SCCM Resource Library-Not Just a Fairy Godmother: Mentoring in the Millennial Generation

Video Transcription

Good morning. My name is Jeremiah Duby. I'm a critical care pharmacist at UC Davis Medical Center. As your moderator, I have three jobs. Job one is starting on time, so check.  My second job is pronouncing. I have three people, three speakers today, pronouncing their names correctly. And job three is keeping them on time so you can all get to the airport.  Our first speaker is Dr. Ron Pauldin. He's a clinical professor at the University of Washington Medical Center and program director for anesthesiology critical care medicine.  Thank you, and thanks to all of you for making it to one of these late sessions. I'm happy to see so many of you here. I have nothing to disclose except that I'm a boomer.  Sometimes, and you'll see what that means in a moment. Goals and objectives for today, I'd like to introduce you to concepts around generational theory and generational stereotypes  in the workplace and allow you to appreciate the potential for generational stereotypes to affect communication between instructors, learners, supervisors, etc.  And hopefully get a little brief introduction to effective feedback and barriers to effective feedback.  Now, generational differences, you don't have to look very far in the media to see multiple publications,  multiple sources that use generational theory to generate this concept of conflict and differences between generations.  I can buy a manual to help understand millennials. I can get a language guide. There's literally hundreds of thousands of memes out there that look at generational differences.  So what is generation theory? It's a set of beliefs that's centered around the concept that an individual's values, motivations, and behaviors  can somehow be inferred and understood based on the date of their birth.  And what this tries to do is to consider social, historical, and cultural influences on a cohort of individuals.  The problem with this is that there are variable definitions and terminology.  So I'm sorry if this isn't projecting well, but here's a number of groups of researchers, how they classify different generations. What I love about this is I'm on the cusp.  So if I don't like what you're saying about boomers, guess what? I'm Gen X. If I don't like what you're saying about Gen X, hey, I'm a boomer.  And just for review, many of you have seen a lot of these concepts. The silent generation from the late 20s through the 40s, influenced by the Great Depression and World War II,  often described as being thrifty and rule followers. Now, there are many, many of these descriptive terms, and this talk will not include all of them.  You can go on your own and find numerous descriptions. Boomer generation, mid-40s to, as you saw, 60 to 64, influenced by the Civil Rights Movement,  the Women's Movement, the wars, often described as industrial, work-centric, or even workaholic, diligent, competitive.  And most recently, out of touch, kind of this okay boomer meme that I think it's been hard to escape lately.  How about Generation X, mid-60s through the early 80s, influenced by cultural freedom, the AIDS epidemic, the Gulf War.  They're often described as a forgotten generation, gloomy, nihilistic, work-life balance.  Most recently, this concept of the Karens, if any of you have heard that, often described as middle-class moms out of touch with their Gen Z children.  And then the millennials, perhaps more written about the millennial generation and kind of the subject of today's talks.  Born from 82 to around 2000, influenced by technology, globalization, 9-11, 2008 recession.  Many descriptive terms, and you'll often see that the emphasis is often on the negative.  If you caught it, one of the book examples in that prior montage, the back of the book cover was all descriptive terms. There was not one positive term in that book cover.  But often described as tech-savvy, community and teamwork are a focus. And for those of us in this room, I think all of us agree that critical care medicine is a team sport,  so these should be very positive attributes for folks that are coming up.  On the negative side, often described as entitled or special, distracted, narcissistic, often in need of very close, immediate feedback and support.  And then the Gen Z, mid-90s through 2010, technology, social media, often described as thoughtful, open-minded, but they're stressed and depressed. So is this a recipe for conflict?  This data comes from the physician workforce, and I think because it's based on time and date,  it can apply across any multidisciplinary specialty, although some of these percentages may be different.  So as you can see, by 2027, not that far away, about a third of physicians will be over 65. Millennials will make up the largest cohort.  And as we all know, medicine is a field where training advancement and mentorship are steeped in tradition,  and there's an emphasis on hierarchy and apprenticeship, and that may be at odds with some of those stereotypical goals of millennials. And we all know that change is slow.  So what about criticism of generation theory? By definition, these are employing stereotypes, and stereotypes ignore differences between large groups.  And this is evidenced by the fact that there are often more differences within groups than between groups.  When the sociologists look at families, we often see that parents and children have less than predicted differences. And what do stereotypes do? They perceptuate assumptions.  They maintain and exacerbate power differentials. And what we see is a labeling, and it's usually by the majority, the generational cohort,  and these are labels that are placed on another generation that really criticize their inability to conform to the norms of the criticizing generation.  And this is so-called othering, somehow creating a subordinate inferior group. What about the research that's contributed to this?  Interesting fact about the initial millennial descriptions is this was done by Howen Strauss,  and it was based on a survey of fewer than 700 high school students in Fairfax County, Virginia, which is an affluent suburb of Washington, D.C.  So I seriously doubt that that cohort reflects all millennials. Another thing that happened in that survey was some pretty strong bias.  They rejected over 40% of the responses that fell into categories of not sure or I don't know. There's often a lack of control groups,  and as we've seen, maybe some overreaching conclusions regarding some of these generational cohort labels.  So is there some kind of omnipresent desire to denigrate younger generations? It may not go back to the days of the dinosaurs,  but what we see is that there are individual specific tendencies to notice limitations in others in areas where one is particularly competent,  and this is just a natural thing that's observed. And there's also a strong memory bias.  So most of us in this room probably think we were a lot more competent at various things when we were 16, 18 years old than we actually were,  and we kind of forget the fact that it took another couple of decades to get to where we are now, and in some cases more than a couple. So here's a great quote.  Kids these days, youth were never more saucy. The ancient are scorned. Honorable contend. Magistrates not dreaded.  If we put in the original spellings, this goes back to 1624 in London. So maybe things haven't changed that much.  Our colleagues in the business world have started to criticize generational theory, and a few quotes follow.  And again, criticizing research, kind of addressing the idea that millennials are in some way narcissistic. If any of you have teenage kids, you might really understand this.  And again, another criticism based on the fact that these things are often based on less than ideal research  and that maybe there are other motivations out there for people that are publishing or promoting this area.  So if you're interested in understanding a little more about some of the examples and ideas of generational weathering, I'd refer you to this article for complete disclosure.  