This week, Jenny and James discuss how organizations, not just individuals, can have hidden or implicit standards that are not spoken aloud. We look at how a tool like the new Advocacy Inquiry Rubric, or AIR, can help make excellent performance visible, learnable, and repeatable, and how explicit standards help us target what actually matters in performance and what we want to move toward as a shared goal.

Workout of the Week: When you detect an implicit standard, say it out loud and make it explicit (but be sure to own that this is your perspective!). For example, “I believe that our standard in this unit is that if we need blood drawn from a patient, we start a new draw rather than using an existing IV.”

#healthcaresimulation #nursing #medicine #debriefing

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

We're taking this week off, but we'll have a new podcast on January 2nd, and the CMS media team will be in San Antonio from January 11-14 for IMSH 2026! We hope to see you there.

This week on Curious Now, we’re joined by an expert in the exploration phase of debriefing to help us better understand the “listen and explore” region of PAAIL. Bridget Van Gotten is a Learning and Design Strategist for the Zamierowski Institute for Experiential Learning at Kansas University Medical Center, and a 2015 alum of the CMS Healthcare Simulation Essentials: Design & Debriefing course.

The KUMC team designed a new approach to exploration when they found that in simulation, learners were simply agreeing with the debriefer’s point of view rather than trying to contrast it with their own thoughts, especially when they were doing the right thing (i.e. “I did the correct thing because that’s the correct thing to do.”) A second major discovery was that learners at all experience levels were describing the same barriers to success, rather than having different needs at different levels. For example, both med students and attendings might describe the busyness of the code space as making it difficult to claim a leadership role during the case, often using the exact same words.

Bridget coaches Jenny on how to conduct better explorations of learner thinking, in this case in a faculty development conversation about classroom management and maintaining the attention of learners.

#healthcaresimulation #nursing #medicine #debriefing

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

Debriefings are often delayed and diminished by questions the asker already knows the answer to. “Wouldn’t it have been better to give epinephrine faster?” “Did it occur to you to have a family meeting?” And when asked why they don’t just share what they clearly think is the answer, the debriefer will often say something like, “It’s better for them to come to the answer themselves.” But we aren’t really asking the learner to come to an answer with these kinds of questions—we’re asking them to read our mind, and then to agree with us once they do. There’s no opportunity for them to understand their own thinking better.

Today’s episode will try to get you ready to live with the discomfort of not knowing the answer you’re going to get for long enough to ask a genuinely curious question in debriefing.

Workout of the week: Every day, ask one truly open-ended, curious question—one you don’t already know the answer to.

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

#healthcaresimulation #medicine #nursing #debriefing #podcast

Dr. Catherine Allan, Director of the Cardiac Care Unit and Inpatient Cardiology at the Cleveland Clinic joins us to talk about readiness for teams to perform pediatric ECMO, a high-risk, high-complexity therapy that staff might only see a third as often as they see patients on ventilators. ECMO can also be called for during CPR, which greatly increases the time pressure and complexity of the procedure.

During ECPR, there is not only the ICU resuscitation microteam but also the surgical team and the perfusion team, leading to potentially having up to 20 people working in the room when running an ECPR case.

We discuss how leaders can help connect seemingly imposed efforts like checklists and huddles to what it is that frontline workers are trying to achieve and are meaningful to them, and how simulation program designers must do the same in order to make sure that training is not a top-down checklist but rather a mutually owned process that gets teams where they believe they need to go.

Host & Co-Producer: Chris Roussin, PhD, Senior Director, CMS-ALPS (https://harvardmedsim.org/chris-roussin/)

Producer: James Lipshaw, MFA, EdM, Assistant Director, Media (https://harvardmedsim.org/james-lipshaw/)

Consulting and readiness with CMS-ALPS: https://harvardmedsim.org/alps-applied-learning-for-performance-and-safety

Dare to Be Ready on Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Dare to Be Ready on Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Just in time for the Thanksgiving Holiday— the CMS Book Club reviews “How to Avoid Awkward Silences” by Patrick King!

“You set the tone for how people react to this… when you act awkward and diffident, people feel awkward and diffident.”

Join us as eight learning conversation experts debate the value of silence, and how we can get the conversation back to flowing when we feel like we’ve lost touch with what’s happening in the debriefing room, classroom, or around the family dinner table.

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Why is it so hard for healthcare educators to share what they actually think in a debriefing or feedback situation? Jenny shares the story of a participant in an anesthesia clinical simulation who helped guide her to be more transparent: “I’m often talking to providers on the worst day of their career, after a medical error has occurred. If I’m going to ask them to be honest with me about what they were thinking, the least I can do is be honest about what I’m thinking.”

Over the years training faculty in feedback conversations, we’ve run into many who ask, how is it helpful to tell my learner that I think they’re an idiot? But telling the person what you think honestly should not be your feelings or attributions about their character. It should be the impact of their actions, which exist at the level of concrete data.

Workout of the Week: Practice saying to people, “When you did x, it led to y.” One great feature about this workout is that you can use it for positive things! “When you stayed late to help me with that report, it lowered my stress level.”

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

When we lead a conversation where we only bring our conclusions and inferences to the table, rather than the concrete data that helped lead us there, we are influencing (sometimes unjustly) what is even discussable among our teams. By going back down to discussing the data that helped us shape those conclusions, we can make conversations and meetings more fair, more equal, and more productive.

Workout of the week: Note when you have gone up the ladder of inference to a conclusion about a person and perhaps lost track of the data that led you there. Then, go back down and incorporate the data into an observation. Example: “She was defensive” is an inference or conclusion. Go back down the ladder to the data and turn it into an observation: “I observed that she crossed her arms and said, ‘I don’t know,’ twice.”

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

Too often, meetings and announcements, especially around policy changes and new ways of working, are a list of topics that fail to address the fundamental questions that matters to team members—why are we talking about this? Whose decision was it? And is that decision final?

Leaders and team members need to understand how power is being wielded, especially when it comes down the line in seemingly inhumane ways. By simply saying a few key words, we can make our teams feel like they had a voice, like power is not being used unfairly, and safe to say when they don’t understand and when they want input.

Workout of the week: Use the subject line of your emails to practice more clearly telling what the purpose of the conversation is.

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

This week, Jenny and James explore recent conversations that didn’t go as well as they could have, because of different types of failures in the words we chose to use or the things we chose to reveal. Building on the work of recent guest Amy Edmondson, we look at the way that people in fearless organizations can talk—using the conversations that you have to frame the work, emphasize shared purpose to create joy even in everyday work, and demonstrate that you don’t think you have all the answers.

Workout of the week: Observe for conversations where you feel unclear—what was the point of this meeting, why are we having this conversation, what are our goals of care for this patient?

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/