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TIPS & TOPICS from David Mee-Lee, M.D.
Volume 2, No. 9
January 2005
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In this issue
-- SAVVY
-- SKILLS
-- SOUL
-- SHAMELESS SELLING
-- Until Next Time

Welcome readers!

Happy New Year! Actually January is nearly over and it seems 2005 is already in full swing.

 
SAVVY
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 This month, I will cover a topic I have never written on before- learning experiences and training ideas. Whilst reviewing videotaped workshops as part of a "Train the Trainers" project, it occurred to me that at one time all of you readers have been participants in training, and many of you have been the "trainer." Here are some ideas about creating effective learning experiences. (My anxiety in writing on this topic is that now participants in my workshops will have essential information to judge the effectiveness of the workshops I conduct!)

Tips:

Tip 1: Interactive training sessions can change professional practice. Didactic sessions do not.

Most licensed and certified professionals are required to have a certain number of continuing education credits per year to enhance clinical competence and professional growth. Now there is nothing wrong with having trainings in nice hotels in nice locations with great food and fellowship. But if the continuing education is indeed meant to positively affect clinical practice and make a difference to health care, then the conclusions of Dave Davis, M.D. and colleagues is worth noting.

In a paper in the Journal of the American Medical Association, "Impact of Formal Continuing Medical Education - Do Conferences, Workshops, Rounds, and Other Traditional Continuing Education Activities Change Physician Behavior or Health Care Outcomes?" these conclusions were made:

"Our data shows some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care outcomes. Based on a small number of well-conducted trials, didactic sessions do not appear to be effective in changing physician performance."

Many physician workshops consist of a series of 25- minute lectures by erudite academicians who flash before your eyes at MTV-lightning speed a hundred slides of graphs and statistics. The talks challenge both your attention span and your college "Statistics 101" prowess! It's a good thing you get Category I credits, because not much else was gained, least of which improvement in clinical practice. Fortunately, workshops for counselors, therapists and other behavioral health specialists are usually more interactive than passive educational settings.

Here are some tips if you design trainings or are deciding which ones to attend:

  • Lectures can change knowledge, skills or attitudes, but didactic lectures by themselves do not play a significant role in immediately changing clinical performance or improving patient care.
  • Interactive techniques such as case discussions, role-play, or hands-on practice sessions are generally more effective.
  • Training sessions that are sequenced (learn-work- learn opportunities) appear to have more impact.
  • Successful adult education is learner-centered; active rather than passive; relevant to the learner's needs; engaging and reinforcing of previously learned information.

Reference: (Davis, D; Thomson O'Brien, MA; Freemantle, N et. al: "Impact of Formal Continuing Medical Education - Do Conferences, Workshops, Rounds, and Other Traditional Continuing Education Activities Change Physician Behavior or Health Care Outcomes?" JAMA, September 1, 1999. 282: 867-874)



Tip 2: To accelerate your learning, use methods that suit your unique combination of intelligences and that use the full range of mental powers.

"The process of thinking is a complex combination of words, pictures, scenarios, colors, and even sound and music." (p.96). "Consciously developing and using your full range of intelligences leads to balanced learning - learning that not only suits your current strengths but also enables you to develop and grow as a person." (p.108).

I was raised in the passive learning, lecture format, where in medical school I usually fell asleep as soon as the lights dimmed and the professor began his 100 slides. Ever since, I have been gradually widening my exposure to different learning methods. I'm not sure that you have to believe the hype of the book by Rose and Nicholl that promises "The Six-Step Plan to Unlock Your MASTER-mind". But they do have some good ideas for a much broader and more effective learning process. One diagram or learning map illustrates some good suggestions for how to use visual, auditory and kinesthetic learning processes to acquire knowledge. They call it a VAK attack (p.106):

Visual methods:

  • Learning Ideas
  • Mental movie
  • Highlight new ideas
  • Diagrams
  • Charts
Auditory methods:
  • Summarize aloud
  • Dramatic reading
  • Make tapes
Kinesthetic methods:
  • Write notes
  • Postcards
  • Cooperative learning
  • Check it off
  • Move
Reference: Rose, Colin and Nicholl, Malcolm (1997): "Accelerated Learning for the 21st Century" Dell Publishing, New York.

