Brain Based Learning Strategies to Improve TeamSTEPPS® Deployment and Health Care High Reliability
Contents
Slide 1. Brain Based Learning Strategies to Improve TeamSTEPPS® Deployment and Health Care High Reliability
Slide 2. Rules of Engagement
Slide 3. Upcoming TeamSTEPPS Events
Slide 4. Contact Us
Slide 5. Today's Presenter
Slide 6. Brain Based Learning Strategies to Improve TeamSTEPPS Deployment and Health Care High Reliability
Slide 7. Hello From UTSW
Slide 8. Texan Thinking…
Slide 9. Disclosures
Slide 10. Learning Objectives
Slide 11. Brain Based Culture Change
Slide 12. Brain Based Learning Theory
Slide 13. Most Great Ideas Strike Out!
Slide 14. How will this one be different?
Slide 15. Effective Training (Kirkpatrick Ladder)
Slide 16. Emotions are More Powerful than Logic
Slide 17. Meet John-John…
Slide 18. Poll the Crowd….
Slide 19. Loss Aversion—preference for certainty
Slide 20. 4 Primal Emotions
Slide 21. Loss Aversion—Avoiding Emotional Pain
Slide 22. De-motivators can be more powerful than Motivators
Slide 23. Power of Framing…
Slide 24. Power of Framing…
Slide 25. Power of Framing…
Slide 26. The Power of Positive Framing
Slide 27. The Power of Positive Framing
Slide 28. Take Home Point—Remove De-motivators and Frame Positively
Slide 29. Effective Training (Kirkpatrick Ladder)
Slide 30. What is Successful Learning?
Slide 31. Brain Based Learning
Slide 32. Goal of Orchestrated Immersion Episodic Memory
Slide 33. Seductive Detail Effect
Slide 34. Seductive Detail Effect
Slide 35. Relaxed Alertness--Cortex and Brainstem
Slide 36. Relaxed Alertness
Slide 37. Relaxed Alertness
Slide 38. Fear of Making Mistakes/Errors
Slide 39. Frame Errors Positively
Slide 40. Error Management Theory
Slide 41. Error Management Learning Paradigm
Slide 42. Error Management Theory
Slide 43. Error Management Theory
Slide 44. Error Management Theory
Slide 45. Error Management Theory
Slide 46. Error Management Theory
Slide 47. EMT and In-Situ Simulation
Slide 48. EMT and Just In Time Learning
Slide 49. Reflection—Active Processing
Slide 50. Reflection—Active Processing
Slide 51. No Change in Non-Technical Skills w/o Reflection (Debriefing)
Slide 52. Human Cognitive Limitation
Slide 53. Cognitive Load Theory
Slide 54. Strategies to Optimize Cognitive Load
Slide 55. Caricature Advantage Effect
Slide 56. Caricature Advantage Effect
Slide 57. Caricature Advantage Effect
Slide 58. Caricature Advantage Effect
Slide 59. Caricature Advantage Effect
Slide 60. Caricature Advantage Effect
Slide 61. Caricature Advantage Effect
Slide 62. Take Home—Amplify and differentiate the new way
Slide 63. Metacognition—Experts vs Novices
Slide 64. Coaching and Learning
Slide 65. Coaching and Learning
Slide 66. Deliberate Practice--Goal Setting
Slide 67. Prime and Goal Set Pre Simulation
Slide 68. Metacognition and Deliberate Practice in In-Situ Simulation
Slide 69. Effective Training (Kirkpatrick Ladder)
Slide 70. Behavioral Change is about Mimicry
Slide 71. Social Influence Primes us for Action
Slide 72. Ever seen this…
Slide 73. Mirror Neurons
Slide 74. Neuro-Biology of Mirror Neurons
Slide 75. Mirror Neurons and The Power of Mimicry
Slide 76. Take Home Point: Leverage Group Think or Social Conformity
Slide 77. Take Home Point—Don't Underestimate the power of competition
Slide 78. It is more Cognitively rewarding to Cooperate than Resist
Slide 79. Questions?
