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Competency-Based Medical Education – The Basics

Introduction

Like all fields, healthcare is engaging with the characteristics and consequences of our digital society. Data with varying degrees of contextualization pours in from diverse sources.  Knowledge changes fast. Problems are complex.  In this new age, healthcare professionals (like everyone else) must not only be technical experts, but also team workers, lifelong learners, creative thinkers, and great communicators.

Additionally, medical education is engaging with the same wicked problems and reform movements as the rest of higher and professional education. Competency gaps have been documented at every transition from undergraduate (UME) to graduate (GME) to postgraduate environments.  Like others, medical school faculty and program directors experience overwork, conflicting priorities, and a lack of faculty development and support around teaching and learning. A stubborn hidden curriculum chips away at the intentional approaches and lessons of the classroom.  Buzzwords like accountability; evidence-based practice; inclusivity; and active, social, and applied learning design approaches are just as dominant in the healthcare literature as they are elsewhere in educational research.

In the “Beyond-Flexner” era, the trend in medical education is to move towards competency-based education as a way to enhance program and student accountability, flexibility, and performance.

The purpose of this blog post series (and I promise – it will be a series) is to provide a little background for individuals who need an introduction to competency-based medical education (CBME).  It will review basic vocabulary: What are competencies?  Milestones? Domains? It will try to make sense of the relationships between and best uses of competency domains and EPAs while comparing these new frameworks to more traditional instructional and assessment frameworks found in medical education.  It will describe how some institutions have chosen to implement CBME and how it might manifest itself at different levels of study (e.g. pre-clerkship UME versus GME).

A blog post is a blog post. It is not a reviewed (peer, if you believe that in that sort of thing, or otherwise) article. This particular blog post introduces the basics as well as one of the best-documented examples of CBME available in the form of Vanderbilt University School of Medicine’s UME pre-clerkship curriculum.  The blog post is not meant to be comprehensive.  Rather, it represents me thinking through the articles I’ve been reading for the last week in an effort to put together a cohesive account.  It is a preliminary effort and should be considered as such.

Initiatives to Know

Highlights:

ACGME Core Competencies (US). A set of competencies (e.g. professionalism, interpersonal communication, medical knowledge) developed for graduate medical education.  Specialty-specific milestones that support the competenices have been created in colloboration with the American Board of Medical Specialities (ABMS).  Now the competencies and their milestones are being used in U.S. graduate medical education and ABMS-mandated Maintence of Certification (MOC) efforts.

Core Entrustable Professional Activities (US). Guidelines published by the Association of Medical Colleges (AAMC) for undergraduate medical education.  Currently, they are being piloted by ten medicals schools across the US. The thirteen EPAs (observable, workplace-based activities that all medical students should be able to perform successfully and with consistency when they matriculate into any residency training program) are meant to interface with the AGME’s core competencies and milestones.

CanMeds (Canada). A role-based (e.g. communicator, professional, scholar) competency framework developed by the Royal College of Physicians and Surgeons of Canada for residency training and specialty practice.  As of 2015, the Royal College is moving towards the development of milestones to support the use of CanMeds at the postgraduate continuing education level.

ACGME Core Competencies

In an effort to address the competency gap between GME requirements and the changing needs of the workforce, the Accreditation Council for Graduate Medical Education (ACGME) partnered with the American Board of Medical Specialities (ABME) in 1999 to create the six domains of clinical competency. These domains included:

  • Patient Care
  • Medical Knowledge
  • Interpersonal and Communication Skills
  • Practice-Based Learning and Improvement
  • Professionalism
  • Systems-Based Care

Over the next ten years, GME programs worked closely with the relevant ABMS-certifying boards to specialty-specific develop milestones (defined in more detail later).  The milestones provide definition around the core competencies, attributing specialty-specific activities to each competency.  These milestones assist in developing curriculum, resident assessment tools, and residency training program evaluation strategies Nasca et al., 2012).

AAMC Core Entrustable Professional Activities

In 2014, the Association of American Medical Colleges (AAMC; the accrediting arm of AAMC, in collaboration with the Amercian Medical Association, is the Liasion Committee on Medical Education – LMCE) followed in the footsteps of GME and created 13 Entrustable Professional Activities (EPAs) which will serve as a framework for assessing the readiness of medical students for graduate medical training.  They are defined as the point when a learner has demonstrated an activity at the level that they no longer require direct supervision.  They differ from traditional competencies because they address performance within distinct workplace expectations that demand trustworthiness as well as expertise (Englander et al., 2016).

As of Spring 2015, the EPAs include:

  • Gathering a history and performing a physical examination;
  • Prioritizing a differential diagnosis following a clinical encounter;
  • Recommending and interpreting common diagnostic and screening tests;
  • Entering and discussing orders and prescriptions;
  • Documenting a clinical encounter in the patient record;
  • Providing an oral presentation of a clinical encounter;
  • Forming clinical questions and retrieving evidence to advance patient care;
  • Giving or receiving a patient handover to transition care responsibility;
  • Collaborating as  a member of an interprofessional team;
  • Recognizing a patient requiring urgent or emergent care, and initiating evaluation and management;
  • Obtaining informed consent for tests and/or procedures;
  • Identifying system failures and contributing to a culture of safety and improvement; and
  • Performing general procedures of a physician (e.g. IV line insertion, phlebotomy, BVM ventilation, CPR).

The AAMC launched the Core EPA initiative: a feasibility pilot study of ten schools that aims to explore curriculum development, assessment, the path to entrustment, faculty development and ongoing development of the EPAs.

Learning Objectives: A primer

Best source for learning more: 

Thomas, P. A., Kern D.E., Hughes, M.T., & Chen, B.Y (Eds.). (2015). Curriculum development for medical education: A six-step approach (3rd ed). Baltimore, MD: Johns Hopkins University Press

There are certain terms everyone should know before entering into a conversation about competency-based education.  These conversations typically start with a discussion of learning goals and objectives. Although goals and objectives can be defined in different ways, they are typically distinguished from each other by their level of specificity.  Goals or outcomes speak to broad educational outcomes while objectives relate to specific measurable actions or concepts.

According to Thomas et al. (2016), objectives can be divided into learner, process and outcome objectives:

  • Learner Objectives.  These objectives address knowledge, attitudes, and skills at the individual student level.  More specifically
    • Knowledge (aka Cognitive) Objectives relate to a spectrum of mental skills relevant to curricular goals ranging from factual knowledge to problem-solving, and clinical decision making.
    • Affective Objectives involve attitudes, values, beliefs, biases, emotions or role expectations that can impact performance.
    • Skill (aka Psychomotor)  Objectives relate to specific actions involving hand or body movements, vision, hearing, speech, or the sense of touche.  Medical interviewing, interpersonal communication, examination, and procedural skills fall into this domain (Thomas et al. (2016), p. 55-6).
  • Process Objectives. These objectives address achievement at the program level and are often expressed as aggregations of learner objectives.
  • Outcome Objectives.  Thomas et al. (2016) points out that ‘outcome’ is not used consistently in the literature or in the world.  Sometimes these relate to patient care while at other times they relate to learner objectives.  The authors recognize that it is unreasonable to suggest that undergraduate medical schools should be held accountable for patient outcomes as their interactions are indirect or their care peripheral and/or secondary.  However, they suggest that some health outcome objectives should be included to emphasize the big picture and potentially influence curricular design choices.

