Catherine Haines, Assistant Professor of Medical Education at the University of Nottingham Medical School contributes our conversation kickstarter guest blog post.
Two articles in the current issue of The Clinical Teacher (#ClinTeach) explore how we may help learners to gain more from their clinical experiences and got me thinking about common sense. We often take it for granted, and often bemoan its absence. What is common sense for learners in a clinical environment? How can we make it more common among our learners and trainees?
Common sense is defined by dictionary.com as ‘sound practical judgment that is independent of specialised knowledge, training, or the like; normal native intelligence’
We certainly select learners who have high intelligence. We give them specialised knowledge and training, but how do we support the development of ‘sound practical judgment’? Where does it end? Do we expect our learners to demonstrate sound practical judgement in all areas of life? Certainly, I am still challenged on occasion.
Consider the following key domains where common sense or practical judgment certainly impacts on work performance:
Are you always:
- Able to monitor your surroundings and take appropriate action to keep safe? (Weather, other people’s needs and moods, calculate risks and dangers etc.)
- Able to live within the limitations of your own body – stress, sleep, exercise, self-care, good nutrition?
- Able to mend and maintain necessary equipment (including your home, transport)?
- Able to analyse and avoid repeating mistakes and predict and avoid possible negative consequences?
- Able to plan and manage resources, such as money and time?
Let’s stick with the first two: monitoring your surroundings and keeping safe and managing the limitations of your own body, especially in responding to stress and distractions.
In Innovative teaching in situation awareness, Gregory, Hogg and Ker describe an early, low-cost intervention which seeks to develop learners’ skills early in their first year. Groups of ten medical students worked together in an empty hospital bay to gather information, interpret it and anticipate future consequences. As beginner Sherlock Holmes’, they investigated four different scenarios, and identified hazards and cues. Slippers by the bed? A possible trip hazard for some mobility levels. A medicine prescription chart? What can we tell about this patient? Are they acutely unwell? A tutor helped draw out interpretations and encouraged learners to formulate future consequences.
I think this has potential. Early exposure to deducing and applying observations from the clinical environment could prime learners to become more proactive. Portfolios do encourage learners to seek certain types of experience, but sometimes fall short of encouraging deeper processing. Students often only see the point of the reflective cycle later in their career.
Do you think a novice can be trained to develop situational awareness or can that only come with experience? How else could we continue this?
In Student views of stressful simulated ward rounds, Ian Thomas considers a high fidelity simulated ward round for final year medical students; and then sees what happens when he adds more stress! The ‘patients’ and their surroundings simulated an impressive array of potentially dangerous outcomes for learners to trap and mitigate as they conducted appropriate clinical tasks. In addition, six time-critical interruptions were introduced: a ward radio, a doctor’s pager, a phone call, a distressed relative, a cleaner doing the vacuuming and an ad-hoc prescription task. Which do you think the students found the most distracting? I’ll leave it to you to read the article and consider how common sense and experience helps us manage distractions and stress and so enhance safety.
For how long will a novice inevitably experience stress in an unfamiliar clinical environment? How could we encourage learners to become more resilient and able to rise above stress?
On reflection, perhaps common sense isn’t so common after all.