This comes from folks at the University of Washington. And here are some examples that follow.  So this idea that millennials somehow are all digital natives, focused with high-speed learning. They make random connections, information processing, game-based activities.  But if you look at this a little further, what about socioeconomic status?  Could this be more of an environmental, socioeconomic implication than it is something that is just based on date of birth?  Folks have to have access to the technology in order to use it. And just because one has access to the technology doesn't mean that they know how to apply it in a rigorous manner.  So interfacing with technology for social media really might be something very different than having a very critical appraisal of information to formulate an opinion about a topic.  What about professionalism? This concept that millennials expect rapid turnaround, they need frequent short meetings, they're often viewed as lazy, unmotivated, and selfish.  Do we really have the same, an offer the same level of autonomy to trainees as we've offered in the past? Again, I'm getting back to this concept of environment.  A lot of our millennials came up in educational environments where they were very much focused on milestones. And they got that gold star for every little step of achievement.  And this is, again, some kind of a construct that comes out of our well-intentioned desire to improve education.  And when you really look in the workplace at millennials and across Gen X, millennials, baby boomers, do they really have different values?  And there's a fair amount of survey data that would suggest that that's not the case. So in avoiding generational stereotypes, recognize that power differential,  try to take an individualistic approach, and try to understand the individual needs, values, and motivations.  And your learners, colleagues, subordinates, superiors, it will reward you well. I'm going to switch gears quickly and just give a brief overview of feedback.  I think this is going to kind of dovetail nicely into the following speakers. Feedback can have many different definitions.  But for today, we're really talking about clinical education.  So we're going to focus on a specific information about the comparison between a trainee's observed performance and a standard.  And this is done with an intent to improve performance. It's often considered to be an integral component of formative assessment.  And we generally think that this has a positive impact on learning. Now, feedback has been written about, and there are multiple sources,  and this is kind of a mishmash of kind of good kind of basically advice for providing good feedback. It should be immediate and timely. It should start with positive comments.  It should take place in a neutral environment. Try to get the emotion out of it.  It's really important that it's based on observation and not our interpretation of an individual's motivation.  And it should be specific so it's actionable, nonjudgmental, directed to behavior and not a personality, and really should be suggestions rather than something that is prescribed.  But there are challenges with feedback. And this group of researchers undertook a study, a meta-analysis of feedback literature,  based on this idea that it's an intractable problem in medical education. Others prior to their work had cited some of these problems, that feedback's often inadequate.  Folks that we ask to do self-assessments are not doing complete self-assessments, and they're defective. Folks tend to discount the feedback they receive.  And there's actually a low quality of evidence in the medical literature for the efficacy of feedback.  And what they identified in a review of 51 publications were a few common themes. Exchange of feedback was often of low quality.  Specifically, the low quality was related to limited amount of feedback and usually the fact that the feedback was too general. There also tends to be a leniency bias.  And I know Caitlin's going to talk about this. We don't like to give folks negative feedback. We really focus on the positive. So maybe they don't hear everything they need to hear.  And that our faculty and supervisors, and you can generalize this to any feedback relationship, are often not the strongest at giving feedback.  They have had no formal training or advice in this area. And in some situations, there might be use of negative feedback or multiple feedback tools,  especially in areas where written feedback is utilized. So that might end up interfering with the quality of that feedback as well. Another thing they noticed was gender bias.  And it was specifically gender bias, but I think that, you know, that kind of begs the question, could there be other forms of bias around race or ethnicity?  So how should this be incorporated into our approach to millennial learners and colleagues? I think the first and foremost are to avoid these stereotypes  and maintain situational awareness around the subject matter and context of what we're doing. Create an interactive dialogue.  And when it's possible, try to see if your organizations can provide faculty development and practice in giving feedback. And try to make feedback more of a longitudinal process  and embrace kind of the principles of coaching. And, again, this kind of levels the playing field, eliminates some hierarchy, eliminates some of the power situations that can occur,  and generating a good culture around feedback in your organization and looking at it as a healthy, growing enterprise.  I refer you to this opinion piece that came from authors at the University of Michigan on mentoring millennials.  And as you can see, what they've done is they've taken some of these negative stereotypes and translated them into something a little more positive  and looked at ways in which folks can then implement those strategies. And that's all I have for this topic.  Thank you, Dr. Paulding. Our next speaker is Heather Meissen. She's a clinical nurse practitioner at Emory Healthcare. Thank you. Good morning, everyone.  My name is Heather Meissen, and I'm an acute care nurse practitioner at Emory Healthcare.  And I have also helped lead the NPPA critical care residency program for the last eight years. I want to thank the Society for inviting me today to share my experience  training this next generation of providers. These are our objectives that you have, and I have taken some creative liberties with my objective,  which is highlighted here, to develop a strategy for teaching and training and multitasking.  I really wanted to focus today on giving you tools that you can take back to your institution to improve your clinical learning environment. I have no disclosures.  So anytime I'm faced with a new challenge or a new situation, I do like to start at the beginning to understand what is driving this new challenge or this situation  and defining this next generation I found really depends on who you ask. This is a study out of the Utah Foundation that saw that we're defining the millennial generation  anywhere from 1976 birth date to 2010. This is where I fall. I am considered by most to be a millennial. As we learned earlier, that would mean that I'm tech savvy.  However, this was what I grew up with. When I turned 16, this was what my cell phone looked like, and I didn't get my first e-mail account until college,  and I wasn't on social media until graduate school. That being said, I think we'd be remiss if we just focused on the millennial generation  because what we are noticing in nursing is now we are starting to see learners in this age, the post-millennial phase, the Generation Z.  This talk is really geared to both of those generations and their learning abilities. Another study we saw is that we have multiple generations currently in the workplace,  in the clinical learning environment. We have everyone from traditionalists to baby boomers all the way to the Generation Z. There are some challenges associated with learning.  We have experts and mentors that have been there. They've seen it. How can we harness that expertise and really deliver that content to our next generation of providers?  