CBME: The Overview

Best source for learning more: 

Carraccio, C., Wolfsthal, S.D., Englader, R., Ferentz, K., Martin, C. (2002). Shifting paradigms: From Flexner to competencies. Academic Medicine. 77(5):361-367.

Competencies are “learner outcomes which are observable behaviors that result from the integration of knowledge, attitudes, and psychomotor skills” (Thomas et al. 2016, p. 58).  These competencies are often grouped into domains.  CBME emphasizes learner objectives for the purpose of ensuring learners are progressing from novice to expert with a framework of essential competencies (Harris et al., 2010).

Some key points worth remembering:

  • CBME focuses on learner objectives. It does not specify particular learning strategies or formats (Harris et al., 2010).
  • CBME establishes a trajectory rather than a baseline for minimal competence (Pettepher, Lomis, and Osheroff, 2017).
  • CMBE requires a commitment to formative assessment, self-regulation, and personalized learning.
  • CBME can provide seamless transitions across educational levels if it is designed with each other in mind  (Harris et al., 2010).

Carraccio et al (2002) published a useful table for distinguishing between traditional and competency-based education – the following table is directly from Carraccio:

Educational program
Variable Structure- and process-based  Competency-based
Driving force for curriculum Content—knowledge acquisition Outcome—knowledge acquisition
Driving force for process Teacher Learner
Path of learning Hierarchical (teacher → student) Non-hierarchical (teacher ↔ student)
Responsibility for content Teacher Student and teacher
Goal of educational encounter Knowledge acquisition Knowledge application
Typical assessment tool Single subjective measure Multiple objective measures (“evaluation portfolio”)
Assessment tool Proxy Authentic (mimics real tasks of profession)
Setting for evaluation Removed (gestalt) “In the trenches” (direct observation)
Evaluation Norm-referenced Criterion-referenced
Timing of assessment Emphasis on summative Emphasis on formative
Program completion Fixed time Variable time

Assessment: Milestones and trajectories

Best source for learning more: 

Swing, S.R., Beeson, M.S., Carraccio, C., Coburn, M., Iobst, W., Selden, N.R., Stern, R.J., & Vydareny, K. (2013). Educational milestone development in the first seven specialties to enter the next accreditation system. Journal of Graduate Medical Education. 5(1) 98-106.

Assessment in CBME is formative, personalized, and based in the language of milestones and trajectories. Milestones describe the typical developmental pathway for a given competency.  They are best used to describe competencies that develop and must be demonstrated over time under increasingly complex clinical circumstances (Thomas et al (2016).

Milestones are defined by the following criteria:

  • Criterion-referenced. They offer a common set of benchmarks that are applicable across courses.  Milestones are standardized across a program to help students identify their personal learning trends and provide stronger evidence to support change, remediation, or growth (Lomis et al., 2017).
  • Performance-driven. Milestones are driven by performance rather than time. There may be a window of time in which – given equal opportunity and practice – most students will achieve expertise (similar to developmental milestones for children), but achievement is not dictated by time alone (Nasca et al., 2012).
  • Escalating behavioral anchors. The trajectory towards expertise is described in terms of incremental improvements in performance. The milestones described in much of the CBME literature is based on the Dreyfus Model of Learning Progression  (Novice, Advanced Beginner, Competence, Proficiency, Expertise) or Miller’s Pyramid of Clinical Skills (Knows, Knows How, Shows How, Does).
  • Indicates current status AND what behaviors are required to progress. (Schumacher et al, 2013 and Swing et al., 2013).   Swing et al. (2013) offers an annotated example of a milestone graphic designed to support the assessment of a student for a sub-competency.

Example: Vanderbilt University School of Medicine

Sometimes it’s easiest to explain something through an example.  Several years ago Vanderbilt redesigned its UME curriculum and assessment to support the development of four of the six ACGME competencies.  It is also a pilot school for the AAMC Core EPA Initiative (more to come on this in later blog posts).

This section draws from the articles that Vanderbilt has published since 2010 about their curriculum and assessment reform and the lessons they learned along the way.

Why did they do it?

Best source for learning more:

Miller, B.M., Moore, D.E., Stead, W.W., & Balswer, J.R. (2010). Beyond Flexner: A new model for continuous learning in the health professions.  Academic Medicine. 85(2): 266-272.

In 2008, Vanderbilt University School of Medicine proposed the following principles for a new model of health workforce development:

  • Learning is competency-based and embedded in the workplace.
  • All workers learn; all learners work.
  • Learning is undertaken by individuals, teams, and institutions and is linked to patient needs.
  • Learning activities are modular; the system allows multiple entry and exit points.
  • Learning is interprofessional, with shared facilities, common schedules, and shared foundational coursework.
  • A rich information technology infrastructure supports the healthcare/learning system.
  • Health outcomes and educational outcomes are directly linked (Miller et al., 2010).

As part of this larger initiative, the school decided to transition away from a traditional curriculum and assessment profile (one based primarily on medical knowledge and content-only exams) to one that was directly connected to four of the six ACGME competency domains.  They focused on the pre-clerkship years (Medical School Year 1 & 2) because they felt that the lecture-driven nature the curriculum was not allowing students to benefit as they might from the collective clinical and professional experience of the faculty.

Who actually did the work?

An interdisciplinary leadership team spearheaded the Foundations of Medical Knowledge (FMK; Years 1&2) redesign, a process which included significant research, piloting, interprofessional collaboration, and faculty training.  The team included an anatomist (PhD), biochemist (PhD), pathology (MD-PhD), and pediatric neurogenetics (MD; Pettepher et al. 2016).

What did they do?

Best source for learning more: 

Vanderbilt University School of Medicine Office of Undergraduate Medical Education. (2018). Competencies for Leaners Across the Continuum. Retrieved from: medschool.vanderbilt.edu/ume/competencies-learners-across-continuum

The leadership team worked with faculty to diversify the curriculum to include active learning (described in detail below) and small group activities which would allow for more faculty-student interaction.

