Rethinking Medical Education

The ThinkerQuestions, observations, and recommendations toward reform of the process and content
Showing posts with label Communication. Show all posts


How much jargon slips into your communications? Does it help or hinder?
Incomprehensible jargon is the hallmark of a profession.
Kingman Brewster, Jr., (1919-88) 
Former President, Yale University
The line between serious and spurious scholarship
 is an easy one to blur, with jargon on your side.
David Lehman (1948-), U.S. poet, editor, critic
Do we use too much jargon? Some have observed that medicine may be the most jargon-ridden profession of all time. Others of us think that medicine’s use of jargon is surpassed by government bureaucrats and the military, but we must acknowledge that medicine gives them a reasonable level of competition. Those of us in healthcare seem to have special names and phrases for almost every ailment, management plan, instrument and body part. One of my anatomy professors published a paper in the mid-1950s in which he reported his calculation that first-year medical students need to acquire more than 20,000 new words and phrases, in addition to everything else they are expected to learn. Listen carefully to casual conversations among health professionals and you may find that a noticeable proportion of the words they exchange would be found in a medical dictionary but may not show up in ordinary school dictionaries. Yet, in my experience, when medical faculty are on the receiving end of someone else's jargon, they are about as jargon-averse as any group. Think of the dismissive reaction of some medical faculty to the language used by professional educators.
A lesson from a "consumer" I had my first lesson in the risks of overusing jargon more than 40 years ago. I was conducting the wrap-up, feedback session at the end of a national conference that I had chaired on Self-instruction in Medical Education. The first audience member to volunteer a comment was a physician who rose to say, “I’m sure I speak for everyone here when I extend warm thanks for this ground-breaking meeting to Dr. Jason and all the jargonaughts.” Message received! Loud and clear!
Ever since that formative experience I’ve made a special effort to pay close attention to the words and phrases that my colleagues and I use in various settings. I quickly came to realize that words can have different levels of utility under different circumstances. In medicine, as in most other specialized fields of human endeavor, words are appropriated or invented as labels for objects, situations and conditions that are commonly encountered in daily work. We don’t just talk about pain in the back in the way that most people would. We typically seek to be more precise by identifying that the pain is in the cervical, thoracic, lumbar, sacral or sacro-ileac area. We might even choose abbreviations, referring, for example, to S-I joint pain. Dentists don’t say to each other that a patient has an infection on the cheek-side of their gum, in the right, lower area. They say, instead, that the patient has a gingival abscess on the buccal surface, below tooth number 26.
This “insider’s” vocabulary can provide a useful, time-saving shorthand among those who understanding what is being said. To them, such words are genuine aids to efficient, precise communication.
Although specialized words and phrases can enrich and lubricate the exchange of information among those who share a professional sub-specialty, those same words can be sources of bewilderment to those who are from outside the inner circle. For outsiders, the insiders' words and phrases are dismissed as jargon. They are said to sound like unintelligible gibberish. As it happens, the word "jargon" is derived, in part, from the Middle English (12th to 15th century England and Scotland) word for "gibberish." 
Do you adapt your words to your audience? Clinicians can find themselves with two different targets of their communication in the same room at the same time. A dental colleague who is sensitive to this potential problem acknowledges the problem up front. When he does his initial exam, he informs his new patients that he will be using dental jargon as a shorthand for communicating concisely and precisely with his assistant while they are pursuing their various tasks. He then adds, "I promise to translate the important information into plain English when we're done."
Put another way, the same words and phrases that can be elegant communication in one context can be unintelligible gibberish in another. Successful communication is comprised of many parts. What is conveyed (sent out) is one part. Whether it is understood and accurately assimilated by the intended recipient is another part, and equally important. A challenge we face as teachers, among the many that should be getting our attention, is developing the self-conscious, reflective routine of tuning in on our verbal habits. Might we have become automatic in our use of some words and phrases? Might we be automatically using jargon with our non-medically-qualified patients or students, and might they be too timid or intimidated to let us know we're failing to communicate? You don’t have to be stuck with the name Jason or be familiar with Greek mythology to understand that we are all at risk of seeming like jargonaughts to some of those with whom we need to achieve successful communication.
Some questions for your reflection and possible comments:
  • How closely do you pay attention to the words (and possible jargon) you use routinely?
  • Are you in the habit of trying to adjust your vocabulary (including jargon) according to the "readiness" of those with whom you are speaking? If not, should you be doing so?
  • Do you help those you teach or supervise become sensitive to the role of jargon in their communication with patients and others?
Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD


First posted: 10/20/08
Revised: 11/16/08

Does humor have a place in teaching?


Q: And what is the single greatest thing that sustains you?
A: A sense of humor. And I laugh at myself.
Kofi Annan (1938-) (7th Secretary General of the UN)
If I can get you to laugh with me, you like me better, 
which makes you more open to my ideas.
John Cleese (1939-) (British comedian, writer)
Less than three weeks before Barack Obama was elected to become the 44th President of the US, he and John McCain shared the stage at a fundraising dinner at which humor was expected. They each told a series of jokes, several at their own expense. The candidates were funny, and the event was humanizing. Several political commentators asserted that humor is a vital element of political success, and acknowledged that it is fortunate the aspirants have talented joke writers available.
Is humor also important in teaching? Let's consider some sub-questions.
What can humor accomplish? In teaching as in politics, effectively used humor can reduce the distance between authority figures (politicians, teachers) and their audiences. The right kind of humor can help a distant figure appear friendly, even safe and approachable. People who share a laugh, by definition, have something in common. If the something they've shared has been pleasant, barriers can be reduced and a sense of camaraderie can emerge.
Why reduce the sense of separation between teachers and learners? In too many educational programs, teachers are perceived as judges, as potentially hurtful assessors. Learners who are on guard, who are concerned about being found inadequate, avoid doing what is needed for learning. People who feel that their deficiencies will be held against them are unlikely to seek help they need. They strive to avoid being witnessed saying or doing anything outside their comfort zone, or anything at all. Do you recall avoiding eye contact with any of your harsh teachers? Have you seen students edge their way to the back of the group during rounds? Might you have been one of the many students who become quite ingenious at dodging questions in class? Why do students and faculty tend to fill the back rows of auditoriums first? To be worthwhile, learning needs to take us places we've not been before. We're only likely to embark on a potentially scary journey willingly if we feel we are in the presence of a guide who we perceive as likely to be supportive and helpful. (For another aspect of this topic, please click here.) Finding ourselves in situations we think could prove intimidating or belittling, most of us choose avoidance; we do what we can to keep from trying new, untested and unrefined ways of thinking or behaving. Cautious learners are handicapped learners. When teachers succeed in reducing perceived barriers between themselves and their learners, the prospects for worthy learning grow.
What kind of humor is appropriate in teaching? Humor can take many forms. The thoughtful humorist/author, Steve Allen (1992, 1993), asserted that most humor, at its roots, involves aggression and hurtfulness. Some American professional comedians of the past, such as W.C. Fields and Don Rickles, built their personas on their nasty put-downs of others. A case can certainly be made that a good deal of humor depends on sarcasm, ridicule, humiliation, insult, or retribution, and quite a lot of humor seeks to diminish its target individual or group. There is a large body of humor that is downright cruel, founded on racism, sexism, ageism, homophobia and even national or cultural origin. But a lot of humor is gentle, kind, even uplifting. Some of our most highly regarded, legendary comedians in the US, such as Bob Hope, Jack Benny, Bill Cosby and, more recently, Jerry Seinfeld, relied on hurtful humor only rarely. What made them endearing and popular, in part, was their capacity for poking fun at themselves. And this is the lesson that successful politicians and teachers have learned. The form of humor most likely to reduce the distance between people, to remove obstacles, is self-deprecating humor. 
What if I can't tell jokes? Unquestionably, some people are more comfortable than others as joke tellers. But breaking down barriers doesn't depend on joke-telling. A constructive sense of humor doesn't need to involve jokes at all. A good sense of humor is a prevailing mind-set far more than it is a capacity to tell funny stories, and that mind-set can be learned if it doesn't come naturally. A sense of humor that can bring teachers and students closer together involves a capacity to recognize and appreciate humor, not necessarily create it. To students, a teacher who never laughs, who doesn't seem to ever be non-serious, who doesn't respond positively to humor they introduce, can feel distant, even unpleasant and potentially antagonistic. A teacher who conveys displeasure at any student's effort to be funny is constructing a wall between herself and her learners. A teacher who seems to derive pleasure from the jokes or funny experiences told by students is greasing the gears of communication.