 

SKILLS
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Here are some thoughts on how to get the most from continuing education events if you are a participant; and how to help people get the most from workshops if you are a trainer - even if you are giving an in- service to a small group at your agency.

Tips:

Tip 1. Plan on finding out what's in the training for you and what you will know, do or apply differently as a result of the educational session.

You likely get a lot of professional reading material - newsletters, journals, papers and articles. Unfortunately mine pile up high and as much as I plan to read, sort, file and discard them, the pile gets taller. Have you noticed though, that if you have a specifically tough client or issue that stumps you, reading that article on co-occurring disorders; or cutting behavior; or systems solutions to lower dropout rates or whatever, now becomes much more focused and useful? This is what happens with me anyhow.

So this is what I suggest before and during your next continuing education event:

  • Think first of what are your most challenging, frustrating clients or issues to resolve.
  • Even if the workshop or training is not titled to focus solely on "your" issue, actively listen for anything that relates to your thorny problem.
  • Decide on what is the one take-home knowledge, skill or application that you plan to actually do something about differently as a result of the training. (You don't have to choose only one, but get at least one.)
  • Break that one thing down into steps - e.g., I will read a paper or book about this insight; or I will do my assessment of one client differently this next week based on what I learned.
  • Don't try to change everything all at once, because the secret of success is to aim low.
  • Make sure you do at least one of those steps this week, rather than file your handout and notes for future more careful reading and application.


Tip 2: Whether you are evaluating a training event, or striving to improve your training skills, finding what works or doesn't is a deliberate process.

I know myself as a participant, especially at the end of a long conference, the Evaluation Form can easily become a necessary evil to get those prized CE credits. As a full time trainer, I am interested in what didactic, experiential or case material was effective in the training; and what parts didn't work for you. I like comments like: 'Great workshop"; or "Knowledgeable and helpful"; or "This is the best workshop I've attended in years". So don't stop saying that. But what is even more helpful in improving my skills is to hear the specifics, even if it is just one thing.

For those of you who are trainers or want-to-be trainers, here are a few suggestions that arose as I was reviewing the "Training of Trainers" videotaped presentations:

  • Take the time to self-assess which parts of the training went well and which didn't first. Second, then compare your thoughts with the actual evaluations to see if you were on track or not. Sometimes it seems like something bombed because of your anxiety or uncertainty, but nobody noticed.
  • When creating an interactive learning environment by asking questions, ask questions in a neutral way that opens up participants' thoughts and clarifies their beliefs and values. For example : Q: "Who rated the severity of the psychiatric dimension severe, moderate or low, and make the case for whatever rating you gave?" Q: " Who would have approved placing the client in hospital, and who did not approve and why?"
  • Don't declare what the correct response is and what point you are making until participants have had a chance to air their perspectives in a safe and accepting environment that is open to all perspectives. In other words, don't shape the responses to get the right answer you want. This is about helping people look at what the answers are in their thinking, not to force them into the mold of your thinking.

    An example
    A participant might say: "I think the client should be admitted into a medical hospital detox." when you know the client has not used anything for two weeks and does not need any detox, let alone a medical detox. Don't say something like: "Are you sure you would want to do that when the client hasn't used anything for two weeks?" Better, would be: "What assessment data are you worried about that made you decide on that level of detox?" That opens up discussion about date of last use; when to worry about need for withdrawal support; severity of withdrawal and level of care to match etc. The initial response shuts down the participant who reads you correctly that they said the wrong answer.
  • Remember your group therapy skills when managing a group of participants in a training. Do everything you can to help participants learn from each other as much as possible, rather than providing all the answers yourself.
    For example
    Suppose you are training on assessment data and what material belongs in what ASAM Patient Placement Criteria assessment dimension, or in what Addiction Severity Index (ASI) problem area or not. If a participant is speaking about certain information as if it belongs to Dimension 2 and it really should be Dimension 3, don't just say: "No, you have the wrong assessment dimension. That belongs to Dimension 3." Better would be to say to the whole group: "What are your thoughts about that comment?" This opens up a discussion where another participant will likely say: "That data belongs to Dimension 3 not Dimension 2." Then you can, as the trainer, reinforce that participant's correction and explain further if necessary. This gets the whole group thinking about the comment, rather than your immediate correction, which shuts down personal clarification and application of knowledge for each participant.