They also created a new approach to assessment that was based on the four competency domains and definitions as follows: (Miller et al., 2010 and Pettepher et al. 2016):

  • Medical knowledge. Demonstrate deep knowledge of the sciences essential for one’s chosen field of practice.  Approach to learning: collect, analyze, interpret and prioritize new information to enhance one’s knowledge in the various disciplines related to medicine.
  • Practice-based learning and improvement.  Compare data about current performance at the individual, team, and/or systems level with expected outcomes, and identify and implement the learning strategies needed to improve performance. They emphasized critical reflection and self-assessment here (through group and personalized learning plans).
  • Systems-based practice. Because students are early in their training, they framed the systems-based practice domain around each student’s role in the learning (rather than care delivery) system. They emphasized interpersonal communication and teamwork skills here.  Discuss the elements of effective team building and utilize appropriate techniques to create, participate in and lead effective teams.
  • Professionalism. Demonstrate a commitment to the duties and obligations of the medical profession, its healthcare institutions and its individual practitioners to patients, communities and society. Demonstrate honesty and transparency in all dealings with patients, learners, and colleagues. Demonstrate compassion and respect for all persons regardless of differences in values, beliefs, and experiences.

For detailed sub-competencies, see the Vanderbilt webpage on competency-based education.

How…did they design and evaluate milestones?

Best source for learning more: 

Lomis, K.D., Russell, R.G., Davidson, M.A., Fleming A.E., Pettepher, C.C., & Cutrer, W.B. (2017). Competency milestones for medical students: Design, implementation, and analysis at one medical school.  Medical Teacher. 39(5), 494-504.

As outlined in Pettepher et al. (2016), the leadership team created milestones for the four ACGME competencies.

They started by using the following sources of information to define core behaviors that should be continually re-assessed throughout a student’s training: 

  • Faculty judgment of importance
  • Priorities represented in existing assessments
  • Consideration of areas in which students historically struggle
  • Areas amenable to measurement starting in the first year.

After applying a Modified Delphi technique to their findings, the leadership team established work groups to work on writing milestones for each competency domain.  They based their work on the modified Delphi results as well as grading forms from multiple UME courses, GME milestones, and GME entry-level expectations.

Next, they piloted their milestones for construct alignment and validated their construct through:

  • Expert review
  • Interrater reliability (including between student and assessor)
  • Qualitative evidence of feasibility
  • User satisfaction

Continuous quality improvement cycles are being implemented (Lomis et al., 2017).

How…did they design their curriculum?

Best source for learning more:

Pettepher, C.C., Lomis, K.D., & Osheroff, N. (2016). From Theory to Practice: Utilizing competency-based milestones to assess professional growth and development in the foundational science blocks of a pre-clerkship medical school curriculum. Medical Science Educator. 26(3). 491-497.

Vanderbilt redesigned their pre-clerkship curriculum to provide ample opportunities to practice and demonstrate competency-related behaviors. First, they rearranged coursework to create a highly integrated block schedule curriculum:

  • Introduction to the profession (1 week)

  • Foundational interdisciplinary science blocks 

    • Human Blueprint and Architecture (6 weeks)

    • Microbes and Immunity (6 weeks)

    • Homeostasis (12 weeks)

    • Endocrine, Digestion, and Reproduction (12 weeks)

    • Brain, Behavior, and Movement (12 weeks)

  • Concurrent longitudinal blocks
    • Physical Diagnosis
    • Foundations of Healthcare Delivery
    • Learning Communities and Research
      • All students are assigned a clinic-based learning community consisting of providers and postgraduate trainees who oversee the care of a population of patients and serve as teachers, advisors, and mentors  (for more information specific to learning communities, see Miller et al., 2010 and Fleming et al., 2013).

Examples of integration across the interdisciplinary science and longitudinal blocks:

  • The genetics content of Human Blueprint and Architecture took place at the same time as an ethics section in the Learning Communities
  • Chest examinations and heart sounds in Physical Diagnosis coordinated with the cardiovascular unit of Homeostasis
  • Pediatric and adult neurological examinations in Physical Diagnosis coordinated with the Brain, Behavior, and Movement block (Pettepher et al., 2016).

Then the school introduced case, team, and experiential learning activities throughout the year.  In fact, they built courses around a similar weekly template of learning activities in order to implement consistent assessment events across the FMK phase.

Case-based learning sessions were student-run, problem-based learning sessions. Groups were crafted intentionally so that they included students from diverse academic backgrounds.  Groups re-formed every twelve weeks to help students practice transitioning in and out of new teams (Pettepher et al. 2016).

Team-based learning sessions were differentiated from case-based learning sessions, but the details were not evident from available publications (for the general differences between case-based and team-based learning see Koles et al., 2005).

Experiential learning was promoted through dissection teamwork (integrated into all basic science blocks) and patient-focused activities.  As described by Miller et al. (2010):

“Whereas most medical schools now include clinical experiences in the preclinical years, this model eliminates the “preclinical” and “clinical” distinction by giving students real responsibility for clinic operations and patient care from the start of their professional education  and by making the learning-working team the focus of their educational experience.” (p. 4)

How…did they design their assessments?

Best source for learning more:

Pettepher, C.C., Lomis, K.D., & Osheroff, N. (2016). From Theory to Practice: Utilizing competency-based milestones to assess professional growth and development in the foundational science blocks of a pre-clerkship medical school curriculum. Medical Science Educator. 26(3). 491-497.

The leadership team sought to design competency-based assessments that facilitated the collection of many low-stake data points for every student.  These touchpoints included self-, peer, and faculty feedback collected through standardized rubrics with qualitative milestone assessments.

Digital milestone forms included six observable behavioral anchors for each competency and described escalating levels of performance from unacceptable to aspirational. Over the course of the phase, minimally acceptable levels of performance were raised to parallel the maturation of the students. Identical milestone descriptors were utilized across the entire four-year curriculum and shift as the student level and experience progresses (Pettepher et al. 2016 includes real examples).

Self-, peer-, and faculty feedback were sought at scheduled intervals.  This included initial self-assessment exercises, standardized rubric assessments, and qualitative “global” questions:

  •  What is at least one valuable contribution this person has made to your team?
  • What is at least one important thing this person could have done to more effectively contribute to your team?

Assessment of the medical knowledge competency domain includes weekly low-stakes assessments consisting of multiple choice questions (autograded by the learning management system) and brief online essays (graded by the case-based learning facilitators).  End-of-block examinations consist of NBME shelf exam questions (autograded on the NBME website) and online essays/short answer questions (graded by block faculty).

All blocks are graded on a pass/fail basis.  Competency domains are weighted equally. Students achieving target scores in all domains pass, while those who receive a threshold score in one competency generally pass, but must set additional learning goals for the weak domain.  Learning goals were established and assessed with the student’s portfolio coach (described below).  

Students with received one sub-threshold score in any domain or multiple threshold scores across domains are handled on a case-by-case basis. Sub-threshold scores in the medical knowledge domain resulted in students passing a remediation exam (at minimum).  Deficiencies in the other domains were remediated through ongoing targeted coaching and monitoring of peer and faculty milestone assessments (Pettepher et al. 2016).

How…did they personalize learning and assessment (beyond remediation)?

Best sources for learning more:

Vanderbilt University School of Medicine Office of Undergraduate Medical Education. (2018). Personalized Learning.  Retrieved from: medschool.vanderbilt.edu/ume/personalized-learning

Spickard, A., Ahmed, T., Lomis, K., Johnson, K. & Miller, B. (2016). Changing medical school IT to support medical education transformation. Teaching and Learning in Medicine 28(1), 80-87.

