Parallel Practices: Sharing the Mental Model, Reflection in Action

One of the biggest challenges of this residency is the scale and also timetabling. Getting contact with students in a meaningful way can be a difficult, especially in November when most of them are on placement, either in hospitals or in the community.  When on placement students work proper shifts alongside their mentors and other qualified practitioners. For the ‘first timers’ it can be pretty tiring, physically and emotionally. Still, I have recruited a few more to ‘Patching Up’ and have had meetings with staff teams from Midwifery, Adult Nursing and Child Health…next is Mental Health.

I’ve also observed a multi disciplinary high fidelity simulation scenario involving final year students from adult nursing, child health, medicine and physiotherapy. This was a series of deteriorating patient scenarios in the simulation centre at St. Thomas’s hospital. All the students take part in a scenario and those not immediately involved observe elsewhere on a live feed, before taking their turn.  Oh, and the patient is a manikin, so no risk to life and limb but still plenty of anxiety for the students who understood the need to ‘get it right’ with only a few months before they are qualified practitioners.

In hi-fidelity simulation the manikin is managed by technician, who remotely manipulates it to exhibit symptoms of rapid deterioration in health; such as loss of consciousness, very raised temperature or falls in oxygen saturation. The success of the scenario depends on communication and teamwork, and most particularly the willingness and ability of those taking part to ‘suspend disbelief’, to accept that this might be a real life situation. Students are introduced to the manikin before the scenario begins, they observe how its eyes move, mouth can be opened and how vital signs are indicated on an adjacent monitor. A few manipulate its limbs and prod at its skin. The technician also acts as the voice of the manikin, which adds a surreal dimension to the situation, a human voice issuing from the moulded body of a life size manikin. And, unlike some giant toy, this voice responds to questions, even laughs a little. I am surprised at how quickly the students accept this, how well they have suspended disbelief.

In all the scenarios the staff are particularly concerned with how the students work as a team, communicate with each other, follow established protocols and ask for help when they need it. We are encouraged to focus on these issues in the debrief that follows, a time when the students are also asked to share their reflections on their performance.

One thing I have been trying to do in my own research practice is to make tacit decisions around making more explicit, to share what I think of as my embodied knowledge, the things we do and decisions we take or make seemingly without thinking. This has involved me giving voice to decisions, literally talking out loud my process. Doing this with spinning – to which I am fairly new - enabled me to see that, for me at least, spinning is not that different to swimming! So it was very exciting to see a similar process in action in the simulation scenarios. One nursing student was actively ‘talking out loud’ her process to her colleagues and patient; introducing herself, explaining each step and justifying it, working in a way that synthesised thinking and action. Apart from giving everyone in the room confidence - always a good thing - it also struck me as very satisfying and that she was working in a well-crafted way; showing empathy and respect for her subject and simultaneously managing the situation through reflection and adaptation. Afterwards she was praised for sharing her ‘mental model’, and I was left thinking how other acts of care, such as the material empathy we develop as makers, are not that dissimilar to roles of care involving ‘live’ subjects. I’m not sure whether she instinctively shared her ‘mental model’, or had been working on it, but observing her do this will stay with me as a transformative moment of this residency and will encourage me to keep sharing mine.