Slide 80. Questions and Answers
Slide 1
Brain Based Learning Strategies to Improve TeamSTEPPS® Deployment and Health Care High Reliability
January 11, 2017
Slide 2
Rules of Engagement
- Audio for the webinar can be accessed in two ways:
- Through the phone (*Please mute your computer speakers)
- Through your computer
- A Q&A session will be held at the end of the presentation
- Written questions are encouraged throughout the presentation and will be answered during the Q&A session
- To submit a question, type it into the Chat Area and send it at any time during the presentation
Slide 3
Upcoming TeamSTEPPS Events
- Master Training Courses
- Registration for courses in January-March 2017 now open
- Registration opening on January 18 for courses in April-June 2017
- National Conference
- June 14-16, 2017
- Downtown Hilton, Cleveland, OH
- Registration open
- Call for Webinar Presenters
- Apply here to present on March 8, April 12, or May 10
Slide 4
Contact Us
Phone: 312-422-2652
Email: AHRQTeamSTEPPS@aha.org
Web Site: https://www.ahrq.gov/teamstepps/index.html
Slide 5
Today's Presenter
Oren Guttman, MD, MBA, CHSE
- Director for Multi-Disciplinary Team Training
- UT Southwestern Medical Center
- oren.guttman@utsouthwestern.edu
Slide 6
Brain Based Learning Strategies to Improve TeamSTEPPS Deployment and Health Care High Reliability
Oren Guttman, MD, MBA, CHSE
Director for Multi-Disciplinary Team Training
UT Southwestern Medical Center
oren.guttman@utsouthwestern.edu
Slide 7
Hello From UTSW
Picture of UTSW, the university being presented from.
Slide 8
Texan Thinking…
A picture of the United States where Texas is the only State and Canada takes up the rest of the country. It is supposed to be " how texans view the US"
Slide 9
Disclosures
- Disclosures
Slide 10
Learning Objectives
- Demonstrate specific brain based strategies to engage participant in new initiatives (K1 Reactions)
- Review how to leverage our current understanding of the human cognitive architecture to improve learning (K2 Learning)
- Understand the psychobiology of social influence in human choice (K3 Behavioral Change)
Slide 11
Brain Based Culture Change
The strategy of leveraging our current understanding of human cognitive architecture to design more successful change paradigms.
Slide 12
Brain Based Learning Theory
A picture of the book "The art of changing the brain"
"The Art of Changing the Brain."
-James Zull
Zull, J. 2002. The art of Changing the Brain. Stylus, Sterling, VA.
Slide 13
Most Great Ideas Strike Out!
Slide 14
How will this one be different?
Slide 15
Effective Training (Kirkpatrick Ladder)
Four boxes, placed diagonally in a straight line from bottom left to top right. Bottom left: Emotions - K1-Reaction WHY. Second left: Thoughts, K2- Learning WHAT. Second from top right: Actions, K3-Behavior, HOW, IF. Top right: Impact/Results, K4-End Points, THEN...
There is an arrow that runs from the bottom left to the top right that says "Embedding New Paradigms."
http://www.kirkpatrickpartners.com/OurPhilosophy/tabid/66/Default.aspx
Slide 16
Emotions are More Powerful than Logic
"Reason and Intellect only control individuals after emotion and impulse have lost their impetus…"
Dis-engaged Engaged
Descartes' Error, Antonio Damasio (1994)
Slide 17
Meet John-John…
1 of 2 thought bubbles. It reads: Heads.... You win $10,000 Cash now
2 or 2 thoguht bubbles. It reads: Tails.... You pay me $2,000 Cash now
You have only two choices—you either play or pay $100 cash now to get out of the bet….
Slide 18
Poll the Crowd….