Understanding the characteristics of these different groups is very important. As our previous speaker mentioned, don't get bogged down in the stereotypes.  Again, I'm considered tech savvy, but I still don't know how to work my television at home.  Don't get bogged down in those stereotypes and really understand what your learner characteristics are.  Understand that we're using this term now, the digital natives for Generation Z. Incorporating things that are fast because they're fast decision makers, they're highly connected,  are really important in your learning environment. I'm going to go over some tips for successful training in this new era, in this new generation of learner.  I'll go through them individually. I don't want to pass over the opportunity to tell you guys it's so important to develop your faculty.  As you saw earlier, we have multiple generations in the clinical learning environment.  If some of our expert mentors don't understand the characteristics of the new learner and the new provider, then there's going to be lost mentorship.  It's very, very important that you develop your faculty and give them the tools to be successful to deliver that content. E-learning is the way that we're all going.  Everybody's e-learning now. I wanted to give you guys some tips, things that I have learned about in the last few years. A lot of our trainees are listening to podcasts.  I have multiple trainees in the room today who will come up to me and say, hey, I just listened to this great podcast.  I think it is so important you should incorporate it into your curriculum. As a program director, as an educator,  it's your responsibility to make sure that those are validated sources and it's validated content. Using sources and resources from societies, SCCM has a podcast.  This was uploaded on the 18th of December. It's up to date. It's out there. Our learners are going to be more receptive to this.  Also, I learned at Congress here that SCCM has their own YouTube channel. So if your learner is on YouTube Googling things, have them go to the Society of Critical Care Medicine.  Rely on your societies, the Surgical Society, the Infection Society, to get your validated content to deliver.  Also, we utilize VCCR in our training program, which is Virtual Critical Care Rounds hosted by SCCM.  The European Societies of Intensive Care Medicine also has some e-learning modules that are available to you. You do want to make your training sessions brief.  This is Dr. Subramanian doing a bedside chalk talk. He's talking about the difference between acute hepatic failure and acute on chronic hepatic failure.  And you can see to the side, we've also discussed CRRT in the ICU.  Our trainees are very receptive to these five-minute microbursts of information, especially when it's done right at the bedside.  The flipped classroom model is a great new concept that's come around. And honestly, we've been doing this for years, right?  How many times did you get a journal article and you were asked to read it and come back the next day and present it? That is essentially a flipped classroom.  So incorporating some of these techniques can engage your learner and make it a better product. We want to turn our lessons into games.  There's this whole gaming theory out there about teaching.  And this is one of my residents who's getting a lecture from Kylie, our RT educator who's in the audience today.  And she lovingly puts them on the ventilator so that they can feel what volume control means and feel what pressure support is.  And sometimes this turns into a game, not promoted by me, but they try to outdo each other to see how big of a title volume they can get.  So it does turn into fun and games and we all have a good time.  But as the educator and as the program director, it's your responsibility to bring it back to the concepts to make sure that it's not just the fun and games, but they are understanding the actual concepts.  We've also enrolled a Jeopardy style quiz in our program during their last month of training and our seniors go against our juniors.  So it can be really fun and it really drives home some of those concepts. I'm only going to briefly mention that this generation really does like frequent feedback.  Caitlin is going to go into more in-depth detail on this. But making sure that your feedback is frequent and appropriate is so important for this group of learners.  Your training should be flexible. There's a theory of personalized learning out there and that can be very difficult from a program director standpoint.  But what I recommend is making your learning modules multimodal.  If you have the learner that is interested in podcasts, having an acute respiratory failure module that includes a podcast, a journal article, a book chapter, a one-hour lecture.  If you have all these different modes of teaching, it's going to apply to each one of your learners. It's going to be more personalized for their learning experience.  So that's a very important concept to include. Also, introducing real-life scenarios is very important in this next generation of learners.  I can't tell you how many times we've sat in exit interviews and our trainees have said, you know, that last week I was taking care of a patient who we ran through in Sim.  We have a simulation where we blindfold our trainees and they have to come into their room. The patient's coded but they're on the floor. They can't see that.  They have to learn how to use open communication to understand where the patient is in the room. And just a few weeks ago, one of our graduated trainees said, I ran that code.  The patient, I walked into the room. The patient was on the floor. And we had that in simulation. So I was very thankful for that opportunity.  Anytime you can introduce a real-life scenario, it's really going to resonate with this group of learners. And then finally, multitasking.  I don't believe that multitasking is a Generation Z or post-millennial or millennial problem. I think it's an everybody problem.  And if you as the educator are modeling a behavior on appropriate multitasking and how to channel that, then your learners are also going to adapt to those behaviors.  There are some tips for successful multitasking, which includes triaging your problems and focusing your attention, creating lists to help you keep on track, managing interruptions,  which can be very difficult in the critical care environment. One example I use is that I work in a surgical intensive care unit where we focus on liver transplant.  And a few years ago, we kept getting interrupted with phone calls and texts and getting pulled out of rounds to discuss a liver transplant patient.  And what we decided was we were going to manage that interruption by having one solitary sign-out from the liver transplant team to the critical care intensive team.  So when the liver transplant team is done rounding, they come up to their critical care team.  We pause our rounds and we run the list of their patients with them that manages that interruption into one space  and so that you're not constantly being pulled in different directions. And as I said, this is an every generation problem.  Managing that multitask, if you model that behavior, your learners will also model that behavior.  Setting that expectation in place at the beginning of the rotation or the beginning of the year is also very important.  Telling your trainees to not constantly be on their phone, only use it for your med calculators, things like that really helps to curtail some of that multitasking.  So in conclusion, we want those short, fast microbursts of information, keeping your information to 15 minutes like this talk.  You want to incorporate some e-learning into your training program. Do some multimodal personalized learning. Make it fun. Engage your learner. Be open to new ideas and innovations.  And also make sure that you pay attention to your faculty development. Really give those experts in your organization the opportunity to share that expertise with your trainees  and develop their abilities to kind of bridge the gap between generations.  