What are some examples of self-deprecating humor? Teachers can constructively poke gentle fun at themselves, and even make some helpful observations in the process, with no joke or punch-line involved. A teacher who is perceived as honest and who acknowledges having difficulties similar to those his students are experiencing can reduce barriers and can make a constructive contribution toward deflating beginning students' common but counter-productive fantasy that perfection is achievable. Are you able to see yourself saying anything like, "Are you having trouble squeezing your question into this non-stop exchange? Just shout it out, and please don't worry about possibly asking a stupid question. There are no stupid questions. Really. Just don't make me promise to never come up with a stupid answer." Or, what about, "Are you having trouble remembering some of the details in all the reading you've been doing? Hey, why should I be the only one here whose memory is undependable?" The critical feature of those sentiments is conveyed only partly by the words you say. At least as telling to students is the ways those words are conveyed. Among those students who don't know you yet, there are likely some who bring with them a fine-tuned radar for detecting potential danger, devised during prior dealings with hurtful teachers. Most students will notice whether you offer your observations with a smile or a frown, whether your manner seems sympathetic or not. You can also help the cause of confirming that you are safe and approachable through the way you use a light touch when responding to a student's comment. If one of your students says something like, "I think I'd find that procedure quite difficult to do," could you feel comfortable replying, with a smile, "Welcome to a large club, in which I'm a charter member."
Humor in teaching is more about atmosphere than jokes. Although there can be times and situations when well-selected jokes can be constructive contributors to an instructional event, they can also be risky. Jokes that are funny to some can be offensive to others. Jokes that seem awkwardly shoe-horned into situations where they are not fully relevant can backfire. More dependably constructive than jokes is gentle, pervasive good humor that influences the overall atmosphere of an instructional event. Of course, there are circumstances in which humor doesn't belong. Teaching in the presence of patients must conform to the reality of the situation. When conveying bad news, or undertaking a painful procedure, especially with a patient we don't know well, establishing a supportive but neutral posture is usually more prudent than seeking to inject humor. In other situations, however, bringing a light touch to what we say and how we say it can exert a positive influence on the atmosphere and enhance the value of our educational exchanges. In general, if we can find ways to bring down barriers, especially by occasionally being constructively self-deprecating, we will likely help our students feel more comfortable in our presence, which can help them become open to engaging in the inevitable risks involved in genuine learning. And we can get all that done without the benefit of hiring any presidential joke writers.
Some questions for your reflection and possible comments:
  • To what extent have you brought humor into your teaching so far?
  • Are there any approaches to lightening the atmosphere during your teaching that you've not yet tried, which you'd like to try?
  • Have you used any humor in your teaching in ways not mentioned in this piece that you're willing to share with others by adding a comment here? We'd love to learn from you.
  • Also, we admit to loving a good joke as much as anyone. Do you have any good jokes about teaching that you are willing to share?
Thanks,
  Hill Jason 
Hilliard Jason, MD, EdD
------------
Allen, S., Wollman, J. (1992). How to Be Funny: Discovering the Comic in You. Prometheus Books.
Allen, Steve (1993) Make 'em Laugh. Prometheus Books
First posted 10/18/08
Updated on 11/06/08

©2008-2012 Hilliard Jason

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