Slide 19
Loss Aversion—preference for certainty
"A Bird in the Hand is better than 2 in the Bush"….
Expected Value=Probability x Pay-off
Scenario 1—Play the Game:
Heads EV= 0.5 x $10,000= $5,000
Tails EV= 0.5 x -$2,000= -$1,000
TOTAL EV= +$4,000.
Scenario 2—Don't Play the Game:
Total EV= 1 x $100= -$100.
A bar graph where the first bar is twice as long as the second. the first bar reads "pain from loss" and the second, shorter bar reads "pleasure from gain"
It hurts more to loose than it does to win…..
Slide 20
4 Primal Emotions
Four emotions, scared, sad, angry, happy
Slide 21
Loss Aversion—Avoiding Emotional Pain
The four face emojis and the bar graph with from before with the pain from loss bar being taller than the pleasure from gain bar.
Higgins, E. T. 1997. Beyond pleasure and pain. American Psychologist, 52: 1280-1300.
Slide 22
De-motivators can be more powerful than Motivators
Triangle split in half to show motivators and de-motivators. From bottom, the de-motivators are: Psychological and safety and security. Moving up, the Motivators are: Love and belonging, Self-esteem and self actualization.
Five rectangles accompany this triangle. from the bottom, the de-moticators are: work conditions/hours/work-life balance and Job security/stability, Financial loss, benefits. Moving up, the motivating rectangles are: joy at work, belonging, climate, collaboration. Respect, Positive feedback and recognition. The top box says "meaningful day, autonomy and empowerment.
Slide 23
Power of Framing…
They showed a video of a car crash to 100 college students and asked..
How Fast were the cars going when they bumped into each other?
Slide 24
Power of Framing…
They then showed the same video of a car crash to a different 100 college students and asked..
How Fast were the cars going when they smashed into each other?
Slide 25
Power of Framing…
The group primed with Smashed estimated a 9 mi per hour faster estimate than Bumped.
Do you recall glass breaking in the video?
**THERE WAS NO GLASS BREAKING IN THE VIDEO**
Bumped Group said "yes" 14% of the time.
Smashed Group said "Yes" 32% of the time.
Slide 26
The Power of Positive Framing
"This study asked 167 subjects to imagine they had lung cancer, half were told:
"of 100 people having surgery, 10 will die during surgery, 32 will have died by one year, and 66 will have died by five years."
"of 100 people having radiation therapy, none will have died during treatment, 23 will die by one year. And 78 will die by five years."
50% Surgery
50% Radiation
Study reported in NEMJ V. 306 #21, 1982
Slide 27
The Power of Positive Framing
"This study asked 167 subjects to imagine they had lung cancer, half were told:
"of 100 people having surgery, 10 will die during surgery, 32 will have died by one year, and 66 will have died by five years."
"of 100 people having radiation therapy, none will have died during treatment, 23 will die by one year. And 78 will die by five years."
50% Surgery
50% Radiation
"This study asked 167 physicians to imagine they had lung cancer, half were told:
"of 100 people having surgery, 90 will survive the surgery, 68 will survive past one year, and 34 will survive past five years."
"of 100 people having radiation therapy, all will survive the during treatment, 77 will survive past one year. And 22 will survive past five years."
84% Surgery
16% Radiation
Change of 34%
Study reported in NEMJ V. 306 #21, 1982
Slide 28
Take Home Point—Remove De-motivators and Frame Positively
Avoid Loss Aversion and Emotional Reasoning:
State with transparency why the initiative is being done and announce it openly
- Expel myths about loss (sadness, fear) and quite hallway talk about false reasons why the initiative is being done (anger)
Utilize Positive Framing:
Frame the challenge being addressed as an opportunity to "win" not only at the organizational level, but at the individual employee level.
- Be ready to answer "what is in it for me"? What tangible benefit/win will the employee get for engagement?
- Anticipate the concerns of the employee and speak out potential questions and solutions?
