- Communication
- surface structure
- deep structure
- Education
- revelation (external locus of opportunity) (directive)
- quest (internal locus of opportunity) (non-directive)
- apprentice
Key is process – “trajectory” – curriculum is limiting
- Define student’s stated position by questioning/reflecting
- Align with student’s views and share problems
- Explore area together to to show that student:
- did already have knowledge on this topic
- can be released from the stranglehold of his own assumptions
- develops the thirst for new knowledge
New age skills:
- Creative insight (asking the right questions)
- Sensitivity (being able to bind a team with shared motivation
- to achieve high goals)
- Vision (having a clear imagination of how things might be)
- Versatility (anticipating change and being comfortable with novelty)
- Focus (orchestrating resources towards a desired goal)
- Patience (having a sense of long term as well as the short)
- Knowledge (“information that works”)
- Skills
- Beliefs (surface, day-to-day)
- Values (behavioural autopilot)
- Mission (detailed blueprint for future self)
It’s circumstances, not arguments, which change values
Lesson goals
- realistic (within student’s capabilities and achievable in the available time)
- positively framed (in terms of performance the student does want rather than the faults he does not)
- specific and measurable
- deserving (important and challenging enough to sustain interest)
Switch from “judgemental mode” to “awareness mode” with Awareness Raising Questions (ARQ’s)
How the inner apprentice learns:
Unfamiliar circumstances generate a need for MUTATIVE INFORMATION. This need results in a disquieting state of COGNITIVE DISSONANCE, which is felt subjectively, and which is also indicated by behavioural MINIMAL CUES, detected by an attuned aand perceptive teacher. At the pivotal POINT OF KAIROS, the learner’s Inner Apprentice attemptts to reduce the cognitive dissonance either by:
(a) discounting the mutative information
or (helped by AWARENESS-RAISING QUESTIONING and under conditions of SAFE INSECURITY) by:
(b) restructuring the knowledge store, including its beliefs and values ie: learning.
Repertoire-enhancing learning produces a sense of COGNITIVE RESONANCE, and in extreme cases a powerful EPIPHANY, which also have learner-specific minimal cues. The legacy of cognitive resonance is an educational EXPANSION SPACE, hierarchically organised, into which the learner grows and develops as the TRAJECTORY OF APRENTICESHIP unfolds.
Some symptoms of cognitive dissonance, indicating learning opportunities:
Insecurity Nervousness Fidgeting Restlessness Awkwardness Self-conscoussness Embarrassment Hesitancy Evasiveness Guardedness Defensiveness Agression Hostility Brusqueness Irritation Surprise Curiosity Day-dreaming Inappropriate humour or laughter Loss of concentration Avoidance behaviour – reduced eye-contact, physical backing-off Sudden increase or decrease in energy level Unexpected rush of emotion
Minimal cues:
- Linguistic
- Gambits (premeditated, rehearsed)
- – Curtain-raisers (unrehearsed, “trivial”)
- eg initial sentence in RCA might indicate
- cognitive dissonance
- Speech censoring (impreciseness caused by
- inner apprentice checking out “friend” or
- “foe”
- Omissions
- Distortions (to offload responsibility)
- Generalisations “…what did you do?”
- Non-sequiturs (“I know what you mean and you
- know what I mean” could be speech censoring
- a knowledge gap)
- Imagery and metaphor
- Para-linguistic
- Delivery (pitch, tone, volume)
- Turbulence (tranquility > agitation)
- Microemotions
- Non-verbal
- Internal search (body stillness, change in
- gaze eg REM, eye deviations, defocussed)
- – Energy shifts (eg inappropriate emotional
- change for the topic under discussion)
- – Displacement activities
- – Gaze
Neo-socratic style:
Superficial level | Inner apprentice establishes knowledge deficit | Clarifying and questionning | Defines deficits of knowledge base | | | | State of Karios Aporia (confessed state of (passion to know) helpless ignorance) | | Agreed agenda and definitions Questions not statements Minimal cues Safe insecurity
Awareness-raising questions:
- What
- When
- How
- Indirect questions
- tell me
- let’s see
- maybe
- imagine
- Why (to elicit values or beliefs only)
When awareness-centred teaching flags:
- What will you take away…
- What will you do differently…
Mutative information:
For maximum effectiveness this needs to be:
- congruent with the learners existing values and beliefs
- non-judgementally presented
- tailored to the specific situation
- carefully observed as it impacts on the learner (watch for minimal cues of acceptance or rejection)
Human needs (Maslow):
- PHYSIOLOGICAL NEEDS
- sex
- sleep
- normal physiological parameters
- food and drink
- oxygen
- SAFETY NEEDS
- boundaries
- predictability
- stability
- warmth and shelter
- security
- roots
- freedom from fear and anxiety
- BELONGINGNESS NEEDS
- love
- intimacy
- affection
- someone to confide in
- friendship
- company
- acknowledgement
- ESTEEM NEEDS
- esteem
- status
- approval
- appreciation
- recognition
- SELF-ACTUALISATION NEEDS
- realisation of innate potential
- self-fulfilment
- self-expression
- self-esteem
- self-respect
- self-confidence
The inner curriculum:
- SURVIVAL
- Timetable, protected time
- Own room, desk, equipment
- Working knowledge of prescriptions, certificates, forms
- Local geography, medical facilities, services, telephone nos
- Knowledge of surgery arrangements, names of staff
- Free from non-professional worries eg money, health, personal
- SAFETY
- Availability of trainer’s help and support
- Able and willing to ask for help
- Availability of books and information resources
- Competent in dealing with urgent and straightforward physical
- illness
- Basic clinical knowledge and skills
- CONFIDENCE
- Accepted by and contributes to PHCT
- Involves other team members appropriately
- Willingness to take responsibility: can “hold” situations
- Makes and manages psychological and social diagnoses
- Recognises and rectifies clinical blind-spots
- Deals competently with minor illness and atypical presentations
- Bonding with trainer
- RECOGNITION
- Hungry for new ideas and experiences
- Aware of and willing to address own needs and motivations
- Intersted in “softer” topics eg hidden agendas, consultation
- skills, doctor/patient relationship
- Can accept criticism and praise
- Attracts a personal following of patients
- Confidence not dependent on trainer’s approval
- SELF-ESTEEM
- Feels comfortable with, not oppressed by trainee role
- Can use “self” in consultations – Balint-wise
- Comfortable balance between private and professional life
- Not addicted to an idealised “doctor” role
- Tolerates inadequacy, uncertainty and occasional failure
- Negotiates and organises own educational programme
- Takes pride in keeping clinically well-informed and up-to-date
- Knows own strengths and limitations
- Can advise, challenge and constructively criticise trainer
- Aware of transference issues in trainer/trainee relationship
- AUTONOMY
- Takes responsibility for own continuing education
- Successfully negotiates transition from trainee to principal
- Finds and maintains ways to enhance job satisfaction
- Discovers, chooses and pursues own interests
- Sense of overall purpose, worth and direction
Hallmarks of excellence:
- Positive response to novelty
- “Caritas”
- Up-to-date clinical competence
- Self-awareness
- “Group-ability”
- Educability
- Motivation
- Personal/professional balance
- Industry
- Communication skills
- A sense of mission
- Critical ability
- Diversity of interests
Source: Roger Neighbour The Inner Apprentice