Our family makes it a practice around the dinner table to ask each other about our day as an effort to stimulate conversation together. We ask three questions about the day:
1. What was your high?
2. What was your low?
3. What was your bronco?
The first two are self-evident. The last question represents anything you want to say.
During a recent dinner conversation, we were sharing our highs, lows and broncos. Due to the relative chaos and lack of equanimity that is more of a feature than a bug of our typical dinner-time conversation, the questions never quite got around to me.
Frankly that’s OK, I’m not complaining. My voice was shot from talking all day. But if I were to answer the questions, I would have said that I had multiple highs. The day was filled with ultrasound teaching all day and training Jiu Jitsu in the evening.
The subject matter of the day's teaching was first a grand rounds presentation about how to improve academic productivity with three specific digital tools. This was followed by teaching a class to a cohort of nurses and paramedics about how to use ultrasound to guide peripheral IV placement in patients who have difficult IV access.
The skill of ultrasound guided vascular access is a skill that I learned over 10 years ago and have implemented throughout my clinical practice since. In the past 3-4 years I have been the medical director of the program in our department that oversees our trained nurses and medics as they perform ultrasound guided IV access. Over the years, I have not just learned the technique and how to troubleshoot various different complications and scenarios but also how to translate that information to new students in such a way that they can then perform the procedure themselves.
The fundamental concept of ultrasound guided vascular access is easy: you use the ultrasound to visualize the tip of a needle as you advance through various tissue planes and into a vein. But when it comes down to it, performing the procedure requires a great deal of eye-hand coordination, millimeter level precision, and spatial awareness in a digital environment. Some individuals pick up on the technique quickly, others struggle.
Jiu Jitsu on the other hand is a skill that I am learning. I haven’t written much yet about training to date largely because I am brand new. Having only been training once per week for about 9 months, I am only a 2-stripe white belt. Which means, I know a very little bit, I’m still very, very new – a novice. I know enough to hurt myself, but don’t know enough to be good. And to share about all the things that I’m learning seems to be just a little bit hubristic at this point.
Fortunately, the training cadre is very patient. One particular instructor has become not just an instructor but also a mentor. Not infrequently, we will roll before or after training to reinforce the skills that are taught in class or work on particular areas of weakness. Each roll ends the same way, I am submitted (usually in some form of a triangle submission). Ever the expert black belt, he regulates his intensity to be just one step above mine. He helps me with a skill then ramps up the intensity to challenge what I have learned.
In this week’s class, we learned a particular move and its defense. The class consisted of drilling different stages of the move and learning particular nuanced parts that make the move more effective (and painful). By the end of the drilling session, I was able to execute the drill (albeit crudely - as evidenced by my white belt).
We closed the class with free sparring. I paired up with the instructor. Clapping hands to initiate the roll, I settled into his guard. While attempting to pass into a more dominant position, it happened... I found myself in the position that we had just drilled. And I froze! After giving me a brief window of opportunity, the instructor swept me into a position that ultimately ended up in my submission. After I tapped, he looked at me and said I gave you that position that we were drilling.
With a smile I acknowledged his statement. Though externally you couldn’t tell it, internally I was disappointed - not that I had to tap. Rather, I was disappointed by the fact that the instructor set me up to practice what we had just drilled and I blew it. I felt like I had failed - not just the move but the instructor. He gave me a softball on something that we just trained, and I missed it. Ever the patient instructor, we clapped back in and started up round 2.
Learning is not just knowledge transfer. It is a process. It is a process of developing a 3-dimensional understanding of a topic. It involves developing an ecosystem into which new knowledge can be understood and integrated and knowing the material so well that you can connect it to other ideas. It involves translating concepts into the physical actions that it takes to appropriately express and use what has been learned.
In educational theory, there is the idea of Bloom's Taxonomy developed by namesake Benjamin Bloom in the 1950s. This framework describes the various different stages of learning. Students progress through the phases of remembering, understanding, application, analysis, evaluation and creation. This hierarchy describes the journey that each student travels from ignorance to mastery of a subject. The maturing student moves through the phases of memorizing the grammar of a subject to understanding the broader context. As this happens, learners are progressively able to move from repetition of taught material to knowledge translation across disciplines and creation of new lines of thought within the subject.
In the early stages of my ultrasound training, I spent my efforts learning the speed of sound in tissue, how the buttons on the machine created the image and how to find the windows that revealed the patient’s anatomy. As I grew in understanding, I began to see how the ultrasound images fit into the broader clinical context and how to use the ultrasound as a tool to reveal the patient’s condition. I went from completing a rigid protocol to progressing through a line of clinical thought with the ultrasound transducer.
One of the biggest challenges that I have faced as I have started training Jiu Jitsu is that I don't yet fully understand the bigger picture. I find myself in precarious positions not just because I don't yet have the skill to defend against my opponent's moves, but also because I don't have the broader understanding of what my opponent is trying to accomplish and how my hand or foot placement put myself in vulnerable positions. I haven't yet developed a full and rich understanding of the objectives and opportunities in each offensive and defensive position.
As teachers, we are often removed enough from the learning process that it is difficult to help our learners grow through these various stages. Students struggle because they do not understand the broader landscape into which each new piece of information fits. We take for granted what we know and that we have developed that panoramic perspective our educational landscape.
We do well to put ourselves back into shoes of our learners, to see the material from their perspective, and to remember what it is like to not be able to see the whole picture. Though it can be done merely with an awareness of the student's condition, I believe that putting yourself in the position of being a novice and learning a different skill can be immensely helpful in maintaining this situational awareness. So, if you want to be an effective teacher, find a subject that you want to learn and begin learning. Being a learner is a great way to help you be a better teacher. And if you are looking for something to learn, try Jiu Jitsu.
Comments