton. He is a family practitioner and medical educator and curriculum and faculty developer that is what I stole from your Twitter. And so Eric, you and I have been talking a little bit over email and social media, about these kind of different social emotional skills and kind of what's involved with self awareness. self management, social awareness and relationship building decision making competencies and kind of how that relates to your role as a, you know, a medical practitioner, but also medical educator. And so I'm wondering what you kind of see now with the shift of more online learning and online practice, I don't know if you're seeing clients like virtually or teleconferencing but what are kind of like maybe one or two skills that really stand out to you that you think are applicable for practitioners and educators and students?
Eric :Well, it's a good question. I think it's some of the same skills that were there before we were online. But certainly that sense of self awareness and, and I find it really interesting how health professionals always have a very emotional dimension to their to their practice. I think You know, part of what makes them curious about people, their, their sense of empathy, their sense of curiosity. And you know, if I have a learner, for example, who's got a patient they're having a teleconference with, I'm amazed at how often they'll have this need to sort of talk about afterwards how that person made them feel. recognizing how to, you know, that that's a big part of that visit is it's not just what happens in the visit the medical decisions you make, but it's the impact it has on you, in terms of, you know, the things that stimulate you to learn more the things that make you feel a little bit icky. And maybe like, you need to explore this a bit more maybe because you're you don't know much but the problem, maybe it's because the patient rubbed you the wrong way because there was a bit of a disconnect because of the virtual type of visit and the difficulty with figuring out what was going on or I've literally had people sort of unpacking their groceries and stuffing things in the freezer while they're talking to me so it's sometimes can it can generate a certain set of emotions in you are you thinking yeah, just focus For a minute, I'm here right now. And, you know, before you lock yourself in your freezer, can we just talk about your headache? You know, and maybe, yeah. Maybe you're getting a little bit too much cold, you know, because you're heads in the freezer. So yeah, I think it's interesting, that notion of self awareness, recognizing that's a big part of what we do. And I'm actually for a learner. And as a medical educator, I spend a lot of time encouraging people to be aware of that. And, and not to, not to let go of that, because I think people in health professions are very good at learning, to have empathy trained out of them, you know, they go into health care, often with a lot of interest in helping people somewhere, you know, in medical school, you know, for various reasons, often because there's a lot of pressures on them, they will often develop a sort of lack of empathy. And so I keep telling people, if if people make you feel something that's good, let it come in, you know, process it, let it go out so that you know you don't, it doesn't eat away at you. But use that to stimulate your learning and to find ways if you didn't connect well with a patient, try to understand is, you know, are they transferring to you some of their feelings of frustration some of their anxieties about themselves. And, and and listen to that feeling. It's what all ultimately will help you succeed in your profession, or possibly develop burnout later. So that self awareness is something I think is is making people aware. And I think the other angle on this with the virtual supervision and care is that sometimes, you know, a patient will be at home, I will have a learner calling the patient from home and I'll be in a different location. Unless we make time to have those conversations and that dialogue. What will happen is a person will have those feelings and maybe not share it, you know, with somebody in their social, their social group, that social learning that happens within in medical education contexts. Health Professions education context, where you help that person stay in a zone where they're learning something from it, they're not feeling overwhelmed, you're able to sort of pick up on, on the challenges and the stresses they're having. And I think making sure that we make time to communicate deliberately about these things is really important in a virtual world.
Heather Woods :Yeah, I think that is an interesting point that, you know, maybe we don't think about so much. I know, like, my supervisors, other students are all counseling students. And so those connections that maybe as they move into, like their second year, and they're going into placement and practicum, same thing for the medical students, right, like, there is those conversations because I always tell them, I'm like it. I'm not a counselor, but I can see how emotionally straining and stressful moving into practicum is. And so I tell I'm like, make sure that you're talking to people and making like your connections and having your coping strategies in place, and your social network and everything. But I think, you know, you almost don't think about it now that we've shifted to online, like, how are they going to navigate that and like, you're right, like the onus, you know, we've got to consciously and deliberately make those opportunities. It's really, really interesting.
