May 28, 2019

Learning Frustration | The RDEPE Process

As a lifelong learner, I have many moments of learning frustration. One obstacle I continue to encounter is trust. Not the process (as I've written about previously), I understand my own emotional traps and how they affect my educational perspective. What I'm talking about is the guidance component of the learning process. Learning requires that the student trusts what he or she is being told, and the student must find the information valuable and appropriate. If I'm being told to perform a procedure or task by someone, I must first make sure this action is necessary and that it correlates with the 'truthful information' file within my mind. I picture the inside of my brain as a room filled with filing cabinets. Have you ever seen the Stephen King movie titled Dreamcatcher? Well, there is a scene when a character is walking around the inside another character's brain. The character is surrounded by rows of filing cabinets. I picture my mind just like that. Cabinets filled with tons of information, neatly filed away according to the topic. Now, when someone is training or teaching you something new, you automatically do the following five things:

1. Reconcile the data - the modification to changing circumstances (mindset change)
2. Deem it truthful - does the instruction coincide with prior knowledge? (filing cabinets) 
3. Evaluate possible actions - what are the available options or paths?
4. Proceed with action - initiate action based on trust/knowledge
5. Evaluate truthfulness - was the experience positive? consequences?

A problem that often occurs in the learning process is the preceptor provides instruction to the student, and he or she finds the direction untrustworthy for one reason or another. Meaning, it's something that the learner can't relate to, nor does the student I find it appropriate based on the scenario. Step two is the problem. Now, I am aware the student might be wrong. The learner's viewpoint is limited by a lack of exposure. But that doesn't change the student's response. When presented with this information, the student will not allow it to enter their 'filing cabinet.' I have been there too. Yes, I am learning, and I could be lacking context. Although, I am also a good 200K into my graduate education, and I'm not going to lose my license based on something I felt wasn't truthful. Nursing is filled with protocols, standards, and scopes of practice. But many gray zones exist, in my opinion. And these gray zones leads to opinion-based educational approaches. Instead of teaching evidence-based protocols and expectations, some instructors focus on how they "usually do things" and what others like best or clinical preferences. These concepts create a chaotic learning environment filled with contradictions and eventual distrust.

Gray zones frustrate me to no end as a learner, especially when they keep according over and over again. One preceptor says we "always" do this. Another preceptor says something completely different. Now if you're asking for advice then yes, different perspectives will be presented. But for educational purposes, educators and preceptors need to keep things as transparent and streamlined as possible. If you want learners to trust the process, you need to eliminate as many gray zones as possible and make sure all the players are on the same page. If I'm a nurse on a floor, the management of patients and charting expectations should generally be the same across the board. No one gets to decide when they feel like charting. Education shouldn't be based on personal preferences or mindset at the moment. Training should be based on institutional expectations and protocols which lead to optimal patient outcomes. As a learner, I don't care what you "like." Teach me what will improve patient outcomes and what my institution requires of me in this professional role.

The trust is lost the second the learner gets contradicting information from various parties. This leads to mistrust, and the learner will be less likely to follow instructions the longer gray zones progress. Now, an educator will perhaps say this student is "stubborn" or "isn't open to learning." When in reality, the student doesn't trust the information he or she is being given. Accepting a job opportunity doesn't equate to blind, unquestioned trust. Respect is given to all, but trust is earned and is the center of the learning process. So as a learner, what can you do? I recommend you to never hand over professional trust if you feel something isn't appropriate. You have worked hard to get where you have professionally. Maintain your standards, even while you're in the learning process. Ask questions, do your research. Medicine is ever-changing, always evolving. What is fact now, can be fiction in the future. Learning can be frustrating but never compromise your professionalism and always remain proactive in the process. You are the end-point. It is your license, use your judgment. Don't allow someone's past experiences to dictate your current actions. You are not a child, you are a professional who is expected to make safe decisions based on your judgement. True educators understand the need for trust and will cultivate an environment that reinforces this concept.

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