And that's all I have. Thank you, guys.  Thank you, Heather. Our next speaker is Caitlin Tenlohaus from Emory University. She's also a critical care nurse practitioner.  Hi, I'm Kaitlin Tinlowhouse. Like he said, I'm a critical care nurse practitioner at Emory University, and I am going to talk to you about how to give negative feedback.  First, I just want to thank the society for letting me talk. I'm actually a year out of my APP fellowship.  Heather was my program director, and so I just received a lot of feedback, and then I'm a year into being an advanced practice provider and giving feedback.  And I have nothing to disclose. So my objectives are to define feedback and barriers to feedback, develop skills in order  to encourage a culture of feedback and give feedback and solicit feedback, and giving and soliciting feedback in the context of different generations.  So my main objective is to really get you excited about feedback. I think this is something we don't really do well, obviously, as you heard from the other talks.  And I don't have enough time in a 15-minute talk to tell you exactly every little nuts and bolts and crannies of how to do it, but I want you to get excited about this tool  so you can take it back to your institution. So first, before we can go into how to give feedback, let's define it.  I thought this was really interesting, per the ACGME core program requirements, which is the Medical Residents and Medical Fellows Governing Body.  In 2013, feedback was actually listed three times in their program requirements. But in 2020, feedback is listed 23 times.  So I think that says a lot about the research that I'm about to share with you and how important feedback really is. So I also really like the ACGME's definition of feedback.  With all the papers that I read, I felt like this really shows what feedback is. I'm not going to read them to you, but I do want to highlight some of the words that talk  about what feedback actually is. So feedback should empower, it should achieve, and it should develop. And most importantly, it should be frequent. So why is feedback important?  I like this picture because we really do have a limited ability to observe ourselves. And feedback allows receivers to compare their performance to self-assessment and learning  goals. It empowers the receiver to grow and improve their practice and demonstrates the giver's commitment when done well to help the receiver achieve their goals.  So are we giving feedback? There are so many studies that show that we're not giving feedback, and when we do, it's not effective.  So I'm just going to go through some of the barriers in medical education that I found in the literature, and then we can talk about how to overcome them.  So some of the barriers are a lack of trust between receiver and giver of feedback, feedback  is not directly observed by the giver, inability of the receiver to accurately self-assess, feedback is vague, inappropriate time or place for feedback, the giver has minimal or no  formal training in giving effective feedback, a lack of culture of feedback within the institution,  and no follow-up after feedback due to short-term relationships between faculty and trainee, and the emotion of it all. You don't want to hurt someone's feelings.  So obviously we have a lot to overcome, but don't worry, we'll get there. So what is the goal of feedback? The goal of feedback should be to promote improvement.  If you're doing something well, tell me so that I can keep doing it. But if I'm not, let's develop an action plan to promote my improvement.  I love this picture, I found this picture, and I think it really embodies what feedback should be.  You, the feedback giver, or the receiver, but really the feedback giver, should be giving the receiver the next step to promote them as a provider. So I really like this picture.  And this is probably my most important slide of my talk. So this shows the shift in mindset for the feedback giver.  So we're all used to evaluations, maybe mid-rotation evaluation or end-of-rotation evaluations that tell us, is this PGY2 ready to be a PGY3? How are they doing?  It's really an assessment. It's usually judgmental. They're usually high stakes. It's often lengthy. And it's usually done, like I said, at the end of the learning process.  It's usually very formal, and it's usually written and placed in the student's record or the trainee's records.  And the whole goal is just to communicate a decision about performance. So that is something that definitely has a place in medical education. But feedback is different.  Feedback is actually an assessment for learning. It's nonjudgmental. The stakes should be low. It should have a very safe environment, should be given in a very safe environment.  And it should be brief. It should be timely, on the spot. It can be scheduled. We'll talk about that in a minute. It should be informal and frequent.  So the goal should be to provide insights that help the learner make adjustments in performance and demonstrate improvements that align with their own goals.  So this slide really embodies how we should be moving from evaluator to coach. And in the units, really coaching the person to improve. So how do we do this?  So this actually starts day one of the rotation before you step into the unit. Proactively establish a safe learning environment. Set expectations that feedback will be frequent.  Define receiver's goals. Enable receiver self-assessment. And ensure feedback will focus on trainee's goals, assessment, observed performance, and action plans for improvement.  Make sure your trainee knows that you have their best interest in mind. This really should go without saying, but studies have shown that if your feedback receiver  doesn't trust you, they're not going to listen to any feedback you have. It's just going to be dangling data. So make sure that you're really creating a, you're being a role model.  All right. So let's get into it. How to give negative feedback. So the first thing is timeliness.  A lot of studies show that if you don't give feedback soon after, it creates distress between the receiver and the feedback giver.  So they'll be asking, why didn't you tell me two weeks ago? I could have had time to improve that. So make sure that you give it soon. Address emotion.  If you're stressed, if you're upset, if it's after a code, you're not going to be in the right headspace to receive any kind of feedback. Make sure you talk about the emotion.  Clear it out of the head. Clear it out of the forefront of the person's head so that you can really get to the feedback. Tailor feedback to the receiver self-assessment.  So this one's really important and what you should probably do day one before you go into the unit.  So allow the receiver to align whatever action they did with their own self-assessment and if it's meeting where they need to be.  Also studies show that if they're able to align it to their self-assessment, they might even be able to point out how they need to change for you and you won't even have to  give them the feedback. And then they're more likely to improve off of that. Also, tailor feedback to the receiver's prior set goals. This should be done on day one.  So if you're really having trouble reaching a trainee, you can bring out these goals and say, hey, this action isn't really meeting the goals that you prior set with me on day one.  Be specific. How many people have heard you need to read more? Anybody in this room? Okay. That's not helpful. That doesn't give me anything actionable that's not specific.  Tell me what I need to read.  Tell me how to find it and make sure to follow up with me that I've learned whatever I was missing. Balance.  So I'm talking about negative feedback, but make sure you're not giving one too much of positive or too much of negative.  The research shows it should be really balanced, so really work hard to find both. And then these two kind of go hand-in-hand.  