Slide 29
Effective Training (Kirkpatrick Ladder)
Four boxes, placed diagonally in a straight line from bottom left to top right. Bottom left: Emotions - K1-Reaction WHY. Second left: Thoughts, K2- Learning WHAT. Second from top right: Actions, K3-Behavior, HOW, IF. Top right: Impact/Results, K4-End Points, THEN...
There is an arrow that runs from the bottom left to the top right that says "Embedding New Paradigms."
http://www.kirkpatrickpartners.com/OurPhilosophy/tabid/66/Default.aspx
Slide 30
What is Successful Learning?
Successful Information Processing:
- Encoding and Storage (Left Prefrontal Cortex)
- Retention and Retrieval (Right Prefrontal Cortex)
- Understanding
- Evaluation and Extrapolate
- Integration and Application
- Projection
Slide 31
Brain Based Learning
3 Critical Features Needed to Optimize Learning:
- Engaging Sensorium --> Orchestrated Immersion
- Activate your Emotions --> Relaxed Alertness
- Enable Deliberate Mindfulness --> Active Processing
Caine, G. & Caine, R. Making connections: Teaching and the human brain. Addison-Wesley. 1994
Slide 32
Goal of Orchestrated Immersion --> Episodic Memory
A flow chart to dipict human memory. Episodic memory has a red box around it.
- Goal of Orchestrated Immersion is to create Episodic Memory.
- Memory is centered on the details of personal experience (sensory and emotional experiences).
- Context (e.g. the situation) and Content (i.e. what was done or learned) are linked together.
- Holistic approach to understanding encoding, storage, and retrieval of information.
- Formed by medial temporal lobe 'binds together' the various neurological traces of an episode.
Tulving E. Precis of elements of episodic memory. Behav Brain Sci 1984;7:223-68
Slide 33
Seductive Detail Effect
- What is this?
When information is introduced to learners that is interesting but unrelated to the learning objectives (John Dewey,1913).
- Text, Photos, illustrations, sounds, music, etc…
- Why is this done?
A common way to try and increase your learner engagement, by interweaving small/short pieces of anectodal information to make the educational material more interesting.
- Why does this matter?
Park CS. et al SSIH, 2014. Vol. 9, Number 2, Pg. 85-93
Slide 34
Seductive Detail Effect
- These details represent an extraneous Cognitive Load and tax on short term memory
- Results:
- Diminish Acquisition and Transfer of Learning:
- Particularly true for High Load Complex Procedural Tasks (i.e. initial acquisition of Laparoscopic Surgery Skills)
- Particularly true when placed at the beginning of a lesson
- Reduce Metacognition (self assessment of learning)
- Improves motivation in low load situations
- Diminish Acquisition and Transfer of Learning:
Gardner AK. Surgery. 2016 Sep;160(3):580-5.
Harp et al. J of Educ Psychology, Vol 90(3), Sept 1988, Pg 414-434.
Park, B. et al. Computers in Human Behavior. 44: 267–278. (March 2015).
Slide 35
Relaxed Alertness--Cortex and Brainstem
Rostral Brain (amygdala) Hijacking of the Cortex, "Downshifting"
Hart, L. (1983). Human brain, human learning. New York, NY: Longman.
Slide 36
Relaxed Alertness
This is a bell curve. the Y axis is "performance" and the X axis in "stress level." moving along the bell: Understimulated, alert, optimal performance (peak), excess anxiety, overwhelmed, distressed, dysfunctional.
Cortical Engagement, Executive Function, and Long Term Memory formation are inhibited by perception of threat.
Jensen, E. 1996, Brain-based learning. Del Mar, CA: Turning Point Publishing.
Slide 37
Relaxed Alertness
- Too Much Stress, No Cortex Engagement, No learning
- Not Enough Stress, No hippocampus activation, no long term memory "Episidic Memory formation"
Hart, L. 1983. Human Brain, human learning. Longman: NY.