Eric :social learning is such a big part of developing and understanding of the norms of a profession, no matter what your profession if it's nursing, if it's medicine, dietary, you know, you're gonna have people who ultimately become, they develop an identity and part of that is the knowledge and, and, and the attitudes that can be positive. You can develop positive attitudes, you can also develop negative attitudes. I think one of the things that a lot of people describe at all levels of Health Professions right now as it can feel very isolating, in fact, I was having a conversation with another staff physician about this where, you know, when you're not in the same workplace as other people who are in the same field, you can feel very isolated very alone. And I think it's important that we keep trying to reach out and understand, especially when people are developing a sense of who they are at the beginning of their, their, their training, it's, it's important to create times when you're deliberately reaching out connecting. And if you have five minutes of teaching, just make sure you have five minutes of making sure you ask how the person's doing any cases they struggled with or challenges they're having. Because I think that, you know, good leaders will have an awful lot of emotional intelligence, good leaders, I think we'll also be able to pick up on some of those things that people are communicating to you. And often it's it's through very informal dialogue. And I think the challenge is to keep people growing. And then it's often to just pick up if people are overtaxed or undertaxed, because if you Don't stimulate people enough they'll be quite disinterested and bored and, and also not grow. So from an educators perspective, that idea of making sure there's that that conversation, that dialogue that sort of keeps people in a growth zone.
Heather Woods :And you mentioned in terms of self awareness, you know, feeling in letting like you feel those emotions and then processing it. So what, what does processing and maybe coping I know in our emails together, we were talking about, like fear and like fear of messing up or, you know, all the things that could go with fear in terms of the medical profession. What does that processing and coping strategy maybe look like? And, you know, for in practice, and maybe you're supporting your learner's at this, you know, odd time.
Eric :You know, it's it's really important. I think that that idea of reflection, I think everybody remember members in health care training that time the first time you were kind of you transition from one level where you were a bit of a wallflower kind of watching at the back of the room to suddenly having responsibility and that fear that you were going to miss something or hurt somebody or make a mistake. And I think that, that fear of failure is such a big part of what drives a lot of people, especially in healthcare. You know, you see all sorts of things that can be very dramatic, certainly we all have, you know, we can all have bad days and, and, and the challenges that we run into in healthcare are no different than a lot of other teachers, you know, trying to teach people who are struggling with learning, but sometimes the consequences of person making a mistake are can be can be quite dire. And so teaching people I think, that idea of, of building reflection into their day so that they're reflecting on what they did. So that, that that notion of reflecting on what they did, but also getting to the point where they're sort of talking out loud and reflecting inaction. So I'm doing this and this is I'm thinking, it helps you I think if you have those conversations, you can untangle ways of moving forward so that you can plan a really solid course of action that they develop more confidence. So much of being a health professional is about being self regulated. I mean, we have a college that, you know, will slap us on the wrist pretty hard. If we do something wrong, people can complain too. And it's really important to have those regulatory bodies but self regulation and self regulated learning is such a big part of what keeps us going. As a lifelong learner, you're having to keep up on subjects. So teaching people those emotional skills to recognize the kinds of patients who trigger them emotionally. They're sort of Achilles heel, if you can, if you can imagine that. We all have the kind of patient who will push our buttons. The sooner that you can recognize that or the sooner you can recognize the kind of context you can actually start to talk yourself through it. And I say to my learner's it's like learning to drive a car. I know that when it gets icy out I have to recognize, first of all the conditions where I might go off the road, what am I going to do? Well, I'm going to, to maybe slow it down a little bit. So if I have a patient who is who will set me off, because I want to be very efficient, and they want to really go through things very slowly, I'll maybe make sure I go a little bit more slowly, I'll book a little bit more time, I'll anticipate the problem. I'll also talk out loud and tell people around me like the nurses I'm working with and others around that if I'm running behind, just let me deal with this right now. This is what's going on and help them make, you know, be aware, just like if I'm driving in the car with people and it's icy out and I'm going a little bit more slowly. I'm just talking out loud. I'm taking all those thought processes and making the verbal and I'm also sometimes very clear with patients This is what I'm doing and you know, just talking through very clearly with them. And really, it turns those situations from ones where I'm feeling out of control, or like there's something going to go wrong to one where I feel a little bit more like it's it's I've negotiated the situation well, so self regulation is a big part of what we and encouraging people to reflect on the feelings that they're having as part of their day to day. Practice, I think is is such an important part of being in this field, being resilient and successful and not burning out because you want to have fun. You want to make sure that the patients are ones who stimulate you and you're not avoiding patients you don't like you have to make sure you're taking care of everybody the same way and succeeding.
