Beyond Learning by Doing: Simulation is a social Practice with Nathan Oliver

"Without relationship, that content is not going anywhere.".

In this episode of Better Every Shift, we are joined by Nathan Oliver, a simulation expert and PhD candidate who has spent over a decade leading medical and nursing education in the UK and Australia. Nathan challenges the traditional "medical paradigm" by arguing that rapport, trust, and safety must be prioritized over clinical content if we want learning to actually land.

We dive into the "spicy" world of simulation and debriefing, exploring how to manage disruptive "clinically strong" team members and how to support struggling new grads who feel like they are "underwater". Nathan shares his unique insights on "debriefing by eyebrows"—why your tone and cadence are more important than your specific questions—and the vital importance of mental rehearsal in high-stress emergencies.

Key Discussion Points

• The Social Learning Shift: Moving beyond Kolb’s 1984 model to understand simulation as a social practice where we learn in community.
• Reading the Room: Identifying "micro-communication" leaks and body language in "muted" or "shut down" teams.
• The "Lizard Brain" in the Clinical Space: Why we don't rise to our aspirations under stress but instead lower to our level of training.
• Mental Rehearsal: Why athletics and aviation prioritize mental walkthroughs and why healthcare needs to make this practice explicit.
• Fake vs. Genuine Curiosity: Why your team "smells a rat" when you ask inauthentic, judgment-laden questions.
• The Burnt Memory: A powerful story of how one piece of negative feedback can stop a clinician from apologizing for a decade.

Chapters

Intro: Nathan Oliver’s journey from "underwater" student to simulation expert.

[04:00] The Social Practice of Learning: Watching and reflecting in community.

[06:00] Scenario 1: Managing the highly disruptive but clinically strong team member.

[09:00] Making the Implicit Explicit: Modeling transparency

[17:00] Scenario 2: The struggling new grad—is it capability or stress overload?.

[20:00] The Adrenaline Secretion: Why we can’t think clearly in the first five minutes of an emergency.

[23:00] Debriefing by Eyebrows: The impact of tone, cadence, and genuine curiosity.

[25:00] The Burnt Memory: 

[28:00] The Gold Tip for Educators: Why relationship always trumps content.

[31:00] Debriefing the Debrief:  stay in the growth space.

Resources

Fixing, Helping and Serving Rachel, Naomi Remen

Author of Kitchen Table Wisdom  Daily Good Story 

Emotional Culture Deck - Riders and Elephants

Work Nathan is contributing to:

• The Scottish centre debrief model
• The Meta-Debrief Club: An embedded model for ongoing faculty development and quality assurance
• Exploring the Meta-debrief: Developing a Toolbox for Debriefing the Debrief - PMC

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Transcript

Introduction 0:30

Nathan Oliver has a head full of anatomy and physiology but as a student he felt like he was underwater. While his mates were bouncing and strutting about their new skills, Nathan didn't even know how to help a patient take off their cardigan for a shower. He realised that learning by doing isn't enough. We have to learn through community and reflection. You're listening to Better Every Shift. I'm Naomi, and I'm here with TV. And today we share with Nathan Oliver. We're drawing on our lived experiences and our questions to help you bridge the gap between clinical stress and professional efficiency. We're tackling the fear of looking incompetent in clinical spaces. Lots of clinicians lower to the level of their training during emergencies because they haven't mentally rehearsed the moves. A burnt-in memory from one bad piece of feedback can stop a clinician from apologizing or speaking up for years. In this episode, we're delighted as Nathan shows us how to use simulation to make the implicit explicit and repair the psychological safety of your team. Let us know who you are, how did you get here?