Enable the receiver to construct an action plan for improvement and set up follow-up. So make sure that you help the receiver figure out how they're going to improve, and then  make sure you follow up with them and tell them how they, if they improved or if they didn't, so that you can continue to build those steps to become a better provider.  Feedback modules. How many people have heard of the feedback sandwich? Okay. Well, unfortunately, it's out.  So the feedback sandwich is actually, a lot of studies have shown that it's used so much people aren't believing the positive feedback anymore.  They think that you're just putting it in there to cushion the blow. So it promotes distrust between the feedback giver and the feedback receiver. And it's also not actionable.  If you give me the feedback sandwich, it's just dangling data. I don't know how to improve, and you're not helping me become better. Okay. So what can we use?  So there's two modules I just want to go through real quick before we get to the case studies.  So ask, tell, ask, and plus delta. So first, ask what went well. This is your self-assessment component. And hopefully, they're going to do your work for you.  They're going to be able to tell you what went well. If not, tell them, but be nonjudgmental. Second, ask what could be improved.  Again, hopefully, they're going to be able to do the work for you. Studies show if they can figure out what needs to be improved, then you're going to, they're  going to more likely to improve. But if not, go back and align feedback with those preset goals you set on day one.  And then finally, summarize the positive and areas for future growth and make plans to follow up on progress. All right. This is something from my home institution, the plus delta.  And it's just like this, just as messy, and it's great. So we used to do this after sim, and plus delta is after an event or sim or maybe a  code, we would go through what can be in, what went well is the plus, and delta, what can be changed.  But before we did that, we would talk about the feelings and how we were feeling so that we could really get down to this.  So case studies, I have a couple things that you may relate to. So you're supervising a resident doing a central line.  And the line's going well, but, and the wire's been placed, but you notice that their hand comes off the wire because they're trying to find the dilator, and they're not very  organized. So the line continues and carries on. And then you notice, and it goes well, they're able to get the wire placed.  But then you notice that a sharp is left behind in the patient's bed. You quickly correct both of these things in the moment, but you don't go into much detail about the correction.  You just say, get your hand back on the wire and make sure you don't leave that sharp in the bed. Has anyone had any of this ever happen to you on your unit?  So hopefully this is familiar. So this is really going through that self-assessment, and the first thing you would do, and we're  going to use the Ask, Tell, Ask module, what do you think went well from your central line? Hopefully again, they're going to tell you what went well. If not, tell them.  Then ask, how can you improve? Hopefully again, they're going to tell you how they can improve.  Hopefully they know and they felt just like you were about to have a heart attack when you saw their hand go off the wire.  They were too, and they can understand that and know they need to choose it. And then walk the trainee of how you're going to fix this problem. Maybe it's going to be you.  Maybe this trainee needs you to walk through a setup step by step, or maybe you just need  to observe them again because they're a self-learner and you can come back and see if they've improved or not.  All right, this one's a little bit harder and a little bit more emotional. So you're supervising a STAR fellow who knows all the correct managements and provides a  high quality of care to his or her patients. However, when the fellow is faced with multiple emergent resuscitations codes on the floor,  their behavior, communication, and posture becomes so abrasive that it borders on the verge of unprofessional and hinders the team from functioning. Has anyone had this before?  This is kind of difficult to deal with, right? So the first step here is check in with emotion. They're not going to hear anything if they're still stressed or upset about the code.  So check in with that emotion before you go on. But we're going to use the ask, tell, ask here again. Do the self-assessment. What went well first?  Then, if you need to tell them what went well, tell them. And then here's where you ask what could improve.  And hopefully they see that the nurse can't even handle the pump because she's so nervous because you're yelling at her. And hopefully they can get there.  But if not, gently go back to those preset goals. Align them. Tell them, you know, everyone's so stressed in the room. We can't function. And that's not what we want to be like.  That's not the team we want. And that's not your goals. And then help them with the action plan. It's great if they can come up with it.  But if not, offer them ways on how to calm down. Observe more codes with them or observe them in more codes and notify them of improvement when they've made that next step.  Soliciting feedback. All right. So now that I've told you how to give feedback, let me tell you how to ask for it. It's very similar. So define your own goals.  Have your own self-assessment so that you can go into this kind of like we did before on receiving feedback with yourself.  And I think it's really important to have a go-to question. Do your goals currently line up with your performance? And know that.  But the go-to question specifically is, can you give me one thing I can do or stop doing that will make working with me better?  How many people have been like, do you have any feedback for me? And you get nothing. Well, this question I found is really helpful because everybody has maybe one thing they  can give you. Ask early and often. And just like we do with the feedback receivers, set up an action plan and follow up for improvement with the feedback giver. All right.  Feedback in the multi-generational setting. I do have to disclose that I'm a millennial. But we all have our own generational relationships to feedback.  And I think this is very interesting and just something to know. And my colleagues have already mentioned this. But millennials do seem to crave feedback more.  A lot of the data shows that it's because of the Facebook liking culture and the status. We kind of grew up with all of that constant feedback.  And I have my own anecdotal story to this. In SIEM, when I was a fellow, I remember doing SIEM for about six months. I always wanted feedback in the middle of SIEM.  But a lot of the evidence showed that terminal feedback from a SIEM is much better than concurrent feedback. So that's how we've done it.  But I remember the EKG tech would walk in, the person who's pretending to be the EKG tech. And I would ask them if it was okay for me to give Keppra.  Because I just wanted someone to help me out, hoping that they would help me out. So that I could win the SIEM.  And finally, at about six months, I realized that going through that process is actually really good for me. And so that's just kind of me being a millennial.  I really have craved that feedback before. And just learning through SIEM that you don't need it immediately within SIEM or in the middle of the code.  You can get through it and come back later. All right. So closing remarks. First create a culture of feedback. Set the stage before you step in the unit.  Feedback should never be a surprise and always a partnership. The goal of feedback is improvement. So guide the receiver to become the best provider or person they can be.  This is a little millennial, but think of giving feedback as tweets, meaning it should be done frequently. And then the feedback giver mind shift.  We need to all move from the evaluator to coach, like some of my colleagues showed. And the feedback should always have followup. Thank you so much.  