Heather Woods :Mm hmm. Yeah. Um, so in terms of like, working with either your students or patients in terms of like building those relationships, you've kind of hinted like talked about empathy, and, you know, checking in and kind of making sure that your students are all right, and processing, you know, their emotions with their, their practice and everything. And so it really kind of, and then you highlight the communication piece, so I don't know if you intend to do this, but when you're thinking out loud, and with a patient or with students or with your colleagues, you know, you're communicating what you're doing. And so they're able to then like, so it's, you know, there's a lot of subtleties there that are happening that, you know, create that social climate and therefore, like awareness to some extent, right. So it's so interesting to see all these bits overlap.
Eric :Well, and I talked about how you can take different parts of medicine and just transpose them from one part to the other. Like, I was telling a new learner today that it's like when we do a type of examination called an oski. It's a simulated clinical examination. And if the exam station says, I want you to examine this patient's heart what I the mistake I made when I was a medical student is I you know, put my stethoscope in my ears and I just started examining the patient's heart because I thought they literally wanted me to examine the patient's heart and I couldn't even hear that the bell Hadn't rung that the station was over. And I was already supposed to go on to the next station. I was just listening around. And, and I was I remember that feedback early on to say you should be talking out loud. Tell the person who's an examiner what it is you're doing because they can't see your thoughts. They can't see what you're doing. You just look like you're off into space, which I probably was. But but but the reality was, you know, the more that you can do that with patients as well, you can make sure you're on the same page, not only with their illness, but their illness experience. And I think that that's really important when you're talking to a patient. in family medicine, the notion of the illness and understanding the illness experience as well is really, really key. So same with learners. If if they're getting to the right diagnosis, but they've got all of this baggage that goes along with the way the interview went or just things they're really struggling with and they're not talking out loud, then they're really they're really missing an opportunity to grow and to learn. I think the other thing is, this is where notions that come in that are really important, I think for us to get out as medical educators, things like unconscious bias. When you get people to start talking out loud, they can start to see that their their ways of thinking might have been distorted by their previous experiences. And you can help them reflect a little bit on themselves. Just like a mirror, holding a mirror up to them when they're, when they're articulating certain things and you're articulating it back, you can help them maybe start to realize some of the things that they might be missing. And this is where you have to create a safe place for dialogue and and as medical educators, the more honest we are with the fact that we're human, that we've made mistakes, you have to have empathy for yourself, and understand that this is a safe learning environment. It'll honest conversations about the things and the sorts of mistakes you've made, will I think allow people to self reflect and maybe spot things that they didn't realize? work some of their gaps in their thinking. So that's one of our jobs, I think, is as medical educators.
Heather Woods :And so, it, I wonder if, you know, maybe this shift to online practice and online, learning and managing students. And you know that, are you able to engage in that thinking aloud kind of process in the same way? Are you noticing that kind of changing at all, or not changing?
Eric :What I've noticed is, when you're doing online, work exclusively, you're much more task focused. And what I found is that so much of Health Professions education, so much of medical learning, is social education process. When you're when you take out the social part, and you're socially distanced from your learners, and it's actually quite possible that you're missing opportunities, unless you're very deliberate about it, and it's in its trickiness in a busy day, to day Sometimes work that in, you realize when you sit with a learner, if you're just talking about the patients who are in front of you or that medical, like the cognitive knowledge problems they're having, you're missing an enormous part of their education. I think people probably find that in other fields to people who are taking, you know, working with, you know, school aged children. If the if you're only focused on whether the person got the right answer or not on their fractions questions, you might be missing the fact that this kid is really struggling in some other sphere or and I think that that's as an as a coach, as a mentor, for a lot of these learners, I think we really have to make sure we're being much more deliberate about taking some time programming in some time to have some conversations. Day to day, if we're not in the same place. We're going to be missing about 1000 times a day when we just you spot little things that are happening in that person. The way they phrase something, even the amount of time they can take with something or Just the way there'll be rubbing the temples, you know, that sort of idea of I'm so stressed and I'm so exhausted right now. So we have challenges moving ahead. I think that that's possibly one of the roles of mentorship as well is to maybe split up some of these roles. So that we have other people having honest conversations with people about how they're doing and giving him a chance to, to, you know, sort of non evaluative kind of way talk about how they're coping how they're feeling. Give them a chance to grow and develop, and maybe talk through some of those, those challenges they're having. I still think though, on a day to day basis as as, as preceptors and clinical coaches, we have to play that role of spotting somebody who's, who's maybe struggling and struggling more than they need to.