As described above, the leadership team was interested in providing students with a multitude of low-stakes data points across standardized milestones so that they could follow their trajectory over time and make adjustments as necessary.  These data points are collected at the individual student level in longitudinal e-portfolios. The data collected in these portfolios are reviewed regularly by students and their personal learning coaches who work together to create and monitor a personalized learning plan.  An illustration of the portfolio-user interface can be found in Lomis et al., 2017.

Portfolios are linked to other digital platforms for streamlined data integration and visualization.   This includes the student clinic digital platform, which allows for seamless integration of patient-care skills assessment.

There is more to come on personalized learning, and medical school IT in future blog posts (coming soon). Also additional examples of how different institutions are implementing CBME.

Featured Image by jesse orrico on Unsplash

Syndicated, Virginia Group

My Digital and Medical Education Mash-up

It’s been almost a year since I joined the iDesign team as a learning architect and nine months since I was promoted to senior learning architect.  For much of that, I have worked with Mayo Clinic School of Medicine on the creation of a flipped classroom experience for first- and second-year medical students.  We designed templates, iconography, workflows, material tracking systems, organizational and file naming structures, transition policies and procedures, and change management strategies even as we designed courses at a remarkable pace. It’s been an intensely creative experience and I am so grateful to Mayo and iDesign for giving me the opportunity to learn from and contribute to this project.

Our task was to design a new digital component for the pre-clerkship (undergraduate medical education Y1 and Y2) learning experience.

Learning to be a doctor is hard. An unprecedented amount of content must be committed to memory with a fluency that is not interchangeable with being information literacy.  Don’t get me wrong – the information literacy is important for lifelong learning, problem-solving,  communication, and collaboration.  The best physicians are digital thinkers, but their capacity for connected learning is situated in a larger context characterized by the ability to manage massive amounts of data in their own heads. 

The face-to-face learning experience at Mayo Clinic already includes the best teaching and learning practices of our times: case-based and team-based learning, interactive whole group sessions, simulations, early clinical and patient interaction, integrated curriculum.   It is a lively, rigorous, multifaceted, active learning program with a lot of moving pieces as well as a lot of course content.  However, from my viewpoint as an educated observer, I think it might be easy for students (and maybe some faculty) to get caught in the busy weeds and lose sight of the big picture.

Our vision for the digital learning space was to provide a deceptively simple map that organizes course logistics, materials, activities, assessments, and resources through motifs that repeat themselves across all courses. If successful, the map would work to strip away cognitive clutter and convey information so clearly that pedagogical meaning and relationships reveal themselves without additional words.

My medical background facilitated an intuitive understanding of how the learning activities fit together (and to what end). However, I leaned heavily on information sciences to inspire design. I read cartography texts.  I studied maps and infographics as influencers and storytellers. I referenced Edward Tufte almost every day.  I placed it all in the pedagogical context of Vannevar Bush, George Siemens and my previous experience with designing connected courses.

As I transition away from the Mayo Clinic Project, I am thinking about writing an article about what it means to design a course site as a map. If anyone thinks that might be of interest, please let me know.

 

Featured Image by rawpixel on Unsplash

 

 

Syndicated, Virginia Group

Visual Arguments and Explanations

Today I had the pleasure of presenting on visual arguments and explanations for Jon Becker‘s class, EDLP 717: Communicating Research Findings (aka Telling Stories with Data). For their final project, Jon has tasked his students with producing a “high-quality modern report” from real data on employee followership for a hypothetical client.  While Jon has spent the last weeks walking them through data analysis and statistics, he thought I might have something to say about information design and reporting.

I have a lot to say about information design, mostly driven from attending Edward Tufte’s day-long lecture on presenting data.  To prepare for this presentation, I reread Tufte’s books and included a lot of images directly from his books (or, more frequently, from his blog in which he uses his own book images to expand the conversation).  However, I also introduced the versatility and ubiquitousness of visual explanation through Berinato’s matrix of “data visualizations that really work” and incorporated other online resources such as the Data Visualisation Catalogue and Ann K Emery, so it wasn’t all Tufte, all the time.

This presentation came at the right time for me, personally.  The work that I do involves a lot of information design, although I did not recognize it as such until my recent deep dive into Tufte’s work.  I rely on his principles (forced visual comparisons, focus on causation, annotations, direct labeling, smallest effective difference, etc.) every day in how I communicate with the rest of my design team.  Since I’ve completed my deep-dive, I find that I am using these principles more strategically and consistently and sharing that intentionality with my teammates…which in turn has improved their information design and communication.

So thank you, Jon and EDLP 717, for giving me several hours of your time.  Once again, I learned as much as I taught.

Here are some slides.

Click to view slideshow.

 

 

Featured image by Carlos Muza on Unsplash

Syndicated, Virginia Group

Dialogue Education: Revisited

This week I facilitated a lunchtime session for the IDEA (Instructional Design and Education Activities) Interest Group at Mayo Clinic School. The group consists of human resource professionals, hospital administrators, instructional designers, adult educators,  faculty & staff, and interested others who function in face-to-face and online domains and concentrate in workforce training, public education, and graduate & professional schools across the health sciences fields.  The IDEA Interest Group leader was very generous in allowing me to choose my topic, but she offered these three guidelines: the topic should have broad appeal, somehow relate one or more best practices in adult learning, and leverage the digital affordances of the group’s meeting place, Blackboard Collaborate.  I chose to talk about Dialogue Education, the highly structured, pre-digital approach to participatory learning described by Jane Vella in the 1980s.

Click to view slideshow.

You can download this presentation here.

At first glance, Dialogue Education seems so opposite-of-cutting-edge as to be irrelevant.  While it may have been considered radical in the 1980s, there is nothing overtly radical about Dialogue Education now.  I recently reread Vella’s On Teaching and Learning, and I find her emphasis on Bloom’s taxonomy and instructor-generated structure particularly disturbing when juxtaposed (often on the same page) with strongly worded mandates for “equality” among instructors and learners.  I’m not suggesting that such contradictions can’t work themselves out, but I always get suspicious when they go unacknowledged.

Additionally, there is nothing emerging about the approach.  A review of current Dialogue Education resources offers the exact same content Vella developed 20 years ago; absolutely nothing has changed with the times, with one superficial exception: the 4 Is (Induction, Input, Implementation, Integration) are now called the 4 As (Anchor, Add, Application, and Away).

The lack of conversation around dialogue education and digital participatory culture makes it look dinosaurian, particularly when compared to connected learning. Vella writes of online education in her 2008 text, On Teaching and Learning, but it’s clear she had not grasped the affordances or implications of flipped, blended, networked, or digital-integrated learning. To be fair, few educators had considered any of this in 2008 but some had; for example, by 2008 the debate over whether connectivism was a new learning theory or just a new take on social constructivism was well underway.