Nathan 1:55

Yeah. Wow. My name is Nathan. It's lovely to meet you. I am a nurse by trade. I live in Canberra. I did my study at Canberra. I spent a lot of time clinically, a bit of everywhere, but mainly found my home in emergency department in an ED in Canberra. I remember all my student colleagues being thriving. They look like they're having the best time in the world, and I wasn't. I found it really quite stressful, actually. Especially when we went on placement. Everyone would go out on their placements across the place and everybody would come back bouncing and strutting. Look at all the new skills they've got. But I didn't feel that way. I felt like I was underwater and I didn't know. I had a head full of like anatomy and physiology, but I didn't know how to help somebody take off their cardigan for a shower. Like I didn't know how to make those kinds of moves. I became a new graduate and then I was a new graduate nurse, and all my mates were coming back and after work saying, Oh, I've got my cannulation competency and I'm thriving, man. And how are you doing, Nathan? And I'd say, I'm all right. But I wasn't really all right. I didn't feel awesome. All my mates got it, I didn't get it, I'll be honest. And then probably before this was a term that was coined, perhaps, but way back, this was many years ago, this is 20, 20 something, this is a while ago. I had a growth mindset thought. The growth mindset thought was, gosh, I don't get this job. This is hard for me. It's not landing. But one day I will, and when I do, I want to help other people not feel as lost as I currently feel. You know what? I it did land, and it took about six months. I tell my nursing students all the time this many of you might be feeling this when you go on placemat. Many of you will feel this when you graduate. Just stick in there, just keep turning up. You'll get through it, and you'll come out the other side. I certainly came out the other side. I felt like it landed for me. After a couple of years of various clinical roles and emergency department work and met nursing and things like this, I found myself back heading towards this true north of helping people feel more supported. That led me to education, that led me to looking after new graduate programs in Canberra, to the magic that you see when learners' light bulbs switch on. That can happen in a myriad of ways, but like often happens in simulation, I've noticed when you get the sort of some little moving bits all together, these light bulbs switch on through rehearsing and debriefing. And that led me into this real career choice of mine, which I've spent the last over a decade purely focused on simulation. So, like you, I haven't been clinical clinical since about 2010-2011, but I have been thinking a lot about how we learn through simulation. I actually ended up packing up family here in Canberra, sold everything up. And my partner and my children and I, when the children were still in arms, we got on an aeroplane and we went over to the UK. I got a job that was really a career-defining role for me. The Associate Director of Medical Education for Simulation in Edinburgh in the UK, NHS Lothian, which was away from nursing. I was no longer in a nursing world or a paradigm. I was 100% in a medical paradigm, working with doctors and leading their simulation setups and suites with simulation technicians and teaching fellows. We had some great impact in helping junior doctors and high-level clinical teams rehearse and practice for really big events. Sounds a little bit like some of the work that you have done, Naomi, in the past as well.

Naomi 5:16

Yeah, on a much bigger scale.

Nathan 5:19

It was an incredible adventure. And I got my master's of education while I was over there, focusing on simulation, and became an executive committee member of the Association of Simulated Practice in Healthcare and had the great privilege of co-directing the graduate certificate in simulation in the University of Edinburgh, doing a lot of faculty development through the Scottish Centre for Simulation and Clinical Human Factors. So my whole life has come around how we all can learn through simulation and debriefing. And I'll finish by saying, because man, I've just monologued, is getting on an aeroplane, we flew back to Australia three years ago, 2023. COVID and children and parents getting older made us think it's time to come back to Canberra. So I'm currently now the simulation convener at University of Canberra in the nursing school, looking to see what impact we can have in simulation across the Canberra region. And anyone who agrees with me that it could be a really helpful way to learn.

Naomi 6:14

Yeah.

Nathan 6:15

I want to say something spicy if people are reading up or carry Kolb around, which is it's a bit of an old way. 1984 was Kolb's thinking, other underpinnings that are really interesting in the way we all learn as clinicians and as humans. For example, this social cognitive piece, it goes a bit like this. We think that we have to learn by doing, because that's we've grown up thinking, oh, that's the way I learn, I have to do. And we do, we do, but in simulation and in the work that we do, just as a human experience, we also learn in community. It's a social practice. My students watching their buddy nurses and going, I don't maybe not do it today, but I watched them do it five times, and I think I'll either definitely do that or never do it. In simulation, we have the ability to replicate elements of an event. We're not trying to make it real, we're just getting a little moment in time, and we're saying, look, imagine if this was a thing that happened. Let's work through it, let's do a thing. But even if people are watching, by engaging through reflection afterwards, we find that people are learning as a social piece rather than when is it my turn? That's important for our work because we've got a lot of people that need to be educated and always a resource challenge, don't we?

