"Give" Time to Think

“Students may say they don't have a question about a certain situation, but I often find they're just processing what's going on and may have questions later.”

- a Manitoba OT fieldwork educator

Whether it is responding to your question or commenting on an interaction that has just occurred, students need extra time to process information.  This might be because they are looking for that “one right answer” and/or that are sorting through and trying to organize all the information they have learned in school and on placement.   

In light of this, our tip for you is to... give time to think.

This may seem like common-sense. But time often feels like it is at a premium when caseload demands refuse to slow down and does not leave space for much of anything else - including time to think. Here is a few suggestions on how to "give" your student time to think:

o    Give the student some questions to consider in advance if you plan to debrief later.  For example: “When we meet at the end of the day, I’d like you to share what you thought went well with this initial assessment and what you’d do differently next time.”

 

o   Wait at least 10 seconds for a response after you ask a question (you may want to add more time if English isn’t the student's first language). 

o   Appreciate that your student may need time away to form a meaningful answer as the pressure to immediately respond could affect their ability to think. I bet we all have found ourselves in client situations where we needed time on our own to think. The student could jot down the question and prepare their answer for a later time.

o   Valdiate that it is okay to give parts of their answer now and then later, follow-up with additional thoughts. This will support their processing of "what they know" versus "what they do not know"... and then, how will they plan to figure out the rest of their response!

o   Encourage your student to share their thoughts and processing with a peer if they are sharing a placement (i.e. a collaborative placement model).

So what do you do when you’ve allowed more time to think and the answer still isn’t “right”?

o    Let them know what is “right” about their answer.

o    Use probing questions to help guide them to modify their answer to be on the right track.

o    Share your reasoning on how you processed the information (i.e. your perspective of what happened) and then how you came to your clinical conclusions.

Of course, the irony is not lost on us - there is so much to do during placement and so little time! As always, the Fieldwork Team is here to support you to problem solve how might you be able to give time for your student to think. Please do not hesitate to connect.

Lisa

Revised by Julie, 2024

Talk about being wrong

While listening to the radio, I was made aware of a TED talk called "Doctor’s Make Mistakes. Can we talk about that?" by Dr. Goldman. I have since checked it out and would recommend  you do too.

Although the focus of the TED Talk was on “medicine’s culture of denial” that keeps doctors from talking about their mistakes, I could see the link with other health professions. 

It got me thinking about some of the mistakes I’ve made in my practice.  While I realize that my mistakes haven’t had “life or death” consequences, my mistakes are ones that I hope wouldn’t happen again.  And when you expand the word “mistakes” to “things that I should have done better”, or “things I’m not proud of”, or “I should have known better” the list gets even longer.

What stood out most to me was a tip Dr. Goldman was sharing with physicians (which I think can be applied to you):

TALK ABOUT BEING WRONG. 

And for those of us who have practiced for a while--don’t just talk about the mistakes you made when you first got into practice.  Talk about the recent mistakes.  Mistakes don’t just happen to us in the first few years of practice.  They can happen at any time.

Talk about where you think you went wrong.  

Talk about what you learned.  

Talk about how this has changed what you do.

I think a few things might happen:

• You will help create a safe learning environment for the student.  You expect that mistakes will be made.  Mistakes that you can talk about and learn from. 

• You will alleviate the pressure the student might feel to have “the right answer” or to be “perfect”.  Although you are an educator in a mentoring/coaching role, you are still seen as the evaluator.

• You might be able to prevent a future mistake.  Perhaps your student can learn from your mistake too.

Around the 17 minute mark, Dr.Goldman says (the bolding is mine):

The redefined physician is human, knows she's human, accepts it, isn't proud of making mistakes, but strives to learn one thing from what happened that she can teach to somebody else. She shares her experience with others. She's supportive when other people talk about their mistakes. And she points out other people's mistakes, not in a gotcha way, but in a loving, supportive way so that everybody can benefit.

We are human.  We make mistakes.  But we can choose to learn from these mistakes.  And we can share this learning with others, including our students.

Lisa

Revised by Julie, 2024.

Ask your student to make predictions

When you, as an experienced therapist, get a referral or review a chart you instantly make predictions about what you anticipate you will see and do.

Despite having only a minimal amount of information, you already have a basic template in your mind of what you will likely need to address with the client.  You probably even have what you need packed in your bag (or trunk of your car).  In fact, you likely have a back-up plan (or more!) ready to go. All of these predictions are based on the experiences you’ve had before with similar clients.

