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  • Fellows at Work: Using Cold Call to Develop Better Doctors

    Fellows at Work: Using Cold Call to Develop Better Doctors


    It’s not this…

    Dr. Bob Arnold, Gerald J. and Dorothy R. Friedmans Chair in Palliative Care and Vice Chair for Professional Development at Mount Sinai’s Brookdale Department of Geriatrics and Palliative Medicine, and Dr. Rene Claxton, Director of Palliative Care Undergraduate and Graduate Medical Education at UPMC, are two of our twelve Teach Like a Champion Fellows from cohort 3. For their final projects. Bob and Rene studied Cold Call in the medical educator setting. They shared the following brief summary of their project! 

    If you are interested in becoming a TLAC Fellow or know someone who might be a good fit, applications for our fourth cohort are open and available here: https://teachlikeachampion.org/teach-like-champion-fellows/ and are due by May 30, 2025. 

     

    Cold Calling in Medical Education 

    For decades, medical educators have employed questioning as a teaching strategy. Senior doctors quiz learners, asking them questions until they do not know the answer and then moving on to a more senior member of the team. The focus is building on knowledge deficits.1 While learners felt this practice known as “pimping” (a gendered term for a demeaning practice) was a rite of passage, it did not cultivate psychological safety and its impact on learning is unclear. In the era of physician wellness, some educators called for the elimination of this form of questioning practice.2 

    Teach Like a Champion Fellows and physicians, Bob and Rene, honed in on the dissonance between their experience of pimping and their observation of exceptionally skilled educators employing questioning strategically to ensure voice equity, demonstrate loving accountability and ensure learning. They came up with the following differences: 

      Pimping  Cold Calling 
    Teacher intention 

     

    Highlight knowledge shortfall  Celebrate knowledge acquisition and maximize voice equity 

     

    Group dynamics 

     

    Reinforce hierarchy 

     

    Create supportive learning environment 

     

    Pre-requisite knowledge 

     

    None explicitly provided 

     

    Provided prior to questioning sequence 

     

    Learner errors

     

    Underscores learner knowledge deficit 

     

    Provides teacher insight into the success of their teaching (allows for checking for understanding) 

     

     

    As they brainstormed replacing the antiquated method of pimping with Cold Calling, they agreed on several core steps:  

    1. Start by outlining the rationale for cold call and distinguishing it from pimping in a short roll out speech. In Rene’s roll out for the first day of a series of fellows’ education, she makes sure to say:  

    What she’s doing 

     

    I’m going to call on people even if their hands aren’t raised 

     

    Why she’s doing it 

     

    Helps us gauge how good of job we are doing teaching…to help us stay engaged…what we pay attention to is what we learn 

     

    What to do if a learner doesn’t have the right answer 

     

    It’s okay if you don’t know the answer. That means you’re learning…that’s why you’re here … just say pass 

     

     

     

    2. Carefully craft and place Cold Call questions in the lesson to set students up for success. Don’t call on someone as a punishment or to call out that they were distracted. To ensure learners have pre-requisite knowledge, assign pre-reading prior to the class session. Use Wait Time to give the students time to think about a thoughtful answer. Use formative language by starting cold call questions with low-stakes phrases like, “Who can start us off?”   

     

    In this example, Bob planned a Turn and Talk before a Cold Call to help learners teach each other (increase motivation) and feel more confident in their responses. He transitions from the Turn and Talk to the Cold Call using low stakes phrasing by directing the group, “We’re going to go from team Becca to team Courtney and see how we do.”  

     

     

    3. Positively frame the Cold Call practice by repeatedly setting expectations that mistakes are part of learning and respond to mistakes with supportive phrases such as, “You’re 80% there” or “Who can build on that?” When the answer is wrong, use it as an opportunity for the group to learn together by using phrases like, “That is a common mistake that we can all learn from.” These phrases maintain accountability for learning while enhancing psychological safety. Learners are more excited to contribute when they know their answers will be taken seriously and used to promote their learning.  

    In Bob and Rene’s experience, medical students reported high satisfaction with Cold Calling – the key was making sure teachers perform the technique effectively–setting it up carefully and making it safe which allowed students to bring their best answers and appreciate what they do know. 

     

    References 

    1. An example of pimping from the television show ER: https://www.youtube.com/watch?v=qoT5QkGBjOA
    2. Chen DR, Priest KC. Pimping: a tradition of gendered disempowerment. BMC Med Educ. 2019;19(1):345. doi:10.1186/s12909-019-1761-1 

     

     

    Want to learn more?  

    Join us for our remote Engaging Academics in the Medical Educator Setting (four 90 minute remote sessions on May 22nd, May 29th, June 5th, and June 12th). Bob and Rene will be co-facilitating with the TLAC Team! Learn more and register here 



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  • Ice cream socials, fights and vomit: Why Cal State resident assistants want to unionize

    Ice cream socials, fights and vomit: Why Cal State resident assistants want to unionize


    Lynn Chan-Nguyen and Faith Ballesteros, two resident assistants at Sacramento State, at the Public Employment Relations Board office in Sacramento. They back unionization for about 1,400 RAs at CSU campuses.

    Credit: Courtesy of the California State University Employees Union

    Takeaways:
    • The union wants to absorb 1,400 or more resident assistants, who do everything from organizing karaoke nights to navigating health crises. They want more guidance about responsibilities.
    • Cal State opposes the bid, claiming it “would have detrimental effects for students.”
    • Student RAs typically don’t get paid, but receive benefits like free or reduced-cost housing.

    To be a resident assistant (RA) in a college dorm is to be many things at once. The person who hosts university-approved events — and cleans up after nonsanctioned revelry. The person who builds community among students — and mediates between feuding roommates. The designated friend — and emergency first responder to a freshman spiraling into a mental health crisis.