Naomi 7:33

Absolutely. Fab, we uh have some challenges for you, Nathan. We thought it would be really nice. A lot of our work is around how nurse leaders and managers actually support their teams, and part of that is through understanding their work, giving feedback, debriefing, coaching, all of those things. So we want to give you some scenarios, and we want you to let us know how you would unpack those. So, how would you debrief those? Because we think there's value in that for others that can take away from your experience. You've done lots of work in this space, you've had lots of experience, you've probably seen it go badly on occasion. So, we really want to hear how you would manage some of these scenarios and what we might draw from that for managers if that's okay.

Nathan 8:31

Oh, what a challenge. Sounds lovely. Let's go, let's let it go.

Naomi 8:35

Do you want to kick off the first one, Tubi?

Tubi 8:40

So you have a very capable but highly disruptive team member. So a nurse who's clinically strong, quite experienced, but are often dismissive of practice of junior staff, they're pretty resistant in simulation um experiences and they tend to shut down the feedback. And while the team looks up to them because they're very experienced, they also are a bit scared of them and feel a bit bruised by how they bring themselves to work and show up to work. So, in a simulation debrief, how would you manage this? What would you do?

Nathan 9:20

Yeah, wow. That's one of the big questions. When I'm working with people who are debriefers and we're talking about the really challenging moments in debriefing, those unexpected. Sometimes you can expect it if you know the team well and it's a very particular personality that you're painting. Often you don't. And you go in with the best will in the world, and something spicy like this jumps in. Yes, it's really difficult. My response would sit on a couple of things. For a debriefer, there's something about this idea of attunement, of which isn't necessarily an emotional picking up of the environment or the dynamics of the group. By looking around, even if you don't know the clinical team and you're in to do a simulation debrief, you do your work to look around and get an impression of who might be the boss here or who has a sense of social capital in this space right now. You also have an emotional reader of the room as you're trying to help foster this psychological safety in the space. Who is exhibiting signs, perhaps the micro-communication pieces of looking psychologically safe? They're quite engaged in their body language, they're nodding compared to uh a collection of people who might be exhibiting signs of being less comfortable in the space. They're notably muted, their body language is a bit shut down. And then obviously, the person we're talking about may or may not be actually the loudest person in the room. Have you ever found that? Um the disruptive force is sometimes a loud uh argumentative one, and sometimes it's the silent one in there, but all of their body language is is leaking from their pores, sort of this crossed off. Um, I'm not buying this moment. So there's something about reading, I think is my first point. And um, it's really tricky when you're simulation debriefing, unless you develop that little sort of level of understanding and expertise through your experience, because I've been surprised more often than I'd like to admit when I've gone, oh, I thought they were okay. It turns out they were not okay, and nor was anyone around them. So feeling it is the first piece. The second piece is like speaking to it. The way I've worked with these types of situations in the past are twofold in the moment, an unexpected moment for me. I'm learning as a debriefer that I need to model for our groups together this thing of making the implicit explicit. There's many unsaid things that could be happening in the debrief that people are all thinking, but nobody saying, and I'm not being the sage on the stage who knows it all. I'm being the guide on the side who's asking questions. But a power that I have is I can model and I can say something like, and Naomi, I'm not making you this person, but for the purposes of this, I'm making you this person. Bring it up. I can be that person very well. Yeah, wow. I could say something like, I can't help it. I'm look, can I just say what I'm noticing? I'm noticing there seems to be a little bit of tension about that last scenario. And Naomi, I'm you I noticed that you am I feeling that you didn't really buy into that much. I wonder if you're feeling okay. Are you doing okay? If everybody in the room knows that something's happening by making the implicit explicit, we can nip it in the bug rather than carry a 30-minute debrief. Yeah. Sometimes afterwards or beforehand. And especially in simulation where there's some simulation programs where everybody is desperate to be there, loves it, and has signed up to be there. And there's other simulation programs where there's one or two people who have bad experiences with sim. If we're talking about simulation, they've been harshly judged, they've not had a good experience, they don't want to be there. Sometimes it's remedial. Their manager has told them you've been having an issue. Your sentence is you have to go to that simulation. I know as a debriefer, if someone's like that, it's really unlikely that I have some magic source that's going to bring them around. But I can speak to them in private afterwards if I can't catch it beforehand. I can come alongside them. My job isn't to antagonize as a facilitator. Feel the room is my first kind of point on the spicy challenge of which Naomi was the source. And the second is try to make the implicit explicit. We can be doing that as nurse managers all over the place, can't we? In our group conversations, in our team-based meetings, and when we've got some challenging team members. Totally.

