Is general practice being called the toilet bowl of medicine such a bad thing?

A couple of days ago, I heard someone describe general practice as “the toilet bowl of medicine”.

It was not meant to be complimentary.  However, on reflection, perhaps using such a statement to denigrate general practice is instead betraying an underappreciation of toilet bowls.

Like in a general practice consultation, what happens behind a closed toilet door is generally private, personal, and absolutely essential to health and wellbeing. Subtle and not-so-subtle signs of disease can be revealed.  Toilet visits can be quick and routine, or they can be long and troubled.  Those with good health and busy lives often don’t give toilets much thought, but expect them to be conveniently located and available when the need arises.  For others, toilet access is always front of mind, sometimes dictating how they live their lives.

Importantly, having an adequate number and distribution of well-functioning toilet bowls is vital to keep communities healthy including preventing and/or managing disease outbreaks.

Like ‘I’m more like herpes than Ebola’, I don’t think “General practice – the toilet bowl of medicine” is a rallying cry which will (or should!) catch on.

However, I believe we need to remind politicians, bureaucrats and our esteemed health practitioner colleagues, that although general practice may not be the sexiest of the medical professions, like sanitation, it is absolutely vital that all Australians have ready and affordable access to properly funded, maintained and supported services.  Without prioritising both general practice and toilet bowls, Australian society is going end up in the poo.

A deeply personal experience of post-traumatic growth: “Just a GP” Podcast

A few days ago, I was lucky enough to sit down, “virtually”, with three passionate and innovative doctors (Ashlea Broomfield, Charlotte Hespe and Rebekah Hoffman) as a guest on their fabulous new podcast “Just a GP”.

They asked me on the show to talk about how personal tragedy has affected me – as a doctor and in other aspects of my life.  It is a heavy topic; a topic society doesn’t much talk about.  I felt privileged to have the opportunity to address it, difficult as it was to speak about.

I spoke about post-traumatic growth – the idea that positive psychological change can occur as a result of adversity.  This is different to resilience, which is about how quickly and completely you “bounce back”. The difference between resilience and thriving is the recovery point – thriving goes above and beyond resilience, and involves benefiting from challenges. It is about finding meaning in the seemingly meaningless.

Post-traumatic growth should not be thought of as “getting over” grief.  You don’t get over grief – you absorb, adjust and accept it. You find a new normal, changed forever.

Not everyone is a fan of “post-traumatic growth” as a concept. Some believe it to be “motivated positive illusion” whose purpose is to protect us from the possibility that we may have been damaged.  If I’m happy and at peace just because I’m deluded, I honestly don’t mind – it works for me. 🙂

Whether you believe that people can become psychologically stronger after adversity or not, I do hope you enjoy the podcast, and that the tips I give about supporting others who are grieving will be of use.

You can’t go back in time and make all the bits of your life pretty, but you can move forward and make the whole picture beautiful.

Also available via the usual podcatchers.



“I’m more like herpes than Ebola” – spreading the message about driving fitness

Assessing to Drive teaching Sydney June 2017

Since my partner was hit and killed in 2015 by an unfit elderly driver, I’ve been on a mission to increase awareness of the importance of fitness to drive assessments by health professionals.

My YouTube video on assessing fitness to drive has not exactly gone viral but it does have over 6800 views, steadily building over time, being passed from one person to another.  Actually, it has gone “viral” in that respect , but more like herpes than Ebola! And like herpes, I hope the message sticks with those who watch it, quietly sitting in the background and then making its presence known now and then, such as when they have to do a driving assessment on an elderly driver.   I’m not sure that the phrase “I’d rather be herpes than Ebola” will ever take off, but it works for me.

I’m very grateful for the opportunities afforded to me to speak in person at educational sessions, especially sessions run by GP regional training organisations including GP Synergy, EV GP Training, Murray City Country Coast GP Training and Generalist Medical Training.