SOUL
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 In TIME Magazine's third annual Mind & Body special issue on health, the focus this year is on "The New Science of Happiness" - What makes the human heart sing? I haven't had time to read the issue yet, as I'm working on getting this edition of TIPS and TOPICS out, and other work deadlines. You'll notice that I haven't had time to read it yet because I was having too much fun at the beach (it's summer down here in Australia from where I am writing this); or because I am so happy that I don't need to read about it, I just am!

Perhaps I should finish this quickly and get on with enjoying the warm weather. Over the holiday break, we visited another warm place, Merida, Mexico. I was impressed how people there seemed to embrace life despite less material wealth. In the USA, it is easy to be brainwashed into thinking material wealth equates happiness. Every weekend in Merida (not just during the holidays) the city center turns into a festival of various folk dance and musical groups; dancing music that attracts older adults and the whole family; food and yes, material goods. The streets are crowded in relaxed gatherings of all ages. Not to over romanticize it, but I couldn't help wondering whether the Meridians were not more happy than the crowds at the shopping mall or cinema complexes escaping reality with a new plasma TV screen or in a widescreen movie hit.

In a restaurant in Spain a few years ago, I wondered why the waitress was taking so long to bring us our check. I was reminded by both my son and daughter who have lived in Spain and Italy, that meals are a focus of relaxed social sharing and rejuvenation. The waitress was more intent on allowing our interaction and recreation than pushing us out for the next reservation to be filled.

Got to go - warm weather awaits, and who knows, perhaps even a little (more) happiness.


SHAMELESS SELLING
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 1. Take a look at this announcement. I am excited about this new twist in my training focus. You can get more information on the website of the Michigan Association of Community Mental Health Boards. Visit them at www.macmhb.org.

ANNOUNCEMENT

A joint venture of the Michigan Association of Community Mental Health Boards and the Michigan Association of Substance Abuse Coordinating Agencies INVITES YOU to:

Spend Two-Days With Two Of The Most Esteemed Clinicians and Trainers in the Substance Abuse Field:

David Mee-Lee, M.D. and Scott D. Miller, Ph.D.

Doctors Mee-Lee and Miller have partnered to develop an exciting two-day conference in which substance abuse professionals will:

  • Learn to engage clients and build the focus of treatment using outcome-informed client feedback
  • Learn to incorporate continuous client feedback into the multidimensional assessment and service planning process
  • Learn the methods and measures needed to re-engineer current services and policies to move towards person-centered, outcome-informed treatment.

"Making Treatment Count: Client-Directed, Outcome Informed Clinical Work With Substance Abusing Clients"
March 2 & 3, 2005 Crowne Plaza, Romulus, Michigan



2. You may know that Norman Hoffmann, Ph.D. who some years ago pioneered the CATOR system of treatment outcome studies had a clinical instrument company called Evince Clinical Assessments. He still has the variety of instruments, but they are now managed and sold by the Change Companies out of Carson City, NV. Here are a couple of instruments for those wanting help to implement the ASAM Patient Placement Criteria. You can see a whole host of other tools in marketing material from the Change Companies.

(LOCI-2R) Level of Care Index): Checklist tool listing ASAM PPC-2R Criteria to aid in decision-making and documentation of placement. Adult and Adolescent Criteria versions.

(DAPPER) Dimensional Assessment for Patient Placement Engagement and Recovery: Severity ratings within each of the six ASAM PPC-2R dimensions.

To order: The Change Companies at 888-889-8866. www.chang ecompanies.net.

For clinical questions or statistical information about the instruments, contact Norman Hoffmann, Ph.D. at 828-454-9960 in Waynesville, North Carolina; or by e- mail at evinceassessment@aol.com


Until Next Time
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 Thanks for reading and I look forward to being with you next month.

David


Contact Information
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phone: 530-753-4300
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