Slide 38
Fear of Making Mistakes/Errors
Dror I. Medical Teacher, 2011, 33:1, 34-38
Slide 39
Frame Errors Positively
Cartoon of family reading.
Dror I. Medical Teacher, 2011, 33:1, 34-38
Slide 40
Error Management Theory
- Learning Strategy that promises to improve long term retention, emotional resiliency, contextualization of learning.
- Rather than avoid errors, learners are asked to embrace errors as part of the initial events of learning
- Learners are asked to understand what "wrong is", or identify errors, error detection, and how best to manage the error, or error recovery.
Dror I. Medical Teacher, 2011, 33:1, 34-38
Slide 41
Error Management Learning Paradigm
Five boxes moving up the page from left to write that say: Obvious errors (others), Subtle errors (others), Obvious errors (self), subtle errors (self), and error recovery.
Dror I. Medical Teacher, 2011, 33:1, 34-38
Slide 42
Error Management Theory
- Phase 1– Obvious Error Detection in Others (misattribution theory)
- Interactive Videos, Simulations, Gaming which highlight embedded key errors
- Learner plays an active role in detecting as many errors as they can
- Learners get positive encouragement and reinforcement when an error is detected
- Initially errors can be exaggerated (i.e. caricature effect) to enable their discovery
- Phase 2—Subtle Error Detection in Others
- As learner skill in error detection progresses, the errors are progressively introduced with increasing complexity and subtleness.
- When errors are not detected, Learners get more information on how to detect them.
- All errors need to be represented—slips, errors, mistakes.
Dror I. Medical Teacher, 2011, 33:1, 34-38
Slide 43
Error Management Theory
- Phase 3—Obvious Self Error Detection
- Learners train in how to detect their own errors
- Phase 4—Subtle Self Error Detection
- Creative ways to introduce errors are necessary
- Competition among learners (total number)
- Speed of recognition
- Sabotage
- Distraction
- Time Pressure
- Creative ways to introduce errors are necessary
Dror I. Medical Teacher, 2011, 33:1, 34-38
Slide 44
Error Management Theory
- Phase 5—Error Recovery
- When an error is detected, an appropriate protocol is offered to the learner, highlighting how to recover
- As complexity is increased, a list of possible interventions is offered to the learner
- Next, not only is a list of possible interventions offered, but within an intervention, the learner is asked to identify the correct prioritization and sequencing of steps for recovery.
- Finally, the learner is asked to generate the recovery actions themselves.
Dror I. Medical Teacher, 2011, 33:1, 34-38
Slide 45
Error Management Theory
- Study looking at Central Venous Annulation (IJ, SC lines) Skill Retention in surgical interns (n=30)
- Instructional videos (correct only vs correct + error)
- Practiced for 30 min. c validated checklist
- Tested 30 days later on Femoral line Placement
Gardner AK. et al. J Surg Educ. 2015 Nov-Dec;72(6):e158-62.
Slide 46
Error Management Theory
A study about Error Management Theory showing retention and transfer improved.
Gardner AK. et al. J Surg Educ. 2015 Nov-Dec;72(6):e158-62.
Slide 47
EMT and In-Situ Simulation
ACLS Error Recognition:
Circulation
Ventillation
Electricity
Medication
Therapeutic Intervention
Adaptive
- Study the paper (Prime)
- Watch a live Terrible code
- Debrief by calling out errors seen
- Actual simulation
- Team A debriefs Team B
Slide 48
EMT and Just In Time Learning
Bag Mask Valve Error Recognition
- ICU Rounding team, 7 minutes, Start the clock….
- Show a short video/do a demonstration of wrong
- Ask the participant to grade/find as many errors as they can
- Then have participant commite those errors themselves (with praise by team)
- Competition—ask teams to perform subtle errors and the other team grade them (they circle the errors they will perform ahead of time on this sheet) and we check off whats called out by competing team
- Candy for all
Slide 49
Reflection—Active Processing
- Experiential learning theory tells us that experiences alone will not magically transform into learning.