I was particularly delighted to be a guest on the wonderful GP Show podcast with Sam Manger, on which I shared practical tips for GPs on how to approach driving fitness.

I was also interviewed on the RACP’s Pomegranate podcast series:

Nothing can bring the love of my life back. But if sharing our story indirectly results in one fewer person being injured by an unfit driver, at least some good has come out of this senseless tragedy.

Dr Viktor  Frankl an Austrian neurologist and psychiatrist who survived the Holocaust, expoused the importance of finding meaning in terrible circumstances. He said “In some way, suffering ceases to be suffering at the moment it finds a meaning.”

Much as putting our story out there has been hard, knowing that it could possibly save someone else’s loved one has made it worthwhile.  And I’m so grateful to the many doctors who have told me that it has changed the way they approach fitness to drive assessments.

Remember, driving is a privilege, not a right.

IMReasoning – a brilliant podcast on clinical reasoning and great KFP study resource

imreasoningI don’t often give unsolicited plugs for FOAMed resources but felt I needed to share my delight at having recently discovered the IMReasoning podcast. It is the creation of two internal medicine physicians, Dr. Art Nahill and Dr. Nic Szecket, working in Auckland and is described as “Conversations to inspire critical thinking in clinical medicine and education”.  I have binge listened my way through most of the episodes and thoroughly enjoyed them all.  They have found the sweet spot – demonstrating a near perfect balance between the informative and authoritative, and the entertaining and self-deprecating.

While relevant and helpful to us all, I think it is particularly of value to those intending to sit the FRACGP Key Feature Problems (KFP) exam for the first time, and for those who plan to re-sit.  It is also a “must” for supervisors and medical educators trying to develop clinical reasoning skills in their learners.

The KFP exam is designed specifically to test clinical reasoning.  It tends to have high failure rates and many candidates find it the hardest of the three Fellowship exams to get through.

As an RACGP State Censor, one of my jobs is to give feedback to failed candidates. While exam technique and knowledge gaps are undoubtedly factors for many, time and time again I see doctors with good clinical knowledge but poor clinical reasoning (memorisers, not thinkers).   They tend to find it difficult to assess patients in the context of the scenario given and to identify the key features/critical steps.

I think this podcast might help people better understand what the KFP is about. From here on in I intend to recommend the IMReasoning podcast as a KFP study plan essential.

You can find it at  and it is also available to download via iTunes.

I recommend starting from the beginning as the episodes build on each other.

In Episode 31: Stump the Chumps International with Genevieve Yates, I present a case for Art and Nic, attempting to “Stump the Chumps” with a very GP-type case. I chose the case because it illustrates some of the clinical reasoning and management challenges when assessing and managing some of the more complex primary care patients. (Spoiler alert – there isn’t a glorious diagnostic prize revealed or a great “ah ha” moment”).


Open letter to OSCE candidates

The below is a copy of an open letter sent to all 2016.2 OSCE candidates today. It was written by the RACGP National Assessment Advisor, Dr Guan Yeo. I’m posting it here as it is one of the best OCSE tip summaries I’ve seen, containing many a gem, and will hopefully be helpful to future OSCE candidates also, when they start to prepare for this last FRACGP exam hurdle.

You can find other OSCE related posts here, here and here. My YouTube channel  has links to various physical examination clips and other videos which might also help in OSCE preparation.

Dear candidate,

How are you progressing in your preparation for the Objective Structured Clinical Exam (OSCE)?

By now I expect you have your regular small-group timed roleplay sessions up and running. Improving your performance in the rating areas that apply across multiple OSCE stations is a good way to maximise your chances of success.