I definitely ran out of paper with this little bedside table hotel pad. We have a lot of time for questions, which I think is great.  This is the kind of topic where you have an expert panel that can address some of your real world challenges.  I have a few to start off if there's not someone pressing towards the mic. Yes, please go to the mic and state your name and where you work. Do you want me to repeat the question?  Does this work? Oh, great. Great talk. Really, they all built off of each other. My name is Lily. I'm from the University of Pittsburgh.  I'm curious for when you try to set up that great learning environment to be able to actually get the feedback. What if they actually say I have no goals?  Are they really overwhelmed? Do they just... When you try to prepare the feedback environment to be as successful as possible, they're just sort of blank slate. What do you do?  Okay, well, I'll start. I think that's where you go back to basics and say, well, why are you here to be a provider? What kind of provider do you want to be?  And where do you see yourself in a year, in six months, next month?  And then really start asking them where they see themselves. And if they're still like, I don't know what I want to do, I would start to venture, well, why are they here?  Is this the right profession? And do they want to grow? I agree. I think I've been faced with that many times and you can't give them their goals for them.  They have to come to that conclusion.  So really helping them to identify what is driving them to this profession, what is driving them to be here.  I can't spill all my veins because all of my residents are in the audience, but we've had some issues where we've had to say, why are you here?  Those words exactly, why are you here? What is it that you're trying to gain? So really helping them to identify what is driving them is very important. I totally agree.  And again, these are kind of espousing some of the principles of coaching and helping people kind of identify where they're going. I think you guys said it very, very well.  I actually have a suggestion for the prior question as well as my own. But one thing that you could do to improve your dilemma as well as improve the quality  of feedback is add specificity and this is what I generally do with my residents. I train anesthesia and critical care residents.  I'm in California, Stanford programs and Palo Alto VA. Is come up with a goal for the day.  Like say today we are going to work on efficiency and then that way the resident knows it's fair game that I'm going to be looking at efficiency, not necessarily whether they can  identify the landmarks or anything else that's going on, but just what their efficiency is, what their hand motions are, or you could pick whatever else.  But I think if you can ahead of time agree, okay, we're going to work on X and I'm going to give you feedback on X.  Then at the end of the day when I'm brain dead and it's 4 p.m., I'm going, God, you did pretty good today, you know, I'll see you tomorrow, you know.  It's not that real low specificity feedback. But so that's kind of a comment that I don't know if that works for you guys, but my question  though is when I have one resident, this is pretty easy stuff, but when I have a group of residents and I'm meeting first time on a weekend or a Monday, you know, I don't know  these six new strangers. It's important to establish trust as I think one of the speakers said. How do you do that?  What are your techniques for establishing trust in this safe environment? I just feel like I'll just act like a nice guy and be a nice guy and show them through  the course of the week that I'm a nice guy, but they don't know that then. It comes from the very beginning of managing the expectations and trust is something that  is earned over time with frequent interactions, allowing you to engage with your learners. On day one during orientation, we say we are going to call you and we are going to have  a conversation and it's going to be frequent and it's going to be often. It's not personal. It's our whole goal is to ensure that you become the best provider you can be.  So anytime we deliver feedback, we say the reason why I'm here is to ensure your success and this is how we're going to get there. So you have to say it over and over again.  Trust isn't established on day one, but and also pairing them with additional graduated  learners who can validate, yes, they are there to make sure that you are going to be successful. You can go to their office. They do have an open door policy.  So having your some of your senior residents also telling your juniors that it's acceptable. I also think that it depends a lot on the context and I'm also an anesthesiologist and  the ICU environment is quite a bit different from the OR environment in terms of giving feedback. And a lot of that is also dependent on the nature of your program.  So I'm in a very large residency program and when I'm in the OR, I may not work with the same resident.  I might work with them one day and then I might not see them again for months. And that really is a huge challenge to providing effective feedback.  So a lot of times, as you said, the trust issue is coming in with that face validity. I mean, if you have a reputation as a faculty member in your department that's interested  in education and really, you know, an advocate for the residents and those kinds of things, you have that face validity coming in.  But that might not be true for everybody or maybe it's somebody that has, you know, they  just haven't been paying attention to those kinds of aspects and I don't think it's reasonable to even expect that they should.  So the onus is on us to try to engage them early, let them understand that we are, you know, dedicated to their education and there to help them.  I mean, you know, I feel like I'm often working for the residents. I treat them very collegially and I've done that for a really long time and I find that  to be an effective approach. The majority of the time I really try to take that, you know, kind of power differential out of it. I mean, they know that you're a faculty member.  You don't need to drive that point home. Thanks for those talks. Some of your examples of task-based feedback seem a little bit easier to implement than  like that example you gave of somebody becoming unprofessional in a high-stress situation. And I've personally run into situations where you're dealing with a lot of, like, highly  educated, motivated, and in some cases personality traits which for all intents and purposes have been rewarded by virtue of where they are at that stage in their life.  And you're meeting these people for one to three years, for one month for some, three years for some, and they've gotten to a people have gotten to a place where, like, whatever  behaviors they have, whatever attitude they bring to certain situations is kind of been validated for more or less for 25 to 30 years.  And even if you have trust and the people I've given this feedback to in different situations is, like, there's no reason for them not to trust me.  There's, like, we've always been collegial. But when I followed back up with it, they've either been able to talk themselves out of  it in a way that made me think that their own history has kind of, like, made them say, like, no, I actually don't trust this feedback that was given about this personality quirk  or this aspect of my behavior that manifested that time. Do you see what I'm saying? And so, like, I've actually found that, like, a really hard hurdle to get over.  And I was wondering if you had any suggestions about, like, tackling those kind of harder like not so much, like, you left the line and the patient sort of feedback, but more  like the, like, you have you have a overall demeanor which is becoming difficult to partner with and to lead a team sort of issues.  I think if they're convincing themselves that the feedback is inaccurate, having multiple data points from multiple different evaluators will help with that situation.  Having a myriad of scenarios and then also modeling how the scenario should have been handled will help in that situation.  