- Reflection is a pro-active cognitive process that looks to enable a learner to understand each experience's relationship and connection to other ideas, concepts, and experiences.
- Two Types:
- Reflection During/In Midst Action…
- Reflection ON/After Action…
Schon, D.A. 1983. The Reflective Practitioner: How Professionals Think in Action. Basic Books, NY.
Slide 50
Reflection—Active Processing
Active Processing—Transform experiences into learning through sense-making…
Adapted from Russell, J. A., & Feldman Barrett, L. (1999). Journal of Personality and Social Psychology, 76, 805-819
Slide 51
No Change in Non-Technical Skills w/o Reflection (Debriefing)
Savoldelli, Anesthesiology 2006; 105: 279-285
Slide 52
Human Cognitive Limitation
- The brain has limited resources and cognitive processing capacity
- Pay selective attention to Information
- Filters Information
- Prioritizes Information
- Mechanisms it utilizes to do this are creating:
- Schemata: simplified mental structure of our knowledge of the world around us
- Automaticity: ability to do things without mindfulness
- Chunking: individual pieces of information are bound together into a meaningful whole
Dror, I.E. (2011). The paradox of human expertise: Why experts can get it wrong. In N. Kapur (Ed.), The Paradoxical Brain (pp. 177-188). Cambridge, UK: Cambridge University Press.
Slide 53
Cognitive Load Theory
- Cognitive Load: the total amount of effort used for your short term memory
- Measured by Task-Invoked Pupillary Response (Sympathetic > Parasympathetic) --> Pupillary Dilation.
- Learning --> Working Memory --> Long Term Memory or Schemata (Sweller 1988)
- LTM are structures that permit us to perceive, think, and problem solve.
Slide 54
Strategies to Optimize Cognitive Load
- Intrinsic Load
- The subject itself is simply difficult
- Management Strategy: Segmentation, or Working examples
- Extrinsic Load
- The subject itself is not difficult, but the manner of presentation is difficult
- Management Strategy: Avoid redundancy and generalization
- Germane Load
- The subject is not difficult, but how it relates and integrates with other knowledge
- Management Strategy: Active linking and contextual examples of relevance
Sweller, J., Cognitive load during problem solving: Effects on learning, Cognitive Science, 12, 257-285 (198)
Slide 55
Caricature Advantage Effect
- Comes from the Facial Recognition literature.
- Based on concept of Categorical Perception: after we process data, our brain then looks to clump and categorize various stimuli (details) into mental representations (i.e. dimensions) in order to recognize and sense make what we experience.
- When we make mental representations of the world, the manner in which we process stimuli affects the extent and ease to which these stimuli are sorted, labeled, and differentiated from one another.
Goldstone, R. L., Steyvers, M., & Rogosky, B. J. (2003). Conceptual interrelatedness and caricatures. Memory & Cognition, 31, 169–180.
Slide 56
Caricature Advantage Effect
- Definition: creating systematic distortions, aimed to increase and exaggerate the distinctiveness and uniqueness of an item, improve the accuracy and the speed of processing.
- It looks to emphasize and magnify differences that ordinarily go undetected.
- An "expert", from a cognitive perspective, is the ability to discriminate information with more narrowed definitions and into more detailed quanta of information, in an accelerated pace.
Rhodes, G., Brennan, S., & Carey, S. (1987). Identification and ratings of caricatures: Implications for mental representations of faces. Cognitive Psychology, 19, 473–497.
Slide 57
Caricature Advantage Effect
Study looking at Aircraft Identification Performance
Pictures of 8 different types of airplanes
Dror I et al. Appl. Cognit. Psychol. 22: 573–584 (2008)
Slide 58
Caricature Advantage Effect
- N=113 participants asked to learn 4 aircrafts from a highly similar (homogeneous) group and 4 from a more distinctive (heterogeneous) group, from a variety of angles.