Use this quick list to check your performance, eg.:

Rating areas Some features of good performance
Communication and rapport Patient centred? Empathic? Patient expectations? Simple language explanations?
History General and focussed questions? Orderly? Demonstrates safe diagnostic strategy? (Murtagh)?
Physical exam Hand hygiene? Explains and is considerate of patient comfort? Orderly? Gives positive findings and significant negatives?
Investigations Prioritised? Staged – initial and later Investigations? Differentiates between your differential diagnoses?
Management Prioritised? Considered patient supports? What does the patient think/understand? What are the obstacles (eg. to behaviour change)? Safety-netting?
It is time to critically review your clinical experience and familiarity with conditions represented in the ICPC2 groupings, e.g. women’s health, mental health, musculoskeletal, ENT, etc. Study up now on the common presentations in your areas of weaknesses: How do they present? What history or examination do you target? How do you prioritise investigation? How do you manage – short term and longer term, explanations, drugs and non-drugs, again prioritisation.

Finally, hopefully you have already booked in for a trial exam. This is often useful to ‘polish-up’ your preparation.

To use your time effectively during the exam consider the following:

  • In the three minute reading time, do read the instructions line by line. Some nervous candidates miss entire lines as they read. It can be helpful to put your finger against each line as you read – it is simple, may sound silly, but it works. You don’t have to memorise – there is the same set of instructions on the desk inside the station.
  • When in the station, if you are nervous, it is easy to miss visual cues. So if eye contact is not your strong point, train yourself to look regularly at the ‘patient’.
  • Use the time at rest stations wisely. Besides toilet breaks and drinks of water, regroup your thoughts, use short meditative exercises/mindfulness, focus, and regain your composure in readiness for the next station. Avoid dwelling on previous cases as that won’t improve your scores, but rather prepare yourself mentally for the remaining stations.

I hope that you have found this information useful and I wish you well in the OSCE.

Dr Guan Yeo
National Assessment Advisor OSCE

General Practice – a strong-link or a weak-link profession?

Not long ago I ran into a recently Fellowed GP whom I’d had the pleasure of supervising as a medical student several years ago.  She was exceptional – bright, keen and an amazing communicator who just “got it”.  During her time with me she joined in with my group registrar teaching and exam prep workshops (AKT/KFP and OSCE).  In the mock OSCE she did better than most of the registrars who were about to sit their Fellowship exams.  After three weeks in general practice (as a student) and a two hour session on what the AKT and KFP were about, she passed both written practice exams (which were shorter than but of a similar standard to the real thing).  Mind you, she wasn’t perfect – there were gaps in her knowledge, and nothing can replace clinical experience, but she was safe.  She knew what she didn’t know.  She knew how to find out.  She was a fantastically self-directed learner.

Fast forward the present day.  I asked her how she found GP training, which she had done with a now-defunct RTP.  She started with some generically nice comments but on my drilling down further she admitted that although it was great socially, the education program didn’t really challenge her and she felt it was, in essence, an exercise in box-ticking.

There are certainly many bright registrars who are extended and challenged during GP registrar training,  but she got me thinking, are we going about this the right way?

The “best and the brightest” are chosen for AGPT training.  Meanwhile, there are large numbers of general practice trainees who are working essentially unsupervised and unsupported.  Some of these have gone down this route by choice; however many are doing so because they are either ineligible for AGPT (usually due to their residency/registration status) or failed to get into the AGPT program.  There are some fabulous GPs amongst them, but there are also many that struggle, both in practice and with their Fellowship exams.  The support for these doctors just isn’t there.

While pondering this inequity, I was reminded of a podcast to which I’d recently listened.  It discussed the difference between weak- and strong-link sports.

soccerIn soccer, research shows that the way to maximize wins is to improve the worst players.  Success typically comes to those teams who have better 9th, 10th, and 11th players rather than those who have the best player.  It is argued that this is due to the nature of the sport, being that one player typically cannot create opportunities alone.  Thus it makes sense to invest in making the least talented players better.  Soccer is a weak-link sport for this reason.

basketballAlternatively, basketball is a strong-link sport.  Typically, the team with the best player wins.  It’s a star-driven sport because one player can have an outsized impact on the game despite also having the worst player on the floor as a teammate.  It is nearly impossible to prevent a great player from getting the ball, and/or helping his/her team score.