I want to make this clear. Dialogue Education is not my (or anyone else’s) everything. However, I think it is most definitely something – something worth talking about with all kinds of people everywhere – and here’s why.

I quit practicing medicine in March 2011.  In July, an acquaintance of an acquaintance – an education professor who was looking to recruit health professionals to her adult education degree program –  met me for lunch in a local grocery store.  She convinced me to enroll in her night class on program planning and instructional design, because, as she put it “what else was I going to do with my time?”

At the time, I didn’t even know what instructional design was – I actually didn’t figure it out until about halfway through the semester.  I sat in that class every Tuesday and Thursday night, a burned out ex-physician with all the anger, fear, and grief that you would expect me to have (and probably more), surrounded by teachers, instructors, and workforce trainers with years of experience.  I not only thought to myself “Why am I here?” but I literally wrote it out over and over again in my notebook.

The professor (who must have regretted her decision to recruit me more than once) taught Dialogue Education using Dialogue Education.  By the end of the semester, I had not only designed a workshop but had used Dialogue Education to teach my (mostly non-medical) classmates how to interpret gynecologic ultrasound studies.  I had also started teaching other subject matter experts how to integrate Dialogue Education into their continuing education workshops.

All this in one semester.  One class. One book.

I was a very conflicted adult learner with a fuzzy understanding of my purpose. Dialogue Education kept me in my seat. I came to class.  I learned something.  I used what I learned.

I was a subject matter expert with no understanding of education as a discipline. Dialogue Education opened my eyes to the fact that teaching and learning are about more than making sure the lectures are in the right order.  There are bodies of literature, best practices, things to know, and things to practice.

I was a novice instructional designer with no idea of how to start. Dialogue Education gave me something simple and concrete that I could wrap my arms around and share with others. The 4Is are firmly linked to the most ubiquitous themes of adult education literature.  When implemented well, Vella’s structure offers diverse and balanced approaches to passive and active learning. I was able to start teaching faculty how to implement Dialogue Education before I finished my class.

Despite all my protestations of “I am NOT a teacher,” I taught every single day of my medical career.  Oftentimes it was coaching, but I was also unusually active on the lecture circuit (back then it was women’s clubs, health classes, and junior leagues).  I would prepare my comments right down to the inflection and punctuation and always end within 5 seconds of my target.  The idea of moving away from that level of preparation and into the unknown abyss of participatory learning was terrifying.  Designing the right discussion questions is hard. What if they didn’t talk?  What if they said something different than what I wanted them to say? What if they said something wrong? Dialogue Education served as a stepping stone, a way to test the waters. If a group discussion bombs, even I could see that it would be okay. There is always another scheduled activity – not a class discussion!- in the next twenty minutes or less.

I believe Dialogue Education could play a pivotal role in the transition from traditional to participatory pedagogies particularly in structure-forward, accreditation-oriented, and content-driven fields.  Despite all indications to the contrary, Dialogue Education might be part of the revolution – leading the way one highly structured learning task at a time.

 

 

Resources

 

 

Syndicated, Virginia Group

Christmastime Reflections

This week,  I shook up my family’s television & movie comfort zone.  While we watch a lot less television than the average American family, I like for us to have one or two programs that we watch together: to stimulate conversation, to diversify our free time activities, to give me an excuse to hug my kids every night on the couch.  As a family, we tend to choose shows that allow us to discuss intersectionality and identity: Black-ish for race, ethnicity, and money; Gilmore Girls for race, ethnicity, gender, and money; Modern Family for all the things they don’t mention about race, ethnicity, gender, and money (at least in the three seasons that I’ve seen so far).

However, this week I decided it was time for a break from our usual shows, and, given the season, I pulled out the classic Christmas movies.  I felt like the kids were finally old enough to handle the black and white, uncut version of It’s a Wonderful Life, and it did not disappoint.  The family conversations about race, gender, and classism were as rich as usual. The look my 12-year-old daughter gave me when Jimmy Stewart swats the family maid on the bottom to chase her back into the kitchen…yes, I had a lot of explaining to do, and explain I did.

But I’m used to all that.

It was my 9-year-old who pulled out the most interesting question, a day later: “Mom, why do we even consider It’s a Wonderful Life a Christmas movie?”

It’s a great question.  Much of the film takes place in a series of flashbacks which do not fall in the Christmas season. From her perspective, the film revolves around power and economic struggle and the classic American dream of owning a home.  These are not Christmas ideas – they are everyday ideas – so why do we watch it at Christmas?

I pointed out that the most beloved and important scenes take place on Christmas Eve.  I mention that angels are most frequently (though not exclusively) associated with Christmas Eve.  However, these two rather superficial points were not enough for either of us. So I compared and contrasted it to A Christmas Carol – a movie that she already accepts as a Christmas film.

Both movies are driven by reflection. In A Christmas Carol, Scrooge is transformed by the realization that he is not engaging with the world as his best self. In It’s a Wonderful Life, George is transformed by the realization that he has been engaging with the world as his best self. These characters really are more similar than dissimilar. The fact that they are both forced to engage in reflection (by supernatural or religious figures…I’ll restrain myself from making these synonymous) at the end of the year…it seems like something to which we all relate.  End-of-the-year reflection is a near-ritualistic act in our culture, so prevalent that my 9-year-old accepted all of this immediately and without further argument (she wasn’t buying the angel angle).

I recently and randomly saw a Willa Cather quote: “There are some things you learn best in calm, and some in storm.”

Brilliant quote.  Reflective learning is not everything, but it is something. It is the learning we do in the calmer moments. While we should do it more than once a year, at least most of us do it this time of year. As we all do it in the next few weeks, remember to think about the year from multiple perspectives – as George Bailey and Scrooge.  Remember that they were both bailed out not so much by the supernatural (or their religiousity) but by their friends, family, and the people who believed in them.

Syndicated, Virginia Group

Beyond the Content

It’s been a busy summer.

Last semester, I was honored to be a part of the Virginia AAC&U Faculty Collaboratives Open Learning Hub steering committee. As part of my responsibilities, I was asked to evaluate and write the final report on the experience.  It was an informal and exploratory sort of document, which fits the exploratory pilot that was #OpenLearning17. This report was also the first time I let myself loose in Adobe inDesign in, say, the last twenty years. There was a learning curve, but I learned alot – you could say that writing this report was my own connected learning experience (personal passion, authentic learning task, active learning) within a connected learning experience.

 

Beyond the Content

 

 

Featured Image: Dev Benjamin on Unsplash

Syndicated, Virginia Group

Connection & Digital Architecture

Yesterday I had the great honor of dropping by the Digital Pedagogy Lab Institute (#digped) to spend the day with Kate Bowles and Maha Bali and participants of the networks track. Informally, I was there to be with my friends who challenge, inspire, and remind me of who and how I want to be in the world. They did not disappoint.  Formally, I was there to give a 15 minute talk on practical ways to start conversations with students around the ideas of networking and connectivity.