Tubi 13:50

We were lucky enough to interview Renee Thompson. Oh, yeah, yeah, yeah, yeah. And um that that was one of the things she says is you've you've got to be aware of it. So you've got to be aware and awake, and then you need to notice it verbally to the person and be prepared to do that. And I think it's really key, certainly as a facilitator. I facilitate a lot of leadership workshops and other things, it but even as a coach, you have to pick up on it. So you've got to be looking and and as you said, tuning in, and then you need to verbalize it. So yeah, I love it. Very transferable skills.

Naomi 14:29

Yeah, they are fascinating in simulation and even other workshops, you've actually got a really clear view of the participant group, those people that are behaving poorly, and have got that, they're pissed off that they're there, they don't want to be there, their arms are folded, the whole thing. It's really obvious. Another thing that really stands out in that is when you call it out early, they either stop very quickly, and the change that you see is immediate, and the group see it immediately, or they escalate and will often take themselves out. They'll actually go, Do you know what? I don't want to be here. Happy days, fun by me. Um, but it the being able to see the impact of calling it out is so clear in that environment, in the clinical space that gets lost, right? Because they can go and hide in other things, or they get caught up in the other activity, or you as the manager or leader get caught up with other work, but in this space it's so visible. Yeah. So I that was a great example. Yeah.

Nathan 15:41

I'd offer this though as a connection piece, is there's a little bit of group first aid that may be required when that's all happening because this psychological safety is a very fragile tapestry. There's a bit of an art and a science perhaps in doing the speaking out behaviour in a way that's less adversarial, but also making a stand on behalf of the health of the group. And I imagine, in that circumstance you just mentioned, Naomi, should that participant say, Look, you know what, this isn't for me, and leave, there'll be a residual tension, there'll be a tear, and then there's further speaking out, there's further explicit conversation that I might do as a debriefer to call that out too. Maybe using a bit of humor if it's appropriate, maybe not for the first little bit, but certainly I'm noticing I'm feeling a bit tense. Should we just take a deep breath? I'm okay, you're okay, I hope our friend is okay. We want to reduce some repairing.

Tubi 16:36

We're both um trained in using something called the emotional culture deck. And with that training comes a lot of reading of articles about the impact of emotions and how emotions drive behavior and how they determine what we pay attention to, what we learn, what we remember, how we make decisions and other things, but they're all relevant to that simulation scenario as well. You know, what what is that person feeling who's sitting there with their arms crossed and that um what are the other people feeling witnessing that? What's the emotional contagion in the group that's happening? That is the facilitator, you have some um, I guess, responsibility to attend to, however, you might do that, um, when they're there and if they choose to go as well, there's there's that level of responsibility to to normalize, you know, what people are feeling is you know, it's not always within their control and it can influence how they learn, and we've got to be in a good space to learn.

Nathan 19:24

Wow. I haven't heard of that emotional, what did you call it?

Speaker 19:28

Emotional culture deck.

Nathan 19:30

Culture deck. Yeah, I don't look, um, I'm just a guest at the podcast, but if you were to put a link to that in the podcast notes, I would certainly pick that up. Yeah, I'll be reading that. I'm thoughtful about the way debriefers develop their expertise. That's what I'm doing my PhD on. It's more than just many faculty development programs, and sim absolutely do great in teaching. Here's a structured debriefing model and here's a style of questions you can ask, but is less confident or capable at doing some of the other work of debriefing development, like this emotional picking up and how to manage unexpected circumstances.

Tubi 20:09

And even prepping with what do I want the people participating in the simulation to feel and not feel but they might, and what actions can I take to help them feel more of what they want to feel and manage and cope if they're feeling what I don't want them to feel, because I want them to have the best possible learning experience, and that's always going to be part of it.

Nathan 20:30

Absolutely. And for somebody, to be who mentioned that you haven't done heaps of simulation for a bit, you're reading off the simulation faculty hymnal with the power of the pre-brief and the time that we will take to try and not only think about it, but situate the learners before the simulation ever happens so that we're in that space together.