Heather Woods :Yeah, it definitely presents a unique challenge. for building in those, like we've been calling it like the the watercooler conversations, right, like those just informal interactions that you would normally be having that no longer happen.
Eric :It's very hard
Heather Woods :So what would you say are some of like the essential skills like social emotional skills that medical educators can foster within their students?
Eric :Hmm. I would say, you know, basically spotting you know, being being much more self aware, and also not being afraid to identify that their emotions. And I think that a lot of times you're taught in medicine that you shouldn't you have to be a little bit removed and dispassionate. I would actually, I actively encourage people to talk about how they're feeling. For the sake of being able to process what that means, and sometimes, you know, as I said, it's a fear of failure. Sometimes it's it's many times our learners are actually they beat themselves up way too much. And they need reassurance that they are, are within the norm. So to help them understand that, that whilst being self regulated means you have to be self critical. You don't have to be your worst critic all the time. Like I think, you know, you have to let yourself breathe, you also have to look out for each other. And I think that notion of having empathy for others, realizing that traditionally health professions education, we're very good at assessing individual competence. But what you begin to realize in a leadership role is that people are competent within a context and as a team, so teaching them to figure out how to cross link with that other learner maybe who's seen the same patient before to have a conversation. They don't feel alone. Also, where possible to try to do group teaching. And I think that That idea that I think shared experiences are ones where people don't feel isolated. Because I think that the way things are being done right now, with a whole bunch of online learning a whole bunch of, you know, people working off in their own corners, it's about individual competence. It's not about teams feeling like they're part of a normal trajectory, that they're part of a growth that other people are wondering the same things. They're not deficient. So teaching them to basically keep thinking as teams keep working, you know, reaching out making connections. And I would also say, you know, encouraging people just to to informally connect. And I think that that's where there's an advantage for medical educators, I think, to have their ear to the ground, not just in terms of the the electronic work platforms, the email and the electronic records and so on. But I think also being aware of being on things like Twitter allows you to understand some of the experiences that that medical students are raising Answer other learners who are, you know, are feeling what? What are some of their reactions? What are some of the reactions within the community. And I think that the better the better social awareness you can have as a medical educator will allow you to take a different perspective. It's not uncommon that any one of us will go into work with our own agenda. You know, we've got, we forget that people are coming at this from their own, you know, with their own challenges, the more that you're more aware of the other things that are going on in the community, the better you can be.
Heather Woods :It raises a really interesting point in terms of like, the social awareness, a lot of people don't think about, you know, the digital social networks that could be leveraged. I know like Twitter is huge in the medical education community. It's huge in the teacher community. You know, and then I hear from kids that only old people are on Twitter. I'm like, yeah, that's okay with me. But you know, like We're building these online professional learning communities that I think are providing, like you said that opportunity to get a sense of what's happening, but then also take different perspectives, you have so many different voices, that you're able to kind of listen in on.
Eric :While the kids like my kids, I have a lot of children, and they will say the same sort of things. Like, yo, you're so old, you have no connection. And I say, I'll say, but do you ever have that happen when you find that perfect meme? That like just captures that thing that you're feeling and, and other social sites? Like I tell people, you know, like on Pinterest, you know, like, it's not just for, you know, tips on how to, you know, do cool things with watermelons and, you know, backyard projects, you can, there's great teacher education sites, or if you have a focused interest on online learning, you can certainly get an awful lot of ideas. It's links to all kinds of blogs, but it's just so gratifying when you find a meme that just sort of expresses what you're feeling in that moment, or Yeah, I got it. And even if it's just for the sake of saying like, you feel like you're not alone, you feel like you're part of a bigger community a bigger conversation and and just how people conceptualize things like kids get that they go, yeah, I get that. But yeah, it's it's part of I think, I think that notion of, of saying be part of the conversation, even if it's not your conversation, you can be a listener, and it will help you understand some of the arguments that are made. When people are feeling one thing or another. And it can be around like, I remember having this conversation about a learner, where it was there's a, there's a, every year the, one of the medical organizations I think, organizes a program called crazy socks for docs. And it's this idea that it's sort of an awareness raising campaign that if you were sort of crazy socks underneath your clothes, people kind of go like they can be mismatched or whatever. It's this idea that I have, I have empathy for people in our profession who are dealing with astronomically high rates of burnout, depression, suicide and it's an epidemic. Now, one of one of my learners said this is this is ridiculous. The fact that you're, you know, this is not the same. And I already had kind of identified from the some of the chatter online that there are some people who say, this is really, this offends me that this is the institutional response that we should, you know, put on different stockings. And I and I said, Yep, that it's the start of a conversation. The fact that we're having this conversation means you're feeling something, and that's good. Let's talk about what that means. So being part of those online communities makes you aware of where the chatter is and how to as a leader address some of the concerns that people are going to come to you with, and you're not blindsided.