The talk really never happened, as we opted instead to wind in and out of some of my slides, leading to a 90 minute conversation on voice, audience, and performativity. It was a deep talk. Clearly, the people in the room were hungry to hear and express meaty thoughts.  We only crossed into the ‘doing’ realm once, a rabbit hole conversation on care bots, their implications and potential impact.  I failed at keeping our attention in the translational space altogether. No one wanted to stay there with me.

Thinking is unfulfilling without the doing, and vice versa. Freire and Dewey taught us that. DaVinci taught us that. In Time and Free Will, Henri Bergson, wrote:

Let us consider…the feeling of grace. At first it is only the perception of a certain ease, a certain facility in the outward movements. And as those movements are easy which prepare the way for others, we are led to find a superior ease in the movements which can be foreseen, in the present attitudes in which future attitudes are pointed out and, as it were, prefigured. If jerky movements are wanting in grace, the reason is that each of them is self-sufficient and does not announce those which are to follow. If curves are more graceful than broken lines, the reason is that, while a curved line changes its direction at every moment, every new direction is indicated in the preceding one. Thus the perception of ease in motion passes over into the pleasure of mastering the flow of time and of holding the future in the present.

In considering of the arc from thinking to doing, we must consider the in-between as well. The translation from thinking to action is an interpretive art, not a given.  Thoreau on the difference between a genius, an artist, and an artisan speaks to this.

Translation is a form of connection and it deserves time and respect. Possibly it is elusive and therefore uncomfortable. I need to get better at inspiring people to stay in that space.

But anyhow, here is the talk.

 

John Dewey famously wrote that “education is a process of living and not a preparation for future living.” He demonstrated this in his laboratory school, where children worked together on everyday tasks, driving their own collaborative inquiry about the world around them.  DaVinci, too, had great reverence for learning through living and tinkering in the world. He put it a bit more directly than Dewey: “Learn how to see. Realize that everything connects to everything else.”

How “everything connects” speaks to context. In a recent talk, Jon Udell said, “Context is a service we provide each other. It is a fluid thing, a negotiation across parties.” If this is true, if we accept that we drive each other’s learning through iterative, multi-faceted, and multi-sourced forms of feedback, what does ‘providing context’ it look like in teaching and learning environments, particularly digital ones?

Laura DPLI Prez

What are some of the things students gain by learning on the open web? Why do we have them blog instead of turning in assignments on paper?  Why do we have them annotate readings in Hypothes.is rather than reading photocopied packets? Why do we hold Twitter chats?

Beyond the superficial reasons (“it’s an online course”) and more basic than the values of accessibility and transparency (which only hold up in some contexts and for some people), digital spaces have a quality that paper-based spaces do not have.

Dig archetecture

Digital architecture facilitates intentional and serendipitous connection.  Hyperlinks link documents across disciplinary silos, geography, and time.  Hashtags cross communities and personal networks. The embedding of images, video, .gifs, and audio takes the phrase “here, let me show you” to an entirely different level. Tags enable the curation (collection, connection) of documents through more than one conceptual planes (I like to think of them like strings through a stack of swiss cheese slices). FSS feeds will juxtapose content in the most interesting patterns – this is the primordial stuff of discovery.

At a fundamental level, digital spaces function through acts of connecting.  So how can we capitalize on digital architecture to help students grow their connective fluency, their capacity for thinking in, building, and seeing connections?

Harel and Papert (1991) wrote:

Students faced with performing or creating a product for an audience will learn more deeply because they must externalize their thoughts for the purpose of sharing them. Once thoughts are made explicit, they can be studied, refined, and made sharper through the process.

Students need concrete things to hold onto particularly at the beginning of their learning journey.  They need to see a thing, fiddle with it, correct their own thinking, show it to other people for feedback.  These concrete things, or “meeting posts” (I probably co opted meeting posts from Wenger’s communities of practice work) are extremely useful tools for instructors, as they provide a shared, concrete space for mentoring.

So what if we use aspects of digital architecture to talk with students about cultivating their understanding of connections and contexts?

The idea of starting with basic building blocks is so basic. Why do we not do it in digital composition or expression?  Why do we force students to work at the transcendent level of the gestalt?

Recently I took a three night adult-only art workshop. It was an interesting experience for a number of reasons. I was surprised by the fear expressed by the women around me: fear of making mistakes, fear of painting something childlike, fear of using too much paint, the list went on and on. (I did not share their specific fears, much to their collective dismay. One literally sniffed at me: “You’re not afraid of anything, are you?”). The teacher guided them effectively through their fear by breaking things down into the basics.

art

Shapes. Positioning. Shadow. Color combinations. Balancing positive and negative space. These are basics – basics that she could remind us to see (“Remember to look at your negative space!”), basics that she could provide feedback about (“Your shadow should be darkest right under the subject!”). Her method worked.

I spent several years studying how students in higher education incorporated digital architecture into their compositions. The full dissertation is here, along with additional student-facing and faculty-facing information, assessment ideas, and so forth. Briefly, I discovered that students were instinctively using hyperlinks, images, and hashtags to make really interesting sorts of connections across concepts, disciplines, people, and their own learning across time.   However, no one was helping them refine these ideas so that they could improve their connective expression. No one, at least in my environment, was helping to guide them to making it an intentional, artful practice.

What I found by working as a connected learning coach in these digital environments was that digital architecture was a wonderful place to start conversation around audience, voice, connectivity, and providing context. You can provide examples, social network visualizations, advice. These are concrete things that students can look at, play with, and discuss like shapes, positions, color, and shadow.

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Talk with students about digital architecture. Talk to them about it to calm their fears about blogging. But also talk to them about it as a jumping off point for deeper, more abstract conversations about voice, audience, identity, performativity. Talk to them about it as a means to enrich their self-expression, build and leverage their social networks, enhance their capacity to provide context, create collective knowledge, privilege connection as an (the) act of learning.

Syndicated, Virginia Group

I’m Not Throwing Away My Shot

Last week I announced that I will leave a non-tenure track faculty position to build my own consulting business, Bandwidth Strategies. The transition from faculty to freelance suits who I am and how I work. It signifies one of several ways in which I am working to let go of “what people do” to be true to myself and the way I want to live my life. Just because it’s a good move – and I know in my heart it’s the right move – doesn’t mean that I’m not nervous.

My family and I traveled to New York this weekend to see Hamilton, the musical. My husband bought the tickets over a year ago, before I even knew I was going to have a faculty position that then I would be leaving.  Yesterday, my husband, my kids, and I were so excited to walk into the theater yesterday. Hamilton is brilliant art on so many levels, and as the lights dimmed, I suddenly realized that the timing of it all could not have been better. There are life and leadership lessons in Hamilton, and I needed to take some notes.

We know that I have a history of drawing inspiration from historical figures.  I’ve tweeted about my “Be like Abe” mantra. When Lincoln was angry he would write a hot letter and stuck it in a drawer. Invoking his name reminds me to wait before responding hastily in anger. Sometimes, it even works.