    That’s why the students behind the current push to unionize an estimated 1,400 resident assistants in the 23-campus California State University system argue they deserve better workplace protections and stronger guidelines defining their positions. If their bid succeeds, RAs would add to the more than 17,000 other student workers who joined the CSU Employees Union last year.

    But CSU is opposing the move. In a letter to state labor authorities, a CSU representative said allowing RAs to join a union would “would have detrimental effects for students” and argued RAs should be considered “live-in student leaders,” not employees.

    An RA’s role can include everything from organizing karaoke nights to making sure students know how to apply for food stamps. At CSU, they help manage dorms that encompass more than 67,000 beds. RAs receive no salary but get benefits like free housing or access to a campus meal plan. 

    “Sometimes we are (students’) therapists, and we’re essentially sitting there and connecting with students, one on one, and we’re talking them through really difficult times,” said Yasamean Zaidi-Dozandeh, an RA at CSU Dominguez Hills. “Sometimes we’re their doctors. We’re sitting there calling 911 for them.”

    And it’s a position that can vary widely depending on the dorm’s size and the students it serves. An RA in one building might sleep peacefully while another is jolted awake by middle-of-the-night calls. 

    The union points out other reasons resident assistants could benefit from labor protections. Because RAs live in dorms, they risk losing their housing if dismissed unfairly, it says. Students interviewed for this story said RAs would be more willing to voice concerns to housing administrators, too, with union backing.

    A successful union drive would put Cal State students in the company of RAs who have already organized at Boston University, Wesleyan University, Grinnell College and Georgetown University, among others. Though some colleges have voluntarily recognized such bids, others have resisted. The American Council on Education similarly argued against resident assistant unions in a 2016 amicus brief in a case before the National Labor Relations Board involving RAs at George Washington University. 

    “RAs often are required to be available around the clock to attend to emergencies. If universities and colleges had to bargain about the ‘hours’ of RAs, it is entirely possible that any agreed-upon hours limits would conflict with real-life emergencies,” an attorney representing the council and other higher education organizations wrote. “Could an RA rely on a union contract’s hours limitation to refuse to assist a depressed student in the middle of the night?”

    The board ultimately gave George Washington’s resident assistants the go-ahead to form a union, though a union election planned for 2017 was later canceled.

    At CSU, the employee union wants to absorb RAs into its existing unit of student assistants, who include part-time workers at places like campus health centers and libraries. Early last month, the union filed papers arguing that resident assistants share a “community of interest” with student assistants, meaning they have similar working conditions and job duties. CSU is currently negotiating its first contract with student assistants. 

    In opposing the bid, CSU says the housing and meal credits RAs receive are effectively financial aid, not wages. It argues that converting RAs to employees will jeopardize “peer-to-peer relationships” with student residents. It warns that RAs would need to pay taxes on in-kind perks that can reach nearly $30,000 in value. And it says blending RAs into the existing student assistants unit would “overly complicate ongoing negotiations.”

    Finally, CSU argues that one of the reasons some RAs favor a union — a lack of consistency in their duties — is a better reason to reject the union’s claim that they share a community of interest with student assistants. “There are no set ‘duties’ or expectations nor set hours for RAs as a whole. In fact, the only uniform characteristic of RAs is that they live on campus alongside other students,” the letter says.

    CSU’s opposition means that RAs will likely have to wait for a few more steps to unfold before state labor officials make a decision on the petition. A union spokesperson said the union disagrees with CSU’s response and expects a hearing before state labor officials to be set.

    ‘No clear distinction in what our role is’

    Lynn Chan-Nguyen decided to work as a resident assistant for one reason: “I really could not afford to go to school without the job.”

    Chan-Nguyen, a third-year student at Sacramento State majoring in nutrition, grew up an hour’s drive south in Stockton. If not for the meal plan and housing she gets by being an RA, she probably would have stayed closer to home and taken classes at a local community college rather than enrolling at Sacramento State.

    But Chan-Nguyen has found noneconomic reasons to love being an RA, too. She enjoys hosting activities like ice cream socials, which help the upper-division, international and transfer students in the apartment-style housing where she works make new friends. 

    Still, parts of the position she could do without, like cleaning up vomit or trying to defuse physical altercations. “There’s just no clear distinction in what our role is,” she said. “And a lot of the times, when people do get hired, or when people are first starting off from the job, it is not defined what we’re going to be doing.”

    First-time resident assistants only start to grasp how emotionally taxing the role can be during a two-week training at the start of the school year, Chan-Nguyen said. 

    It’s then that RAs realize they might face a life-or-death test of their counseling skills if called on to help a resident experiencing suicidal ideations or a similar health crisis. A 2019 study found that RAs who encountered a resident engaging in self-harm experience higher levels of burnout than RAs who didn’t have those interactions.

    CSU Monterey Bay students move into campus dorms in August 2021.
    Credit: Monterey Bay/Flickr

    Resident assistant Zaidi-Dozandeh at Dominguez Hills, who supports the union drive, said her first-year on-campus housing experience prompted her to become an RA.

    The university’s housing department mishandled an escalating conflict among the students in her three-bedroom apartment, Zaidi-Dozandeh said. As an out-of-state student, however, she felt she had no choice but to return to university housing the following year. She shared her concerns with a staff member — who suggested she use that passion to become an RA. 

    Zaidi-Dozandeh, a fourth-year computer science major, enjoys connecting student-residents to resources like the school’s food pantry. But the work of an RA can also be vaguely defined, she said, creating miscommunication, inconsistencies, and, ultimately, a worse experience for students who live on campus — a problem as CSU campuses experience enrollment declines

    “The question really is, why are these students leaving housing,” she said, “when in some cases they really don’t have anywhere else to go?”





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