And having it, again, come from multiple individuals will help. I also think that in that situation, there's a lot of data that says don't focus on the  personality traits, focus, go back just to that self-assessment and goals. And obviously, this person can't self-assess, but if you go back to their goals, and that's  hard with colleagues, but if you go back and say, hey, what are your goals and this is how you are not meeting them, that's another way to open their eyes.  I mean, if you're saying, you know, the way that you act is impeding our team, that is definitely not going to be one of their goals, and they're not being a competent provider  in that way. I would add that I think, again, it depends a little bit on the context. Occasionally, you're going to encounter those situations. Somebody's having a bad day.  There's some external pressure at home or whatever, and they happen to behave in a fashion that's unacceptable, but it's different from their normal behavior.  And if you have, and I agree, the multiple data points, if you have repeated demonstration of disruption in that manner, that elevates to like a level of professionalism, and there  are different ways of handling that. So that might be something where you say that, you know, this daily feedback model might  not be as effective for that individual because they're going to repeatedly reject that for various reasons, and then that's a deeper dive and kind of a different direction to  take to help them professionally. And also recognize that there may be some of those folks that really can't be helped.  Go ahead. Hi. Chris Newman from Children's Colorado. So we're supposed to give feedback in a timely manner. It's supposed to be specific, and it's supposed to be actionable.  And I have noticed that many of the junior faculty that I work with actually communicate fairly robust, complex, emotionally involved conversations using digital devices instead  of face-to-face. And I am wondering, has anyone started, one of you actually put in there, you know, treat them like tweets.  Well, do you ever DM them the first part of the feedback? You know, is anyone using Slack to say, hey, what do you think went well 12 minutes ago,  that they can then answer 30 minutes later when things slow down? Has anyone played around with non-face-to-face methods to ensure that you can respond when  you're ready to respond, and I can give you the next step when I'm ready to give you the next step? No.  And I caution that because we've all gotten the email that has ticked us off, right? So communicating electronically can be misconstrued.  And when they hear the inflection in your voice versus an email, I can't tell you how many times I've gotten an email, and it's just made me so mad.  But then you go and you talk to the person, and you're like, oh, okay, well, I understand that better.  So no, I haven't, but I've also, in preparing for this lecture series, have understood that  the Generation Zs, the post-millennials, aren't comfortable with personal interaction, and they're not comfortable with that. They're more comfortable with the tweets.  So it is something to consider, but also you have to be careful with your inflection and your email etiquette or your tweet etiquette.  And something I would say to that is there's a lot of studies that have shown that 80% of communication is nonverbal. So if you're doing that, you're going to take that away.  And I think it's important to give them time. So maybe, yes, best on-the-spot feedback after the code or something happens, that's ideal.  But if they are so emotionally not ready to hear it, give them time and set up a time within the next day, at least. Don't wait three weeks.  But that they can come back and discuss it with you and say, hey, when are you ready to have a feedback talk on this? Yeah. I'm sorry. I'm just curious.  Because, I mean, you provide these models of feedback that seem fairly straightforward. If the same thing you asked every time is, what do you think one thing that went well  is, how emotional is that question? And you're making these models of, like, set up a time. But I'm on service for seven days in a row.  If there's an interaction with a family that occurs Monday morning at 7 a.m., the next time we can really set an emotion-free, neutral space, I'm just sort of curious.  I hear all the thing about the non-verbal communication. But then I'm watching people who are, like, conducting marriages over Twitter.  And are we sure that there aren't ways to just get better at that communication instead of saying it doesn't work? There could be. I don't know. There could be.  Maybe it's the next project. Yeah. I mean, like I said, the next generation, the post-millennial, we don't have a lot of data on them just yet. But that might be where we're going.  And back to your faculty development, I'm going to have to learn how to do that and how to give that feedback. So making sure that as we all age, we also adapt.  So that's an excellent point. Thank you. Yeah. It may also be important to take that in the context of how feedback fits into your global education and evaluation system.  And I think the point was made earlier that feedback is not evaluation. They're different. They're different pieces of it.  And some of you may be education true experts in the audience. But some folks, they make this differential between formative and summative feedback and how we use those things.  And some people think that that's a very artificial construct. There's evidence of that in the literature as well.  So maybe digital applications for some of these elements of feedback may be excellent ways to do it. I just think we don't know yet.  And like in this area, where there's not a lot of high-quality data, I think we've  seen a lot of what's out there. And Caitlin did an excellent job of presenting the available evidence. I think we have time for one more question. Thanks. I can speak to that.  I give all my residents my cell phone. So they text me quite frequently, actually, on a small list. But the bigger question for me right now is this.  I know feedback is great and all that. But the one thing I'm finding is just general resilience, just the ability to cope and dealing with that.  I'm having a very hard time right now in terms of how do you instill feedback in a setting where the person in front of you is literally crumbling. And it's a repeated thing.  That's a whole other hour lecture of developing resilience. I know. I just want to get back into that when you watch a person melt.  I think in the future, we're going to see resilience training and modules incorporated into our educational tracks.  I know that there's some nursing programs specifically that are incorporating resilience training into their educational didactics to help with that.  And I think as a program director, you're responsible for knowing which resident's crumbling and which one's surviving and being able to reach out to them.  So that's a great point that you've brought up. I think we all have anecdotes. I just have to share this with you because I think I was blown away by this.  And it was probably five or six years ago at a graduation dinner. These were anesthesiology residents at a graduation dinner somehow. I don't know why we got on this topic.  Just talking with a couple of our graduates about feedback and evaluation and that sort of thing. And the conversation eventually evolved.  And I said to them, sometimes when I'm working with someone, and I know they're a particularly strong resident, they're doing well, but there's something that went wrong.  And we kind of talked about how we evaluate that and debrief.  And I said, one of the things that I've often said to folks is, you know, this happened. This was the outcome. We debrief on it. You're too good to let that happen.  And one of these graduating residents looked at me and said, if you had ever said that to me, I would have been devastated.  And I just, how do you, you know, how do you protect that space? That's a very difficult thing to do.  That's great.  Well, thank you. Fly safely. Thank you.