Naomi 20:52

Yeah, beautiful. So I'm gonna take you back to a potentially fraught state. Uh, but I'm gonna ask you to look after a graduate nurse uh who's performing, has been kind of performing relatively well in that routine work, uh, but you're aware that there's been some emergency situations that um that he hasn't coped with. Are you running a couple of simulations and he becomes visible um and you're starting to worry about you know are they suited to the role? How are you gonna tell the difference between a lack of capability and being overloaded um with stress and anxiety? How do you how are you gonna unpack that?

Nathan 21:44

Yeah, wow. Yeah, that's uh you guys don't ask like questions.

Speaker 21:50

We're like pet deep quick. No, we're in there.

Nathan 21:55

Uh well, uh what would I say? Not everybody is suited to every piece of work ever. Everybody's different, amazing. There's no easy way of telling what lies underneath the deep waters of where someone's at. Some things that I do hold if going into that type of conversation would be to try and understand the other person's frame. I know that yourselves and your listeners might be aware of Jenny Rudolph, who brought that idea from psychology into simulation world at least, that looking for someone else's frame, I know that I'm seeing that my graduate nurse really struggle in those emergency situations whilst being good at routine moments. But I don't know why. And the only way I'm actually going to know isn't by making assumptions, which can be the great risk of nurse leaders giving feedback. We know what we see, we don't know why it's occurring, and rather than spending the time asking, insight generating, probing, genuinely curious questions, we rather say you are fine at the routine, you keep stressing out, study harder about this area and be better by this certain date, or it's going down a HR route or something like this. There could be a plethora of things happening. But I'm mindful of this, I like to acknowledge this. You ask a diagnostic question, I'm gonna respond for a moment in a different way. In my met nurse days, in doesn't have to be nursing, could be anywhere, but when the non-routine occurs, when the emergency occurs, when you walk into the room, you'd like to believe that in that moment you are going to just scale the heights and be the nurse that everybody always talks about. You're just gonna accomplish it. But the reality is when adrenaline starts to be secreted from your adrenal glands and starts to do the things that fight, flight do, you're not gonna do that. For example, here's the thing when you're on the road it this week and somebody, a car cuts you off or beeps or something like this, you're statistically much more likely to have a car accident within the subsequent five or so minutes because your adrenaline's gone, you're not thinking as clearly anymore. So, our new grad, a part of the story may be in these emergency moments, it may be the I don't know what to do with my stress in that adrenaline secreting moment. We don't rise to our aspirations, is the end of the adage. We lower to our level of training. We lower to that space. There's something about doing some diagnostic pieces. Should the person's attitude be for the job and passion be for the job, and they're here to learn and they want to grow and they have the internal impetus, the growth mindset, which I can't overstate enough, under whichever state you can do. Then my diagnostic piece is are we talking about a knowledge gap in the moment? It's not with you. Are we talking about a skills gap? The knowledge is there, but you don't know how to operate with communication skills or psychomotor skills. Is it a drills gap? There's a paper that I was a part of in Scotland that talks about knowledge skills, drills, and performance. By drills here I mean a sequence of skills, like an ALS algorithm or an anaphylaxis algorithm, and they're all built from sequential kind of skills that you need to get in a row and you're just going to have it in your muscle memory. A new grad will still only be able to do that if they did their training. But only if it's recent until this new grad now, again, let's assume that he has a growth mindset and he wants to develop and grow. I might suggest that if we've covered all the knowledge, skills, and drills moments of the things that he feels like he's lacking through simulation or through coaching or through feedback or workplace support, then there's something about getting some things in your head and rehearsing mentally. Mental rehearsal is massive. They do it in athletics, in aviation, for some reason in healthcare. We don't prioritize that or we don't make it explicit. But when that pager goes off and you're a Met nurse, many Met nurses, they're marching up to the ward, they're not thinking about what they're gonna have for lunch that day. They're going, A for airway. When I walk in the room, I'm just gonna walk in, I'm gonna assess that airway. And then I'm gonna go to brick, and they're just mentally rehearsing. And our new grad nurse would do well once all of those sequencing has been accomplished to just get good at mental rehearsal.

Naomi 26:16

I can't tell you my name when the pager goes off.