So how can you support this development? Because the truth: is there is much, much more nuance and thought behind this skill than simply experiencing something twice.

Prediction Tip: Part 1

When you ask your student to read a chart or a referral, have him/her create two lists.  One list can be called, “Things I know about the client” and the other list can be called “Things I anticipate”.  When the student is thinking about what is anticipated, he/she might consider:

• How I expect the client to present based on the diagnosis or referral (I think he will have difficulties concentrating, poor balance, difficulties with swallowing etc).  The student may need to look this up if the diagnosis is not familiar.
• The occupational performance issues that are anticipated (So what occupations do I think this will impact based on what I know about the client?  What occupations should I make sure I ask about?)
• The environmental conditions that need to be looked at based on what I already know (Is it important to know about stairs? Who else lives in the home?)
• How the client will progress (Is it likely this condition will improve?  Get worse?  Maintain?)

Prediction Tip: Part 2 (add a reflection!)

After they interact with the client, encourage them to go back to these lists to see what was right and what was off.   Have the student ask themselves...

• For things that were off, why was this so?
• Were there cues that I missed in the referral/chart?
• Would I do anything different next time?

Students are only in placement for a finite amount of time. Every opportunity to learn - including learning how to make predictions! - is truly going to support their ability to practice now and in the future!
Lisa

Revised by Julie, 2024

Thinking Out Loud

You probably don’t give yourself enough credit for all the thinking you do in a day.  You may even think a lot of what you know and do is “common sense”.

Students can’t see all your thoughts, revisions, and detours that can happen in a blink of an eye. In fact, you might not even realize they are happening. By “thinking out loud” you will make your reasoning more explicit and will help the student to understand your thinking.

Thinking Out Loud: Level 1

Explicitly talk through your thought process.  Think of this as the "director's commentary" bonus DVD.  It's one thing to see the movie (or observe the session) but by having a "what the director was thinking" bonus gives students insight into the decisions that were made.

- “With yesterday’s client we used the _____assessment, but I don’t think that will work with    the woman we’re seeing today because of _____.  That’s why I’ve decided to use ____ as it will be better suited to her.”

- “My first thought was that his biggest issue was his mobility, but after talking to him I could see that we needed to explore issues related to ____ as he was clearly depressed”.

- “After question 9 of the assessment, I could see that she was fatigued and becoming frustrated. I decided it was more important to maintain rapport and switch to another activity than to finish this today”.

- “You can see here in the chart that he has a diagnosis of _____.  In my experience, this typically means that he will have difficulties with ______ so these are the areas that I will need to make sure are covered in my initial assessment”.

- “When the wife said ____ I didn’t really know what to say.  I’m not sure how I’m going to follow this up just yet”.

Thinking Out Loud: Level 2

Engage the student in a dialogue:  have them fill in some of the blanks of what you were thinking.

- “When I walked in the room, there were some cues that he wouldn’t be discharged so soon after all.  Were you able to pick up on any of these?”

 -“Why do you think I ended the assessment early?”

Thinking Out Loud: Level 3

Now that you’ve done all that great role modeling, it’s the student’s turn.  Have them explain the rationale behind their decisions making.  You can cue them by asking the trusted 'who, what, when, why and how?' prompts. 

Lisa

Revised by Julie, 2024

Who, What, When , Why and How…Coaching Questions to Foster Reasoning.

As educators, one of our roles is to foster and encourage the development of our students' ability to professionally reason.   One way we can do this is by asking open-ended questions which encourage the student to verbalize the thinking behind their practice.  

The following are some suggestions for the types of questions that may help coach the students along:

HOW: 

How did you come about that? 

How is that the same or different with what you already know/ have done?  

How did you feel/think/act when that happened?

WHAT: 

What makes you think that? 

What was important about that? 

What did you learn from that?

What might you do similarly/differently next time?

WHEN:

When did that first occur? 

When did you realize that? 

When do you anticipate that will happen?

WHERE: 

Where can we start to make a change? 

Where did it go wrong? 

Where do you see yourself fit in?

WHY:

Why did you do that? 

Why do think that happened?

Why is it happening? 

Why do you think you got that response?

A note about “Why?”:  Try to use these questions more cautiously and/or with a mix of the other questions.  Why questions can sometimes feel more interrogatory for students…like they need to “defend” their decisions.

Bonus Tip:  If you have asked the student to complete a journal, ask them to keep these questions in mind when they are writing.

Happy educating!

OT Fieldwork Team

References

Zeus, P. and Skiffington, S. (2000) The complete guide to coaching at work. McGraw-Hill, Sydney.