The question this threw up for me is whether Australian General Practice is closer to soccer or basketball.  Should we spend more time and resources trying to create a climate that maximizes the number and the relative success of already really successful and talented doctors, or should we do more to help those who are unsuccessful?  Obviously both are important, but which approach best defines and strengthens our profession?

Personally, I think we should take the weak-link approach.

I hasten to add that I’m not advocating a drop in standards, nor a regression to the mean.  We will still have our GP stars, and these inspiring individuals will continue to do our profession proud.  They still need (and deserve) support during training.  My point is that their needs are different, and perhaps the standard AGPT program is somewhat wasted on them, or at the very least would be more useful for others.  I would like to see a more tailored approach.

I’m also not suggesting that any doctor, regardless of suitability, should be working in general practice, and supported to do so.  There should be, in my opinion, baseline competencies, knowledge and experience required – a cut-off point, so to speak, below which a GP provider number cannot be issued.  This would require everyone entering general practice, not just those applying for AGPT, to undergo a rigorous selection process perhaps including an entrance exam.

For those who have reached the required standard of entry, I would like to see the distribution and type of support based on the needs of individuals.  It would be fantastic if extra Commonwealth funding was put towards GP training, but that is unlikely to happen. However, I think we could do so much more with what we’ve got. There are limited resources available, but wouldn’t be wonderful to see quality training opportunities given to those potentially great GPs who have the most need for structured and supported training?

Pie in the sky thinking, but a girl can dream…

 (The views expressed are entirely my own and do not reflect those of my employers.)


The Life Cycle of an OSCE Case

Where did I come from imageI was asked recently, “So where do OSCE cases come from?  Who writes them and how do they get chosen for use in an exam?”

These are not uncommon questions. For many, the life cycle of an OSCE case seems to be a mysterious process, shrouded in secrecy.

It’s time we had the “Where did I come from?” talk…

It starts with a twinkle in an OSCE case writer’s eye, often during a patient consultation.  “This could be a good OSCE case,” the case writer muses, and from there, a case is conceived. It’s a long and complicated gestation, however, with no guaranteed delivery at the end.

OSCE case writers are neither a special breed nor an elitist group. They are a diverse mix of practising College Fellows from around the country, who are all experienced RACGP OSCE examiners specially trained in how to write OSCE cases, RACGP style.

Cases are based on real patients seen in the case writer’s own practice.  They are not derived from the rare and obscure conditions we all find so interesting, but from common and/or important presentations that competent Australian GPs are expected to be able to manage.

Taking care to de-identify the patient and to ensure that the issues involved are widely applicable to Australian GPs, the case writer creates a first draft using a standard RACGP case writing template.   With support and feedback from OSCE case reviewers, this initial draft may require considerable to-ing and fro-ing.

Once the first draft is complete, it gets formally reviewed by an OCSE medical educator (ME) and then road tested.  Yep, road tested.  Tried out by volunteer GPs who have not previously seen the case to see how it performs – which is not as much fun as taking a new car for a spin, in my opinion.  Essentially, these are people willing to do OSCE cases under exam-like conditions.  Some may call them dedicated, others may say masochistic, but everyone agrees that they are fulfilling an important role and helping make the OSCE better.

After the road test, the case goes through another round of review before moving to Standardisation. This is when a group of experienced OSCE examiners put its eyes on the case and marking scheme, suggests modifications if necessary, and decides on which aspects of the case (“Key Features”) are the most important.  These Key Features are then bolded to assist the OSCE examiners marking the case.

After all that, the case goes into the OSCE pool, vying for selection.  Unlike selection for the Australian Olympic Swimming Team which is, I’m guessing, based largely on swimming very fast in the right races, the selection of cases for the OSCE team is nuanced and complicated.  It is governed by the Exam Blueprint which takes into consideration many factors such as the General Practice curriculum, the frequency a condition is seen in general practice, and the importance of being able to diagnose and manage said condition.  This is why emergency presentations such as myocardial infarction occur more frequently in FRACGP exams than they are seen in a typical general practice.  They are uncommon, but you really need to get the diagnosis and management right when you see them.