- Group A- studied non enhanced images
- Group B- studied enhanced, caricaturized images
- Learning phase and a testing phase
- Following a learning phase, participants completed an identification task.
- Speed of accurate identifications was recorded during both learning and subsequent testing phases and represented the dependent variable.
Dror et al. Appl. Cognit. Psychol. 22: 573–584 (2008)
Slide 59
Caricature Advantage Effect
- Learning Phase:
- 960 images shown per set of planes (homo, heter)
- 1920 randomized images shown total
- Name and Picture shown for 5 sec, after which time image disappeared and Participant's task was to press the appropriate key to indicate name of aircraft they were looking at.
Slide 60
Caricature Advantage Effect
- Testing (i.e. Over-learning ) Phase
- 320 randomized pictures split into 5 sequences of 64 pictures.
- Two previously unseen distractor aircrafts were randomized into the pot of images. These were included to minimize the influence of guess responses.
- Participant's task was to indicate which aircraft they were looking at by pressing one of the four known aircraft names, or a fifth key to indicate a 'new aircraft'.
- Images remained in view until the participant had responded, and feedback was again given in the form of a beep to indicate an incorrect response.
Dror et al. Appl. Cognit. Psychol. 22: 573–584 (2008)
Slide 61
Caricature Advantage Effect
- RESULTS:
- Homogeneous clearly easier
- Performance was consistently aided by the presentation of caricaturized images.
- Presentation of caricaturized images led to significantly faster response latencies than the presentation of original images.
- Effect was consistent regardless of the initial similarity of the stimuli, or the stage of training.
Dror et al. Appl. Cognit. Psychol. 22: 573–584 (2008)
Slide 62
Take Home—Amplify and differentiate the new way
- By caricaturizing specific important details, that differentiate the new way from the old way, you accelerate expertise faster and more accurately to novice learners.
- Curriculum design should take into account distinctiveness and detail of subject matter and exaggerate those aspects in training to enhance the learners ability to differentiate detail.
Dror et al. Appl. Cognit. Psychol. 22: 573–584 (2008)
Slide 63
Metacognition—Experts vs Novices
Thinking about the way (HOW) we think and (WHY) we think….
- Coaching
- Goal Setting
- Deliberate Practice
Slide 64
Coaching and Learning
- Coaching is a social interaction that aims to enable a learner to gain increased self-awareness and metacognition about their current state, thereby improving performance, through structured and objective feedback and specific goal setting.
- Its focus is constructive, not corrective
- Its utilizing inquiry and encourages development
Slide 65
Coaching and Learning
- Structured coaching can improve new procedural task learning in experts
- Laparoscopic Suturing
- Experts prefer reflection On practice rather than In practice (desire to appear competent >> desire for continuous improvement)
- Huge role for Video Based Coaching
Palter VN et al. Surgery. 2016 Jun 11. pii: S0039-6060(16)30124-6.
Greenber CC et al. Ann Surg. 2015 Aug; 262 (2): 217-9
Slide 66
Deliberate Practice--Goal Setting
- Enhances Engagement with the Learning
- Enhances Metacognition
- Effect most noticeable in new learners
Stefanidis, D., Acker, C.E., Greene, F.L. Performance goals on simulators boost resident motivation and skills laboratory attendance. J Surg Educ. 2010;67:66–70.
Slide 67
Prime and Goal Set Pre Simulation
WHAT ROLES DO WE NEED IN Arrest?
- Event Manager (TL) to run the code
- CPR Team
- Access (hemorrhage, need large bore access)
- Airway management team
- Time keeper and recorder
- Med admiration and preparation
- Electricity administration
- Cognitive 5h and 5T
- Historian--Chart Biopsy
- Goffer to get equipment
- Security—crowd control
- Liaison—call consultants
In the orientation, we remind the team of the various roles and responsibilities needed to manage a crisis…
Slide 68
Metacognition and Deliberate Practice in In-Situ Simulation
Give out the NASA-TLX after all in-situ simulations as a means of enabling staff to reflect more objectively and gain increased awareness of their cognitive architecture during the simulation.