There are so many reviews and blog posts already written on Hamilton that there is no need to be comprehensive or even pedagogical in this space; it’s all been done. However, when I say “Be like Hamilton” I will be reminding myself to do the following:

“I’m past patiently waiting. I’m passionately smashing every expectation. Every action is an act of creation. I’m laughin’ in the face of casualties and sorrow–for the first time I’m thinkin’ about tomorrow.”

Hamilton, My Shot

Aaron Burr wasted so much time marveling at Hamilton’s success rather than focusing on his own. He was a brilliant lawyer – Hamilton even said so. Where Burr hedged his bets, Hamilton was transparent. When Burr was reserved, Hamilton wrote with passion. While Burr was bitter, Hamilton sparkled.  Hamilton sparkled – that is how he caught the eye of George Washington, whose mentorship was essential to Hamilton’s success. People are drawn to and influenced by honesty, passion, and joy.  I can be Hamilton. I can sparkle. You can too.

Syndicated, Virginia Group

Leading through Visualization

Two weeks ago, Bonnie Stewart invited me to speak to #Ed6170: a faculty summer course in educational leadership sponsored by the University of Prince Edward Island. Bonnie focused her curriculum around leading under complex and changing conditions, because (1) it’s relevant and 2) it’s challenging.  In a move that I find particularly admirable, she created assignments that require her students engage with the content through multiple modalities.  Among other tasks, they will be making concept maps and infographics.

Bonnie and I went back and forth for several weeks on how I might contribute to the curriculum, and we finally settled on the idea of leading through visualization because it hit on strategies for leading teams through complex problems and contexts while also providing her students with some concrete tips on how to complete their visual assignments.

Creating this presentation required me to connect pedagogy, leadership, and information visualization, so I drew a direct line through constructionism (Papert) to learning communities  (Wenger) to reflective practice (Schon) to quantitative data visualization principles (Tufte).  It was fun to build the scaffolding for what is intuitive for some people, but not for others.  This presentation is about pointing out the obvious. I think simplicity is underestimated.  Sometimes, you just have to say things.

The following is a summary. Email me at lauragogia@bandwidthstrategies.com if you’d like the entire slidedeck. I’m always happy to share.

Leading through Visualization

Current trends in leadership

In the past, leadership development involved providing strategies for commanding, controlling, and wielding one’s authority.  Power was housed in one’s position at the top.  Information flowed in one direction.  However, the world is more complex than it used to be. There is more information to know. Conditions change rapidly and therefore what needs to be known in a given situation also changes rapidly. Complex problems require highly creative approaches to problem solving.

The constant influx of data from every direction and the dynamic conditions surrounding us has led to significant changes in the workplace.  The focus is no longer on the single person or product; rather it is on relationships: relationships between pieces of information, between people in terms of organizational teams and collaborative partnerships, and between workflows across those partnerships. The emphasis on relationships in the workplace and the world alters how leaders must behave. Influence replaces Authority. Collaboration replaces command and control.  Google “modern leaders” and you will not find descriptions of how to be authoritative or “top-down” officials; what you will find are a number of frameworks for transformative, collaborative, creative, inclusive, and design leadership.

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The approaches to effective leadership require similar skillsets: transparency and accountability, reflective practice, pattern-identification and connection-building, and flexibility in the face of change. The purpose of this presentation is to introduce information visualization as a strategy for practicing these skills. I will present you with three arguments on why the ability to present data visually is key to modern leadership. I’ll provide examples specific to higher ed teaching and administration and provide design tips so that you can integrate this into your current practice or if you are already doing some of these things, perhaps approach them with a little more intentionality.

Keep the following connection to pedagogical theory in mind: A good visualization makes the abstract concrete. From a constructionist standpoint, making the abstract concrete facilitates deeper learning, because learners are externalizing their thoughts for the purpose of sharing them.  Once the thoughts are made explicit, they can be studied, refined, and made sharper through the process.

Power of visualizations: Meeting posts, big pictures, and pathfinders

Meeting posts. Visualizations create a concrete meeting post for collaboration and sharing as well as opportunities for transparency and accountability.  I was tasked with creating a comprehensive recruitment plan for my previous workplace, which supports four programs and an annual conference, each with overlapping but distinct audiences.  Additionally, the audiences in question transcend organizational boundaries and professional sectors. I needed to develop an outreach plan that was efficient, sustainable, and offered obvious paths for expansion.

Furthermore, I needed to think about the structure and location of the data; what contact info would go in our listserves? Mailchimp? Were would content go so that it would be accessible? How would the data be structured so that we could access lists that lived in different locations without creating duplicate communications? Finally, I needed to find a way to effectively include the rest of the team in the planning, since they are actually more knowledgeable than I on the day-to-day operations and historical knowledge of the institute. I also needed to find some pathway for negotiated accountability for the student workers who would be doing much of the work.

recruitment plan

The key to success was the whiteboard hanging behind my desk.  This is a simplified version of the visualization I used to create our communication plan. On the left we have the communication platforms – social media, emails, mailings, & media postings by potentially interested parties.  In the middle are the programs listed and then on the right side of the board are listed the physical location of the lists and the person responsible for the job.

Tables on whiteboards are so common that we take them for granted.  However, they are an extremely powerful collaborative leadership tool.  Here’s how a visual meeting post works to promote collaborative leadership.

  1. When speaking with my director, I focused us on the left side; She shared a significant amount of historical knowledge and cultural nuance as we moved through the concrete list.
  2. When speaking with my content developers – my social media coordinator and copywriter, we focused on the patterns made by the X’s under the programs.  When was it possible to group messages about certain program for certain markets.  In developing our social media plan, there needs to be a very different feel, a different photograph for a Facebook post that includes information about Program 2 and the Conference, as compared to a Facebook post that combines Program 3 and the conference. Same with email and mailing content.  Having a concrete pattern of X’s helped us brainstorm about the possibilities.
  3. When speaking with my communications manager, we started with the data location and then moved left. Together, we needed to design the actual databases – how would we prevent duplicate communications when we had people who crossed lists and lists in different database systems?  The whiteboard visualization gave us a concrete model to test; we walked through mailing scenarios until we understood what filters would have to exist, what rows would be needed in the excel spreadsheet, in order to prevent duplication.
  4. When speaking with my student workers, we focused on the last columns, their assignments; we set expectations and deadlines and we could take the opportunity to negotiate, since they know their summer schedules better than I do – I merely presented the work that needed to get done and the team really helped me distribute it in the way in which they were most likely to succeed.

Transferable concepts from this example:

  1. The whiteboard is too obvious to hide. This was hanging in a physical shared location that everyone accessed everyday.  They couldn’t help but see it.  You can have these in online spaces too, like a homepage that you have to click through to get to anything else.  However, the point is that successful meeting points are never hard to find.
  2. The whiteboard is easy to erase and change. Our communication plan went through multiple iterations prior to its final iteration – imagine how tiresome and potentially confusing that would have been if we had been moving through multiple document versions and saves. If you have a version that you think you should save, take a picture.
  3. The whiteboard is accessible. Anyone can write on the whiteboard. There are no administrative privileges or tech skills necessary.
  4. Whiteboards support multivariate approaches. There are a variety of ways you can convey additional layers of information if necessary: hashed lines, sticky notes, color coding…In our case, each program has a “signature color” so it makes sense to color code anything and everything to the signature color to help people recognize it instantly.