Heather Woods :So what would you say is like, a critical strategy or practice, like one or two critical strategies or practice Is that, you know, doctors or medical educators can kind of implement as we move forward online?
Eric :Yeah, I go back to dialogue, I'd say safe, honest conversation with the reason for social learning and mentorship and self reflection. And I'd say, you know, creating opportunities for dialogue would be probably the the biggest and most important thing. It's nice to have a bit of an agenda, what I've learned is having an agenda to cover, especially if you're not going anywhere, you know, it's awkward to have made an appointment with somebody and have nothing to talk about. But feel free to deviate from that agenda. And I think the other thing I would say in terms of emotions is I think that true transformative, learning the truly valuable developments that people have come when people feel something from the encounter, and you can look at whichever learning theory you want. But I think recognizing that you feel something and sometimes it's you're feeling a little bit disoriented, or you feel strongly about a patient encounter. Recognizing that as, as an opportunity for growth is such an important thing that, you know, capturing that letting the person sometimes just get through the day because I think we've all had that in healthcare, you have to debrief if there's an adverse event or something goes wrong, you need to just sort of have a quick little debrief, like what happened, and how's everybody doing? And let's and then, and then when you have a chance to truly talk about it, make it make some time again, to say how can we just talk about what happened there? Because the, you know, quickly, people will sometimes just short circuit and say, I don't want to ever encounter that kind of person again, or I don't ever want to go into the room. I don't want to be the first person at the code. Now, but if you break it down and say there's something you're feeling something like, you know, bigger and deeper, they have an opportunity for growth, so Creating I think opportunities for safe dialogue and recognizing opportunities for transformative learning would be two things I would say.
Heather Woods :Mm hmm. And anything else that you can kind of think is important to mention in regards to, you know, medical education practice? being online right now? Who knows what's gonna happen in the fall and winter terms?
Eric :One of the things I would say is, I've learned for medical educators, it's very the easiest kind of presentation to give as a lecture. It's what we've often grown up with, it's often the least effective at actually, for everybody, it's it, you feel the least good when you're doing it as an online presenter. People you can't test people's understanding really, of material. It's, it's it can feel quite terrible. So if people are going to do online teaching, don't just lecture online, make sure that it's much more engaging, try to figure out how have those conversations, use some of the electronic tools to have those little breakout rooms or those conversations, figure out how to make things case based and pick up the speed a little, make things short, so that you just don't feel so exhausted by the end of it as a presenter or as a participant try to have a, you know, the online format allows us to have all sorts of fun audio visual components that were not necessarily part of it before. And it sometimes allows you to do things asynchronously, so you can have a chance for people to watch a little bit longer video clip. If you're doing something live, it might be 10 or 12 minute video you'd watch at most. If it's something a little longer if it's a movie or something you want them to watch, they can watch it on their own and then just have a more animated discussion. So more of a flipped classroom kind of approach. So people are going to teach online. Use this as an opportunity to do something cool, fun, funky, explore your skills, feel like a novicde, fail. I mean, I'm a master of failure. I fail most online things fail more often than they work for me.
Heather Woods :Yeah. Yeah. Excellent. Well, thank you so much, Eric, I really appreciate you taking the time to talk to me and to my soon to be to my class. And, yeah, that was really, really great. So thank you so much.
Eric :Well, I hope I get a chance to, to meet some of your some of your group that at some point, so thank you very much.
Heather Woods :Thank you. Thanks for listening to the SEL in Action podcast with Heather Woods. If you like the show and want to know more, check out SEL-in-Action.com. Or leave us a review on iTunes. Be sure to follow SEL in Action on Facebook and Twitter for updates on our podcast. I'll talk to you soon.