To develop expertise you have to create the environment

One person’s “Eureka!” can be another’s “Just hold on there.” When that happens, you’ve got a dilemma ― two opposing points of view, each one valid from the perspective of the person holding it. And you don’t need more than one person for this to occur.

Consider the scenario Janet Cromer describes at the beginning of her feature on medical ethics this month. You are an emergency room RN and a hurricane is bearing down on your city. You also have a family that needs to evacuate. Patients. Coworkers. Community. Family. How do you assign priorities? Then, once you do, how do you feel comfortable with the choices you make?

When I worked in the writing lab at a community college in Massachusetts, the overwhelming majority of students we saw were enrolled in pre-college writing courses ― what some people want to call remedial. Even though the students in these courses were required to sign up and pay for writing lab, we designed the lab using a writing center model. Students came to the lab on their own schedule, and once there, they set their own agenda. They could work by themselves, they could meet and get feedback from a lab facilitator, or they could work with peer tutors.

This was not the standard approach to working with “remedial” students, who, some believe, need direction. Nor did our unorthodoxy stop there. The “peer” tutors the students saw were their classmates, other students enrolled in pre college writing who got no more instruction in how to tutor than they asked for or than they picked up from being tutored themselves. There was always a facilitator there to handle questions that needed answering and to ensure that students were not doing each other’s work. But the goal was to make students, not teachers (which is what a student who has received training in tutoring really is) responsible for their language choices ― both on their own and in concert with others.

The experience in the writing lab parallels in more than one way Janet’s description of the initiative at MGH to develop each clinician’s competency in recognizing and addressing ethical issues.

• First, the goal was to empower individuals to make their own decisions based on the particular circumstances they faced, just as healthcare professionals have to consider ethical questions in the context of specific cases.

• To achieve that goal, we ran workshops with formal discussions about the issues people encountered. MGH runs regular training sessions and makes ethics a focus of rounds.

• We recognized and encouraged those individuals who demonstrated interest that went beyond just the immediate paper they were writing and who wanted to help others develop their own abilities. Mentors at MGH help develop ethic resources for each unit so staff have someone to turn to when they need to work through their issues.

• We provided plenty of opportunity for people to meet informally and discuss either specific issues or larger questions about the writing process, just as informal discussion is key at MGH to the development of medical ethics expertise.

It worked for us in the writing lab (albeit raising a number of ethical education concerns that needed to be addressed). And the approach is working at MGH.

Contact On Call Managing Editor Joe Saling at joesaling@comcast.net.