Slide 69
Effective Training (Kirkpatrick Ladder)
http://www.kirkpatrickpartners.com/OurPhilosophy/tabid/66/Default.aspx
Slide 70
Behavioral Change is about Mimicry
Persuasion= Observability + Triability + Risk Tolerance
Rogers EM. Diffusion of Innovations. 5th ed. New York, NY: Free Press; 1995
Disseminating innovations in Health Care JAMA, April 2003, Vol 289, No.15
Slide 71
Social Influence Primes us for Action
Change in an individual's thoughts, feelings, attitudes, or behaviors that results from interaction with another individual or a group.
Slide 72
Ever seen this…
T. Chartrand and J. Bargh. "The chameleon effect: The perception-behavior link and social interaction." Journal of Personality and Social Psychology, 76, 1999. p. 893 – 910.
Slide 73
Mirror Neurons
A mirror neuron is a neuron that fires both when an animal acts and when the animal observes the same action performed by another. Thus, the neuron "mirrors" the behavior of the other, as though the observer were itself acting.
By watching others do a behavior ( the activation of sensory neurons and motor neurons), doing an action oneself is much more likely because "neurons that fire together, wire together."
Rizzolatti, Giacomo; Craighero, Laila (2004). "The mirror-neuron system" (PDF). Annual Review of Neuroscience. 27 (1): 169–192
Slide 74
Neuro-Biology of Mirror Neurons
Brain regions associated with being mimicked. Unconscious recognition of a perception-action matching during mimicry increases activity in TPJ and right inferior parietal cortex.
Being mimicked increases functional connectivity between vmPFC and striatum/insula reflecting reward and positive responses to being mimicked.
Hale J1, Hamilton AF2. Cognitive mechanisms for responding to mimicry from others. Neuroscience Biobehavioral Rev. 2016 Apr;63:106-23.
Slide 75
Mirror Neurons and The Power of Mimicry
- Improves Sales: Simply mimicing the mirror the verbal and non-verbal behaviors of random Customers, prospective customers that where "mirrored" purchased an MP3 player 79% of the time vs non-mirrored customers, at 62%. 17% difference.
- Inspires Trust and Action: mirrored customers were more likely to act upon the sales person's recommendations because mirroring someone's behavior induces the feelings of sameness, which inspires trust.
- More successful Negotiation: mirroring others in negotiation results in the other side perceiving your request favorably and increases your chance of the other side complying with a request.
W.W. Maddux, E. Mullen and A.D. Galinsky. "Chameleons bake bigger pies and take bigger pieces: Strategic behavioral mimicry facilitates negotiation outcomes." Journal of Experimental Social Psychology, 44, 2008. p. 461 – 468.
"Idea Watch: Monkey See, Monkey Buy." Harvard Business Review, January - February, 2012. p. 28.
Bailenson, J. N., & Yee, N. (2005). Digital Chameleons Automatic Assimilation of Nonverbal Gestures in Immersive Virtual Environments. Psychological Science, 16(10), 814–819. http://doi.org/10.1111/j.1467-9280.2005.01619.x
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Take Home Point: Leverage Group Think or Social Conformity
- Social conformity refers to changing one's attitudes, beliefs or behaviors to match group norms.
- Human attitudes and preferences are susceptible to social influence.
- Attributed to the posterior medial frontal cortex (pMFC).
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Take Home Point—Don't Underestimate the power of competition
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It is more Cognitively rewarding to Cooperate than Resist
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Questions?
Thank You
oren.guttman@utsouthwestern.edu
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Questions and Answers
For more information, please contact our team at:
AHRQTeamSTEPPS@aha.org
