“What did I like about that?” Mitchell asked rhetorically. He followed up with a, “What were you thinking at this point?”, and a perfectly timed, “What happened there?”. Just like when he was playing, he knew the answer to every question before it was asked.
Bilton, Dean. ‘’What Do I like about This?”: Using the Sam Mitchell Method to Assess the Premiership Candidates’, 11 August 2020. https://www.abc.net.au/news/2020-08-12/using-sam-mitchell-method-to-assess-the-premiership-candidates/12546144.
This tweet from my football club, and the accompanying text from a news article about the video are examples of how I think using video in WBA might benefit the medical education community. More importantly, I think video can help trainees improve faster by giving them formative feedback in a learning conversation. In my mind, a WBA should be the formal documentation of the formative learning conversation that provides another “pixel” in the summative picture that is programmatic assessment.
Professional male Aussie rules footballers normally play once a week for a 22 week season plus finals. They spend the week training, recovering and reviewing footage and being coached (like in the video). By comparison, doctors work full-time jobs, often with precious little down time to reflect on their performance and be coached. If WBA were done as demonstrated in this video, would trainees want more frequent feedback? Conversely, would professional sportspeople be satisfied with only three reviews every three months and didn’t have access to their videos?
However, before we revisit using video in medical education, here are some of my observations from watching the football coaching video.
The master questions the apprentice to encourage the apprentice to self-reflect:
Master: And why was your GPS (i.e. your running) so good?
Apprentice: I don’t know. I felt fit.
Master: What did you do last week? Like during the week?
Apprentice: Oh yeah, I did a bit extra, didn’t I?
The master encourages the apprentice to to think about what he is thinking (aka metacognition) that led to his actions:
Master: What were you thinking at this point?
Apprentice: hmmm… I should be thinking… trying to get in here (pointing to screen) or come here…
The master encourages forward planning:
Master: Where’s your next involvement likely to be?
The master encourages self-assessment, and also encourages the apprentice to think like a master, and uses the video to explain why he is happy:
Master: What did I like about that?
Apprentice: Split step
Master: Yep, so because you did it… (technical stuff relating to the footage on the video) so you’re straight onto it
Master: So tell me what I like and then what happened? So what do I like here?
The master respects the apprentice’s autonomy and asks permission:
Master: Do you think… during the game… is it the type of thing I should remind you when you come off, about keeping your feet? Or do you just need to remember yourself?
Apprentice: Nah, I just need to remember myself. I don’t do it that often, do I?
Master: No
The master uses video to explore the apprentice’s thinking and understand the thought processes:
Master: You did this three times, four times. What are you doing? Why are you lurking around here? (both looking at the screen)
The master uses video to demonstrate a mistake and what the apprentice could have done in the situation with greater awareness:
Master: See you running like?(pointing in a direction)
Apprentice: Already going.
Master: Yeah… grab it and run really fast. That’s a… like one of those… like you can make a big play here.
Apprentice: Yeah
Master: Step, come back this way, draw this guy, come back to him. Goal. So pretty much you cost us a goal. (laughs)
(Incidentally, I’d love to be able to capture this type of behaviour as data on video in my research.)
So why is it that we DON’T do this in medicine? I think the answer is complex. It’s culture, it’s time pressures, it’s patient privacy, it’s hierarchies, it’s bullying and burnout, but ultimately I think it boils down to trust. It’s about the patient trusting the clinicians to do the right thing, to use the video as intended and respect their privacy. It’s about the trainee trusting the supervisor not to use the video punitively or to belittle their actions. It’s about both doctors trusting the patient and the legal system in which they work not to subpoena the video for medicolegal purposes if it’s being used for teaching purposes.
So how do we build trust? Onora O’Neill says that in order to be perceived as trustworthy we need to make ourselves vulnerable, or at least accountable. This is in keeping with a little “intellectual candour” which certainly doesn’t go astray in building trusting relationships. O’Neill also boils trust and trustworthiness down to three ingredients: honesty, competence and reliability. What makes it complex is that we need all three parties to come to the table with these magical ingredients. For some patients and some doctors are dishonest; and dare I say it, some supervisors are neither competent teachers, assessors nor coaches.
(Previous notes I made on trust are here, here and here. Also note this interesting quotation: “Placing trust is much harder where institutions are complex and remote and where interactions with others are formalised or very short term.” – doesn’t that describe most rotational #meded schemes?)
So where does this leave us? At my research project of course. I think that we need to empower those with the least power in workplace-based assessment so that it is acceptable for all parties. When video is introduced, it can be used and/or perceived for good or bad purposes, depending on how it’s used. In order to make sure it is used for good, my research will need to engage patients and junior and senior clinicians to develop guidelines as to how video should be used.
#gohawks #always
Dr Andrew Huang's Blog 