What I learnt this week: Not knowing what other people know is uncomfortable #WILTW

This is the 69th #WILTW

Health care professionals experience a lot of change. Either in the form of needing to follow updated guidance and clinical practice or by way of environmental change such as moving to a new ward or department. The latter can be quite daunting as you need to become accustomed to new names and faces and, probably most importantly of all, different ways of doing things. I had a good lesson this week in the importance of being empathetic to how unsettling this can be.

On Sunday I competed in my second ever triathlon. Given my first was over 20 years ago and took place at school I’d say I was a novice. I certainly don’t do any more swimming than splashing about in a pool with my daughters and my experience of cycling is a 10 minute relaxed ride to the train station and back. I do regularly run and used to be fairly competitive. I therefore approached this triathlon as someone with some fitness and knowledge of sporting events but basically zero understanding of this particular environment.

Nervous smiley faceWhile these blogs receive (regular) jovial criticism for some of their speculative analogies I unashamedly would like to contrast the following:

  • Having skills, but not knowing how to apply them, reduces your confidence

I remember looking around a the other competitors feeling very out of my depth. In fact, as it turned out, I wasn’t too bad at the running or swimming but I was spectacularly poor at the cycling. The context of putting a bike onto a metal bar and having to remember to put your helmet on before you touched your bike made me feel uncomfortable. It’s the same feeling joining a new department as an experienced health care professional – it’s not that your don’t know anything, it’s that you don’t know how to apply it in this new place. It’s ok for people to feel nervous and current staff should appreciate this.

  • Not knowing what other people know is uncomfortable

I remember feeling faintly amused as a group of people next to me  were talking about how they had spent the last evening practicing transitions between the swim, cycle and run. But I felt more nervous just before the swim as the others in my group (there were staggered start times with 3 minutes between groups) clearly knew each other. It’s a reminder that it can be lonely being in a new department with in-jokes and prior knowledge – everyone has a friend but you.

  • There are some things you just need to experience to learn

We tried very hard at our new staff induction this year to give them as good a possible grounding to the working of our Emergency Department. Clearly though you can’t cover everything.

As I was awkwardly setting up my bike I over-heard someone talking about how its useful to set your bike up in the lowest possible gear so it’s easier to start after coming out of the swim. Really useful information – I wonder what gems we missed telling our new starters?

Whether it was nerves or just stupidity I nearly got all the way the swimming pool without my googles on before realising I didn’t have them. For someone who wears contact lens’ this is a pretty important omission; probably not dissimilar to forgetting your stethoscope. Something I suspect at least one new starter has done this year.

A good reminder to me to be aware of what it is like to be in a new starters shoes…

What did you learn this week? #WILTW

2 thoughts on “What I learnt this week: Not knowing what other people know is uncomfortable #WILTW”

  1. Thought-provoking post, as ever, Damian!

    Two complementary thoughts it has provoked in me:

    1. This reminds me – actually more of a flashback than a memory! – of when I moved to my current hospital 14 years ago. I had already been a consultant elsewhere for 11 years and had come to feel quite competent in that role. However, it took me at least a month or two to begin to feel confident in my new environment here. It seemed that just about *everything* was done differently – mostly neither better nor worse, just differently! I quite often felt very inadequate in those first few weeks, knowing perfectly well *what* to do, but just not *how* to do it. it did have the upside of encouraging me to question many givens about what actually *is* the best way of doing things, and I have continued to do this since. Curiosity is the first step in rebellion!

    Over the past year or so (as I get older!) I notice that when I have to perform both roles – i.e. medicine: doing it, and ‘meta-medicine’: explaining how to do it – I find it much more tiring. I think it’s because I do the former on autopilot (i.e. unconscious, or at least some of the time I hope, reflective competence), but I have to do the latter at least partly consciously (i.e. conscious competence). Doing thing consciously, i.e. paying attention to what one does whilst one does it, takes more energy. I only realize that now, since it appears that my energy banks are now smaller and more rapidly depleted – i.e. thinking consciously has now become a ‘saturable system’ to use a pharmacokinetic analogy.

    2. As far as the matter of settling in new team members is concerned, I am increasingly of the opinion that rather than concentrating on *effective* induction, we should focus more on *affective* induction.

    By this, I mean making people welcome, and encouraging them to feel both at home, and safe with their new colleagues, rather then trying to tell them how to do everything on day one. We take our new F1s out for drinks and nibbles the night or two before they start, together with their outgoing predecessors.

    My years spent as clinical tutor (in two different hospitals) showed just how much stuff people believe is ‘mission critical’ and which they insist on being thrown at the newbies on day one. Experience teaches me that the the law of diminishing returns operates in spades here, and (in my view, more importantly) the more stress, and/or disengagement, occurs in the victims (sorry, inductees!). I haven’t looked to see if anyone has researched this – if not, it would be a good study!

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