Nathan 26:21

Yeah, it doesn't matter how experienced you are, when it goes off, you go.

Tubi 26:27

What's the favorite, what's a question you find yourself coming back to time and time again when you're um debriefing a simulation where it is a bit tricky, maybe like one of the scenarios we've proposed. What's a question that you find yourself coming back to?

Nathan 26:42

Well, I love that. That's a great question. Um before I ask any question, I need to do exactly as you've just said. I need to do a little bit of an assessment of myself because I'm I feel like the most prone person on earth to make assumptions. It's the easiest thing in the world, and I need to consistently as I debrief check myself moment to moment to stay curious. And so that before I ask any question, and with experience, you can do this quicker and quicker, I think. I go to a what is my thought process genuinely and the question about to ask, is it genuinely curious or is it fake curious? If it's fake, it doesn't take long before the group smell a rat. They smell the the inauthenticity of the question, and you're doing something corrosive to this psychological safety where people can speak up. So it's got to be genuinely curious. It almost doesn't matter what question you ask if it comes from a genuinely curious space where you're holding someone in positive regard anyway. I want to do a PhD on debriefing by eyebrows. I don't know if your listeners have video, but it's do you think it's true? Like you could ask. Um, so in the room during the emergency, you seem to be still for a really long time. What were you thinking? And I could say that with a frown, if we're listening audiobly, or I could do the whole thing, and you'll there'll be a tone difference. But it's something like I'm in the room, new red nurse of mine, when the emergency happened and you seem to be still for a while. What was going through your mind at that time? Uh there's a different tone, there's a different cadence to it, and there's one's a genuine, what were you doing? I actually know what you were doing, and I want you to own it for me. I want you to guess what's in my head and tell me. And the other is the conversation we can we'll have could be any number of conversations. I just would love to know what's going on for you. It might be anxiety, in which case let's do the knowledge skills drills and let's rehearse. It might be I got yelled at before I came in by the charge nurse and said, stand in the corner and just watch. So I was standing there not knowing what to do. I have one story. In the UK, we had a simulation one time, and the point of the simulation with these junior doctors was the simulated patient in the bed space. There'd be an accidental double dose of a medication, and it was going to require the patient to have a prolonged stay in hospital. The learning behind the scenario was to help junior doctors rehearse having some candor with the patient, being honest with the patient, expressing saying sorry. We actually deliberately built the scenario to be one of these Swiss cheese models of failure where an earlier doctor had prescribed it not quite right, and then the nurse hadn't really questioned it and given something. The Swiss cheese model, we're not throwing anyone under the bus, but it was for the junior doctor to own it, and it was for the junior doctor say, I'm so sorry this happened to you. Now here's the thing that happened in the scenario was no matter how we prompted and moved the scenario to try and see that behavior happen, this doctor would not apologize. They were polite, they were open, but they wouldn't apologize. The simulated patient was staying in an escalated emotional state to try and bring them. It wasn't happening. We ended up ending the scenario, that's okay. We thought we can debrief through it. Now, here's the thing: if in the debrief we were letting our assumptions run wild, in our heads and our listeners' heads, you might already have the type of doctor that you could probably imagine in your head, the agenda. You can have all these assumptions about the type of person, the type of clinician, the type of discipline that is less likely to apologize. But we didn't want to lead with assumption, that's just not the way we operate. So we asked, in that scenario, there was about five or six minutes where the patient was seemed really upset. And I noticed that you were holding back. And I'm wondering what was going through your mind when you were trying to navigate that. He said, Here's what happened. When I was a medical student, we went on a medical ward round, and something terrible had happened to a particular patient. The ward round was all happening, and they were telling the group what happened. And when they finished telling the group, I said, said the medical student, Oh man, I'm so sorry. I'm so sorry about that. Drop a pin, it was really awkward, he said. And afterwards, the consultant removed him from the ward round and said, Do not ever apologize in front of my patients ever again. It's not our fault. We're not here to be sued by anything like this. Do not ever do it. That medical student then graduated and spent two years of practice not knowing if and how and whether it's appropriate to apologize because of that burnt memory from that one piece of feedback. And it was only in that debrief that we were able to talk to the real thing, which is if you're worried about legal proceedings in the UK, apologies, apologies isn't owning that moment anyway, but from a more human perspective, there's something powerful about the apologies.

