Telluride East Final Reflections: Never Stop Improving

When I began medical school, my academic mentor advised me to be cognizant of when the more experienced would drop pearls of wisdom.  Well during these past 4 days it’s been raining pearls.  After trying to absorb so much knowledge, my brain feels like an overfilled suitcase with a weak zipper; it’s about to burst.   And therein may actually lie a problem.  To those with less clinical and formal patient safety experience, Telluride covers too much information in too little time.  Many of the activities and discussions felt rushed.  Here I present an open, honest critique of the Telluride program and make suggestions for improvement.

I will focus on 3 observations: 1) The negotiations, listening and human factors lectures were some of the best received, 2) Group exercises/games are highly beneficial and are worth the time expense, 3) People felt that there was not enough time for discussion.

Telluride promotes discussion between those of vastly different disciplines and experience levels.  The benefit is the plethora of viewpoints from the resulting diversity.  However, the challenge is creating lectures that can be informative for such a diverse audience.  Many of the experienced nurses were already well-versed in tools and  concepts such as SBAR, TeamSTEPPS, Just Culture, etc.  Therefore, although I as a medical student was overwhelmed with information, this was just review for many others.  The lectures that garnered universal interest, due to their novelty to all parties, were the non-clinical lectures.  I heard both the inexperienced and the experienced alike wishing they could have heard more of or done more activities with the negotiations, listening and human factors lecture.  Going along with this, there was unanimous praise for the efficacy and utility of the exercises done in Telluride such as the dominoes and see-saw.  Although activities such as these are time expensive, they are fun, and more importantly, effectively get the message across.  There should be more of these exercises.  One suggestion for a listening and retention exercise would be to have one person explain a very abstract topic, such as computer algorithms, to another and see the amount of retention.  This would model the feelings of a health illiterate patient listening to medical jargon.  Finally, several felt that there was insufficient time given to discussion.  This may have been due to incorrect expectations of what is Telluride.  A couple students had voiced that they expected Telluride to be more of a think-tank and were excited to brainstorm and interact closely with such titans of patient safety.  Instead they felt that this was too focused on didactic lecture.

Based on these observations here are my suggestions for improvements.  First devote each morning to a single topic.  For example one morning for negotiations, the next for human factors and the next for listening.  With each didactic lecture include 2 – 3 activities/games for each topic (like a dominoes, see-saw, parker-gibson, etc.).  Then save the entire afternoon for small group (~7 people) discussions devoted to brainstorming solutions to a selected patient safety issue (informed consent, decreasing central line infections, patient call buttons, etc.). Ideally within each group would be at least one person not from healthcare that has suffered an adverse event.  Finally end the day with each group sharing their proposed solutions or progress with the rest of the groups and opening the floor to comments.  These problem specific discussions have several advantages: 1) Allows for close faculty, student interaction, 2) It gives something specific and concrete that people can take away from the conference and work on.  This is especially important for the students who need some guidance as to a specific area to focus on in the vast realm of patient safety.  3) Finally the research collaborations that stem from these discussion ensure continued communication between various Telluride scholars.

Telluride has been one of the best learning experiences I’ve ever had.  I just hope these comments will be able to further improve upon the awesomeness which is the Telluride experience.


Accomplishments, Negotiations and Dominoes

I am sitting in this room and I can’t help but think, “Oh crap, what did I get myself into.”  We all had been asked to introduce one other selected individual.  The lists of accomplishments and accolades accrued by the other Telluride scholars sat over their heads like 5 foot top hats.  In contrast, as a very green MS2, my head looked pretty bald, maybe covered by a flat cap.  Traditionally I would just shut up and try to steal the wisps of wisdom that they utter.  Upon conversing with these illustrious men and women however, I was struck by their humility.  These people were really listening to what I have to say, as if we were on even playing fields!  Truly a testament to the unassuming, non-judgemental nature which is Telluride.

“I cannot believe you played an X!”  The objective: Win as much as you can.  The rules: each player (4 total) can play an X or a Y, every combination of X and Y will result in Y losing points except when everyone plays Y (everyone wins) or when everyone plays X (everyone loses).  With the ability to negotiate prior to playing our hand we thought we agreed upon all playing Y’s.  We trusted that no one would stray.  But when someone did, the trust was destroyed.  There was no more cooperation and discussion.  From then on, invariably, we all played X’s, and as a result, we all lost.  Distrust casts a deep shadow.  One bad apple ruins the bunch.

It has all the makings of a good family game night activity: build a configuration of dominoes in under five minutes with only verbal instructions to guide you.  To say it crassly, we all kind of sucked at it.  Rarely did a group manage to achieve a perfect configuration.  Most were happy with 75-80% accuracy.  This would be haha funny except when you remember that similar if not more complicated verbal instructions are being tossed around hospitals all the time.  That statistic does not pass the mother test.  I would not trust 75% communication if my mom’s life was on the line.

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