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Big Pictures. For the amount of work that gets done in my previous workplace, it is very efficiently staffed with a director, an associate director, two program coordinators, and six rotating student workers. There were a lot of moving parts involved. I noticed that a significant number of deadlines were being missed or forgotten because of miscommunication or a failure understand expectations.

I had experienced this phenomenon before, as a physician. When you work in environments where conditions change quickly, tasks are complex, and staff come and go, it is easy to lose track of the big picture. This is why the most dangerous time for a patient in the hospital is immediately after a shift change: because it is difficult to transfer information from one shift to the next. Obviously healthcare technologists are working on this problem, but one of the most basic and universal components to the solution is what’s typically called “the board.”

Picture1

Anyone who has spent anytime in a hospital or watching medical dramas on television should be familiar with this sort of board.  It’s a meeting post where all the rooms and patients are listed, along with their essential information and the people who are assigned to taking care of them. At every shift change – or anytime the team needs to get refocused – a staff member will ”run the board” to make sure everyone is on the same page about priorities and personal responsibility.

So, given that the team did not seem to be on the same page, I adapted the concept of the OR board for our office.

IMG_0903

One Friday afternoon, I gathered the students and program coordinators.  I asked each one to tell me the story of their program from the beginning to the end of the program cycle.  I used sticky notes to mark all the deadlines and tape to mark the end of the fiscal year and winter break, as these are very real, hard deadlines for a lot of things.  It took a couple of days to get everyone’s input and as we did, questions were raised and either tabled for our strategic planning retreat or answered.  Several students had light bulb moments in which they literally exclaimed “OH! THAT’S WHY I’M DOING THAT!”  One program coordinator finally understood why she hates January a lot more than July.

Then, once the staff was on the same page, I grabbed our director – she made some corrections and then I asked her to change it to her dream scenario and she changed some things around.

Design points illustrated in this story:

  1. The sticky notes are qualitatively different than the whiteboard in the previous example; sticky notes can be made and then saved to the side if you don’t know where they belong yet.  There were several instances in which a student knew there was an event that needed to occur but couldn’t tell me exactly when – I had to wait for the program coordinator to contribute to get it right.  There are times when not having to erase things can be helpful.
  2. By having a concrete visualization, you can have an asynchronous conversation, deciding where and when you bring people to the meeting post.  By having the students contribute, then the coordinators, then the director, we were able to unveil and correct some misconceptions; everyone was able to pick up on any logistical problems, and the director was able to set new goals in a public and documented fashion.

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Pathfinding. Finally, visualization support reflective practice.  I’m not going to go too far into defining reflective practice, because I think you already know what it is. But here’s a visualization if you need one.

Reflective practice is an intentional process in which you look back at events, ask questions about what could have gone better, evaluate your performance, and then make changes so that you can continue to improve. However, sometimes we need help identifying what needs to be fixed. One approach is critical incident analysis, which is also something I learned in medical practice although you’ll find it across disciplines. Briefly, a critical incident analysis is an approach to dealing with challenges in everyday practice. Reflective practitioners pose problems about their practice, refusing to accept ‘what is’.  So they explore incidents which occur in day-to-day work in order to understand them better and find alternative ways of reacting and responding to them.

reflective Practice

A fishbone diagram, also called a cause and effect diagram is a visualization tool for categorizing the potential causes of a problem in order to identify causes. The basic idea is to have your team identify and create a problem statement and then brainstorm on the major categories of things that could have contributed to the problem. Once you have your categories identified, you can focus on specific possibilities related to each category.

Leading through Visualization (1)

And finally, almost like a juicy postscript:

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1. Content first

A visual is only as good as the content you present. Your impact is only as good as your documentation.  Identify yourself. Cite your sources. Credit your artwork. Make it easy to check your work.

2. Tell a story with your designs

Write the story first, as you would for any article.  Lay out your narrative or argument in a logical, compelling order.  This infographic, for example, has the same components you would find in a newspaper or journal article.

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3. Write in data paragraphs

Edward Tufte defines data paragraphs as a cohesive set of numbers, words, and graphics. Consider what each element is bringing to the understanding of the information. Graphics, just like words or numbers should never be randomly placed on a page.

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4.  Simplicity is discipline

In matters of design, more is rarely better. Directly label your information when possible (instead of using a key). Limit your color palettes to three to five colors.  Limit your fonts to one or two fonts.  Limit unnecessary punctuation.

5. Make a color palette & pre-select your fonts. It will save you time.

 

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Featured Image:  Isaac Benhesed on Unsplash

Syndicated, Virginia Group

When you are a muse

Being a muse isn’t easy. It seems like it should be, as you aren’t the one actually doing the creative work, but it takes a certain amount of courage to be willing to relinquish control and accept what other people do with you.

I have a friend. He’s a very dear friend. He has my best interest at heart, always.

Tod paints, or at least he used to and he does now.  He painted, then he played golf, then he painted. All of this is documented on his blog. But when Tod started painting this last time, he collected selfies of the people he loves and he used those as inspiration. He’s painting a lot of people, but he painted me almost first.

I take a lot of selfies. Most of the time I take them to mark changes in my life. Educational degrees. Jobs. Seasons.  There was a time I was taking one every week because the changes just kept coming.  I happened to be working for Tod at the time.  He has since remarked that he never knew what he was going to see when I walked into the office, and there was some truth to that;  I looked like an entirely different woman every day.  I think it threw him for a loop in real life, but in retrospect I think he sees it as an opportunity: the documentation of a woman in transition. He chose one of his favorite selfies that I took (in our shared workplace at the height of my midlife crisis) and he painted that.

Selfies are self portraits.  I’m good at them. I know how to use composition, shadow, light, and most noticeably my HAIR to hide what I don’t like and to emphasize what I want. I intentionally use my hair to hide the intensity around my eyes – I’ve never liked the way it looks. It looks too hard or hungry or masculine to me. I don’t like it but I can’t shake it and the only time I can erase it is when I’m have a beer and take the selfie laying down.

When Tod painted me, he took my hair out of the equation.  He literally took my hair completely off my face. All that intensity is staring back at me and there is nothing I could do about it. I can’t reframe or retake. I can’t vignette or tilt shift.  I can’t tilt my head to let my hair fall forward from behind my ears.  But I can’t deny it either. I can’t tell him Tod got it wrong, because in reality he got it very very right. Fuck it all, there is no way for me to hide. I’ve never felt more publicly naked in my entire life, but I’ve also never felt so accepted or valued either.  It’s a unique sort of tension to it all.