Listen as our esteemed guests Dr. Rachel Hathaway (@rhathaw) and Sara Bailey discuss teaching strategies for when emotions run high in the learning environment. We discuss the pyramid of behaviors and emotions, ‘differential diagnoses’ for what may be occurring for learners, and how to approach these challenging situations!
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Dr. Hathaway and colleagues have built a pyramid framework for how to think about what may be happening with learners’ emotional state.
At the top of the pyramid are various reactions and behaviors observed in learners, the next level is their specific emotional states that drive these observable reactions or behaviors, and then underlying all of that, at the base of the pyramid, is our ‘differential diagnosis’ for the emotional state. We use the word “differential diagnosis” here to prompt us to think broadly and humbly about various root causes of emotions and reactions, though want to be careful here to not imply our learners have medical disorders.
For example, if a learner is demonstrating anger and frequent interruptions, while we may think that this is stemming from a tough past personal experience with this learner, but really the differential is still broad. They could have had a tough patient case recently, be coming from an emotionally charged teaching session before yours, or have just gone through a break-up. There are so many possibilities (Dobmeier 2008, Steinert 2013).
Plan curriculum with the overall goal of building relationships with learners and providing room for emotional and learning needs to be articulated.
Some strategies when planning a teaching session:
Take a mindful breath. It is important to be aware of your emotional state as a teacher. (You can’t regulate a dysregulated person without regulating yourself first) (Sottile 2022). When we feel stressed, we need to engage our parasympathetic nervous system, and we can do this through using our breath.
Circuit breakers can be used to anchor yourself as a teacher when emotional dynamics are interrupting a session.
Dr. Hathaway’s go-to circuit breaker when the main emotion feels inattentive or distracted, is to invite learners to physically stand up and move around the room, or even take a 5-minute break.
Another strategy is to use a pair-share or breakout group activity in the moment to help contain the distress and area of impact for learners experiencing high emotions or to engage learners who seem disconnected. This may also be a solo writing activity for learners, which could relieve the pressure in the moment on the individual level for each learner.
After a session, we as teachers may feel alone in our emotions and experiences. It can be useful to ask for feedback from the learner(s) in question, however, be aware of the power dynamic that exists. It can also be helpful to debrief the situation with a trusted group of few educators in your institution to critically review your teaching practice and help you unpack, get clarity, and find solutions (Carlson 2018). This ‘Critical Friends Group’ is a term borrowed from the education world, specifically from the National School Reform Faculty (NSRF).
First step to creating your own ‘Critical Friends Group’ or as Era names, ‘Council of Medical Educators’ is identifying 8-12 trusted colleagues who you can bring together to discuss challenging teaching scenarios. NSRF has protocols to help guide discussion so that all members of the group walk away with some meaningful learning.
Listeners will identify strategies to teach when learners’ emotions run high in the classroom.
After listening to this episode listeners will…
Dr. Hathaway and Sara Bailey report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Dr. Hathaway and Sara would like to acknowledge their collaborators who built the workshop version of this topic, which was presented at this year’s National SGIM conference: Dr. Ariel Majidi at Massachusetts General Hospital and Harvard Medical School, Dr. Priyank Jain at Cambridge Health Alliance and Harvard Medical School, and Dr. Mike McShane at Penn State College of Medicine.
Citation
Hathaway R, Bailey S, Ue F, Heublein M, Kryzhanovskaya E. “Check Your Pulse First: Teaching Strategies When Emotions Run High” The Curbsiders Teach Podcast. http://thecurbsiders.com/teach. September 20, 2022
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.
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