Naomi 31:43

I'm really curious if you've got a tip for educators that are stepping into an educator role. What piece of gold would you give to them? What thing do they need to be able to do, or what mindset do they need to have to be good educators?

Nathan 32:03

Oh, that's a beautiful question. My response might be mildly controversial, and I don't mean it to be, but they also make for the funnest things to think about afterwards. Are you ready? Here's my mildly controversial. As an educator, we have content that we want to transmit, transfer to our learning group so that they can be successful and fruitful and whatever they want. So we put content as king, but I'm gonna challenge the status quo by offering that without relationship, that content's not gonna go anywhere. So often, and I say this carefully, all the things like rapport and trust and safety, I'll prioritize all of those things in my stance as an educator above the content.

Naomi 32:53

I love that answer. That is so.

Tubi 33:58

When actually I'm just gonna go to some work by Rachel Naomi Reman, who I'm not sure if you've heard of her work. She's got a book, a couple of books, but um one is Kitchen Table Wisdom and what she talks about, but she's also got an essay which we could probably share in the in the link. And it's about are you fixing, helping, or serving? And when you're serving, you're bringing your whole self, your darkness, your light, your knowledge, your gaps in knowledge. Um, because you're coming as human to human. When you're coming to fix, then there's a deficit in the other person that you wow.

Nathan 34:36

That's actually very beautiful. I'd I'll re I'll when you put that in the notes, I'll be clicking that link and listening as well. The cognitive load of many of these learning conversations of facilitating these is absolutely heavy. There's evidence to show how heavy a cognitive load it is when you're trying to think about what am I reading or what's happening, or uh, where's this conversation going? How am I going to get to that frame? There's all of this stuff that you're trying to do simultaneously. And certainly, novice, all the way through, I'm a bit lost in all of this weeds. And to people in that moment, I'd want to reassure with this idea of relationship, Trumps content, which is your group, your team, your the person across the will forgive your clumsiest questions, your biggest guess what I'm thinkings and accidental judgment laden questions, if they know and trust you. Conversely, if they don't, man, that you're probably not going to get the best out of the conversation or the learning anyway. This has been lovely. What a lovely conversation. I feel all filled up and could talk for hours of all of these things. One good way to land, perhaps, would be I'm doing a lot of thinking about this PhD on how we can get better at doing these conversations. I so appreciate how we've been expanding it around simulation, but what it means to all of us, regardless of context. Debriefing and these types of conversations, a skill set, like many skill sets, are complex as well. And we've talked about mental rehearsal and all these other ways that we want to act clinically, but it's the same with these kinds of conversations. If you could go to a wonderful faculty development workshop in debriefing and you could use it once, you'll never really catch some of the things that I think we've been talking about here, like you will by doing it and rehearsing. And what I found is I need to I subject my own practice in this way and the practice of colleagues around me to in simulation. People get really nervous when they go into a room and they're exposed amongst their peers and people that they respect, they're going to watch them in a room and either manage or not manage as well as they would like to. And we say it's okay, it's safe, it's for your learning, let's all just learn together. I therefore say for us as communicators, as nurse managers or debriefers, that I think we should put ourselves through the same experience by in seeking to get better at this. We do a lot of work around in my networks in playing back scenarios, play back pieces of footage of our debriefs, and we really debrief these debriefs to interrogate them and go, what can we all be learning together about how we do these conversations even more effectively? So the thing I'd love all of our listeners to really take and run with is even in the stuff that we've talked about today, there's never a settle-forget in any practice that we do, is there? Something about if you're committed to it, push yourself into that slight, uncomfortable space because that's where you grow and watch yourself thrive as you keep putting yourself through it. Like me trying to learn to be a nurse. Let's just keep turning up so that we get better at what we do.

Tubi 37:40

Yeah, I I love ending on that because it's really is the spirit of our podcast, too, actually. So it's a beautiful place to end. We're all doing the best we can, and when we know better, we can do better. And sometimes we need to be shown lots of times before we know better. And that's okay. We're all learning together. I totally agree with you. None of us is tick the box of human development.

Nathan 38:08

Thank you. Oh, it's been lovely talking to you. Thank you for having me. What a great conversation this has been.

Introduction 38:18

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