There are many people involved with the transition from university student to health professional, and it is at this time of the year that preceptors, mentors, educators and managers reflect on the achievements and areas for improvement for their graduate programs.  This article will focus on the new area of neuroleadership and how it can complement, or perhaps change, our current strategies for working with new graduates in the health professions.

We have been aware of Malcolm Knowles’ model of adult learning, defined as andragogy, since the 1970s.  This involves  respecting the past experience of the learner and focusing on practical, problem-based learning.  In my experience however, it has been a challenge to harness the internal motivation and self-direction of adult learners.  I have hypothesised that this may be related to learning burnout after a long period of study at university or perhaps to the overwhelming nature of starting full-time work (shift work for some) combined with all of the responsibility and accountability associated with being a health professional.  However I have come to believe that we, as experienced professionals, can sometimes create barriers to the flow of learning and development.

The role of the preceptor/ mentor/ buddy and the graduate has changed over time.  The apprenticeship model required a doctor or nurse to follow, watch and learn from their teacher.  The learner provided cheap labour for the privilege of having a teacher to observe.  With changes to patient acuity and technology came changes to the way we educate.  In many areas, certainly in nursing, we have dedicated educators that focus on facilitating educational experiences, assessing competence and making sure that new graduates know what we perceive they need to know.  It is a teacher-led system and the result of this is the diminishing ability for adult learners to assert their internal motivations and self-direction.

So how do we strike a balance between ensuring competency and allowing for the natural drive for knowledge of intelligent graduate health professionals?

Developments in neuroscience allow us to understand the complexity of how the brain responds to new information.  Each and every experience results in a ‘mental map’.  You have a map to remember how to drive to work, another to remind you how to put on your socks.  There are maps upon maps upon maps.  When the brain encounters a new experience it will attempt to match that experience to a pre-existing map.  If a match cannot be made, a new map will be required, which is time, energy and concentration intensive.

“The brain is constantly trying to automate processes, thereby dispelling them from consciousness; in this way, its work will be completed faster, more effectively and at a lower metabolic level.  Consciousness, on the other hand, is slow, subject to error and “expensive”.”- Gerhard Roth (2004) from Quiet Leadership by David Rock (2006)

To add to this complexity, each brain is wired in a unique way. Preceptors often have trouble relating to the requirements of conscious map making.  I like to use the analogy of a ballerina and a toddler to demonstrate this theory. 

The experienced ballerina looks effortless and graceful while performing her skills.  The mental maps have become hardwired by chemical and physical links between neurons.  The brain of the ballet dancer has become efficient and can focus on higher level thinking about the finer details such as hand placement and facial expression.  The toddler, on the other hand, is a novice.  The number of mental maps required to perfect the skills of standing, walking or coordinating muscles to do the hokey-pokey is enormous.  It is taxing and it is all the toddler can focus on. 

It is not surprising that the experienced health professional can unintentionally disregard the effort required by the novice to learn what appears to be the most basic of tasks, especially those practical skills that they have had minimal time to practice given the relative lack of clinical exposure in the current university model.

Health professionals are taught to think critically and to be accountable for their actions.  The role of those involved with facilitating new graduate learning is to do so in a way that enables graduates to make their own connections and mental maps.  We know that the didactic approach does not work for adults thanks to the theory of andragogy, but now we understand why.  The experience that fits with an existing mental map of one person may not fit the existing mental map of another.  In the same way as we cannot teach a child to walk – we can only provide encouragement and support to increase their confidence – we need to assist graduates to process ideas effectively, clarify those ideas, to establish relationships between concepts and to prioritise their thoughts.

While this sounds abstract it can be as simple as adapting the way we question them.  Changing the old, ingrained mental maps is near impossible.  A focus on creating new maps by being solution-focused can enhance learning:

Teacher:  “Why didn’t you manage to complete your workload this morning?  What went wrong?”

Grad: “I was too busy to make a plan or look through my charts so I was behind from the beginning of my shift…”

In most cases the graduate in this situation will already feel dejected about the shift.  The questioning focus is on the negative which further decreases the ability of the graduate to feel energised about trying again.  An alternative, solution-focused approach could be:

Teacher: “What do you need to do next time to make sure you are able to meet the requirements of your workload?

Grad: “I really do need to take the time to make a plan and look through my charts so I know when to ask for assistance.”

The graduate, being an adult, has already assessed what went wrong.  The focus of this style of questioning is on planning for future attempts. 
In his article titled SCARF: A brain based model for collaborating with and influencing others (2008), David Rock asserts that the following five domains of human social experience elicit an approach/avoid response dependent upon whether it is perceived to be a reward or a threat:

• Status
• Certainty
• Autonomy
• Relatedness
• Fairness

He states that a person feeling threatened in any of the five domains will have a reduced capacity for complex problem solving.  This can negatively impact the ability to utilise the brainpower required to create mental maps.  In contrast, providing fairness and certainty, appreciating the past experience of the graduate and allowing them the time required to make their own cognitive connections leads to improved learning cultures and fosters motivation and self-direction.

If performance equals potential minus interference, as suggested by David Rock, then as organisations we should be looking at the structure of our graduate programs to create a culture of support and encouragement.  We should account for the time, energy and patience required to ensure that strong, knowledge-based connections are formed in our graduates as a basis for long lasting, highly skilled and motivated experienced health professionals.

References

Rock, D, 2006. Quiet Leadership. 1st ed. NY: HarperCollins.
Queensland Occupational Therapy Fieldwork Collaborative. Date Unavailable. Adult Learning Theory and Principles. [ONLINE] Available at: http://www.qotfc.edu.au/resource/?page=65375. [Accessed 11 September 14].
David Rock. 2008. SCARF: a brain-based model for collaborating with and influencing others. [ONLINE] Available at: http://www.your-brain-at-work.com/files/NLJ_SCARFUS.pdf. [Accessed 11 September 14].