Video Summary

In this video, three presenters discuss the topic of generational differences and effective feedback in the workplace. The first presenter explores the concept of generational theory and how it is used to understand and categorize individuals based on the date of their birth. He discusses the different generations and the stereotypes associated with each, highlighting the importance of avoiding generational stereotypes and considering individual needs and motivations. The second presenter focuses on strategies for teaching and training in a multi-generational workforce, emphasizing the importance of creating a safe learning environment, providing frequent feedback, and using diverse teaching methods. She also discusses the challenges associated with giving negative feedback and provides tips for making feedback more effective. The third presenter delves into the barriers to effective feedback in medical education, including a lack of trust, vague feedback, and inappropriate timing or place for feedback. She provides strategies for overcoming these barriers and stresses the importance of setting clear expectations and goals, as well as following up on feedback. Overall, the presenters provide valuable insights and practical tips for improving communication and feedback in a multi-generational workplace.

Asset Subtitle

Professional Development and Education, 2020

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2020 Critical Care Congress held February 16-19, 2020, in Orlando, Florida, USA.

Learning Objectives

Discuss the value of trainees receiving different types of feedback from mentors
Develop a strategy for teaching, training, and multitasking as parts of critical care training
Identify strategies to deal with the emotions associated with negative feedback

Tension Point 1: Hearing and Delivering Feedback

Ronald W. Pauldine

Tension Point 2: Mentoring Millennials

Heather Meissen

Are You Ready to Hear Criticism? How to Give Negative Feedback

Caitlin ten Lohuis

Meta Tag

Content Type Presentation

Knowledge Area Professional Development and Education

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Fellowship Training

Tag Medical Education

Tag Communication

Year 2020

Keywords

generational differences

effective feedback

workplace

generational theory

teaching strategies

training strategies

multi-generational workforce

barriers to effective feedback

communication

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