The “team” of cases chosen for a particular exam needs to be balanced, so that a sufficiently broad spectrum of knowledge and skills is assessed. It may seem from the outside looking in that in some exams there are very similar cases, but even when the condition is the same, the different cases test different aspects, that is, the assessment tasks are different.

An OSCE case cannot rest on its laurels after selection for a particular exam. There is more scrutiny to come: firstly by an OSCE ME (a “fresh eyes” review) followed by the Assessment Panel Chairs (APCs), then the Quality Assurance (QA) examiners and finally the assigned examiners.  You would think by this stage there would be nothing left to review, but regardless of how many times a case is reviewed there can still be little typos or omissions which have slipped through the net.  Cases requiring last minute adjustments get “green sheets”, on which the changes are outlined for the case’s examiners.  Better to be green sheeted then yellow carded, but still, something to be avoided if possible, and with increased pre-exam reviews green sheet changes are getting fewer in number.

Finally the big day arrives and the OSCE case is role played in upwards of 45 rotations in approximately 15 exam centres around the country.

But it is still not over for an OSCE case.  Post exam, the examiners and QA examiners provide feedback on the case, and the statisticians work their numerical magic to see how it stacked up. If the case fell outside certain statistical parameters (e.g. discrimination index), it goes through a further review process.

After all that, we thank the case for its service by sticking it into quarantine for several exam cycles.

After being brought out of exile, it is updated, reviewed and road tested again before it is considered for use in another OSCE.

OSCE cases, like doctors, diet fads and mobile phones, don’t last forever. At some point, each case will need to come to terms with being pulled out of the pool.  After a bit of rehabilitation, the lucky ones will have a working retirement by being used for examiner training, mock OSCES and the like.  Others disappear, remaining only in the memory of those who tackled them on a long ago OSCE game day….

Such is the life journey of an OSCE case.


(First published in RACGP Queensland’s Examiners’ Newsletter, August 2016)

Dealing with the Known Unknowns

If patients want a GP with excellent theoretical knowledge, I recommend they seek out a GP who is about to sit, or has just sat, the Fellowship exams.  Breadth-of-knowledge-wise at least, for most of us, it is all downhill from there.

In my RACGP Censor role, I spend a lot of time working with GPs in the peri-exam phase of their careers.  I’m constantly impressed with how much “stuff” they know and find myself wondering where all the “stuff” I used to know has gone.  I’m not far past forty, so can’t blame age-related cognitive decline.  I did get a knock to my head which resulted in six facial fractures and temporal lobe contusions, but I passed my FRACGP OSCE exam three weeks later so it can’t have done me too much harm.

And yet here am I, constantly having to look up drug doses, item numbers, clinical guidelines and the anatomy of the facial nerve.  Sometimes I feel like I’m just an ignorant lump of carbon.  The human brain is an unfathomably complex and wondrous organ, but its data storage and retrieval capacities are beaten hands down by a $5 USB flash drive.

What I find most frustrating is that it’s not just the old facts which have slithered out of reach: it’s the newer information too.  I try to keep up.  I read.  I listen.  I discuss.  But some things just don’t stick.  I’ll read an article on the newest research findings regarding the pathophysiology of chronic kidney disease, for example, and think, “Yep, I get it.  Kidneys sometimes confuse me but this I understand.  I follow the logic from start to finish.”

It’s like a light bulb.  A light bulb which blows five minutes after I’ve closed the journal.  Nothing.  Ask me to explain a single pathological process and I would probably say something like, “Well it is to do with sodium and tubules… and umm… you know, it is a great article.  I can email you a link if you like.”

