Facilitating the paradigm shift

Paradigm shifts are notoriously hard to facilitate.  I’m in a position now where I am trying to trigger faculty to think strategically.   I suspect it’s a lot like faculty trying to trigger students to think critically.

I remember the exact moment I learned to think strategically.  I was a second-year resident, rounding with an attending on our high-risk obstetrical floor.  We had about 50 patients and rather than going from room-to-room, we were running the “list” –  a paper-based table of all the patients, basic demographics, admission diagnosis (e.g. bleeding, mild preeclamsia, etc), plan for the day (e.g. ultrasound ordered, lab work to-be done), and long term plan (e.g. delivery at 36 weeks, etc, delivery if/when —-,etc).

Except the columns on the table weren’t really called anything and the examples weren’t as clear cut as the ones I just gave you (obviously they are clear cut because I get it now…I didn’t necessarily get it then).

For every single patient (a table row), I would run through the columns left to right, and with every patient, the attending would frame her response in the exact opposite order as my presentation:  “So what is the best we can expect for this patient?  So what should we be doing today?”

She said the exact same thing 25 times in a row before my brain picked up on the pattern and saw the light: the big picture (the best mother/baby outcomes) must drive the short term plan and not vice versa.  The attending physician *finally* got to stop asking the same questions on Patient 26, and we got through the second half of the list a lot faster than the first. It wasn’t that I didn’t have all the information in my head, it was only a matter of re-prioritizing it.  And I’ve never looked back.

The thing is…she and I never discussed the significance of the re-orientation…not before, not after.  My discovery of strategic thinking was entirely situated – situated learning.  It’s only now, after years of PhD school and exposure to educational theory and training, that I can call it was it was (strategic thinking) and apply it intentionally across other contexts.

This leaves me to wonder:  Why do we expect people to learn things like strategic thinking and critical thinking by hitting them over the head 25 times with situations that require it (or the information needed to perform it), rather than weaving in an explicit,  “meta” sort of approach that labels it, values it, and identifies it when it happens?  The hitting over the head with information and situations is important too. I get that. However, the meta discussion makes it easier to explore and transfer.  We need more meta.

Featured image: Nick de Partee, unsplash.com


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