Now before you put in a concerned call to the Medical Board, let me assure you that I am a safe and competent doctor.  I’m pretty good at knowing what I don’t know, and just as importantly, knowing how to fill the gaps left by the information that sneaks out of my cranium after dark.  I can Google with the best of them and I’m adept at ‘phoning a friend’.

What’s helped me most in my quest for knowledge retention is teaching.  For me it is not a matter of “Those who can’t, teach”, but more a case of “If you don’t know it, teach it”.  I find that there is nothing as effective for memory-boosting as explaining to others, especially with the luxury of repetition.  By the third or fourth time of delivering a particular topic, the content is usually firmly cemented in my brain.

While it is all very affirming and enjoyable to teach what you know well, preparing for and then teaching things you don’t know much about is so much more valuable.  If you’re up for the challenge, combining an unfamiliar topic with a knowledgeable group is even better.  You can channel and feed off their combined wisdom, and practise your skill at deflecting or redirecting those tricky questions.

I may know less about more nowadays but I’m happier than I’ve ever been.  Perhaps ignorance is indeed bliss.

Luckily, there is a lot more to being a good GP than the instant recall of facts and figures.  For the pathophysiology of kidney disease you can always ask Dr Google, or GP who have just sat their RACGP exams.

RACGP Supervisors guide to assist your registrar in how to pass the FRACGP exams

Some wonderful tips from the brilliant Dr Rob Park (the below are personal views of Rob’s and not endorsed by the RACGP)


Doctor teaching

Where do we start?

 Is your registrar a little lost on where to start in studying for their RACGP exam?

What is your knowledge of the RACGP exams?

Did you sit them a long time ago?

Or have you simply blocked them out of your memory!

The idea of this article is to assist supervisors in understanding the RACGP exams, provide advice on ways to assist your registrar in preparing for their exams, and highlight materials which can be used in exam specific teaching sessions. A large amount of this information is available on the RACGP website; however this article is designed to give you a more rapid overview as we are all time poor and sometimes just need the key features!

What is involved in the RACGP exam?

The RACGP exam involves three sections:

  1. Applied knowledge test (AKT)(Think a multiple choice paper but based on applying clinical…

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How to pass the RACGP exams – Leela’s way

A very practical and useful post chock full of study tips by a recent successful exam sitter   (the below are personal views of Leela and not endorsed by the RACGP)


Screen Shot 2015-12-16 at 2.40.26 PM

Guest writer: Dr Leela is a GP registrar completing her training in Hervey Bay and will soon be returning to Brisbane with her wonderful family. She recently successfully completed her FRACGP exams.

“A few people have asked me for exam tips so here it is. Don’t take it as gospel. There are a hundred different ways to study and pass these exams, this is just my way.”

How long to study for?

I studied formally for about 6 months before the written exams, probably somewhere around the 10-20h per week depending on what else was going on; sometimes more and sometimes less. However, I’m possibly not the most efficient and tend to get distracted by Facebook way too easily. From my experience, how much you “need” to study is a very individual thing. I did pass well, and to be honest I probably could have done less study and still…

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Murtagh, a zebra and the elephant sat in your consultation room…


‘It would be so nice if something made sense for a change’- thought the doctor.

Just when you thought the start of the day couldn’t get any weirder, a ships captain arrived with a red flag, followed quickly by Sherlock Holmes, and Zorro. ‘Sorry we’re late’ they exclaim, ‘we’re ready to help you take on the day.’

Then Murtagh spoke up and suggested- ask yourself these 5 questions for the presenting problems today:

  1. What is the probability diagnosis?
  2. What serious disorder/s must not be missed?
  3. What conditions can be missed in this situation?
  4. Could the patient have one of the ‘masquerades’ commonly encountered?
  5. Is the patient trying to tell me something?

Before you point out Murtagh is sitting next to a zebra, you remember Dr Cox quoting Dr Theodore Woodward at JD:

And you remember that the top 30 reasons for encounter in General Practice make up 58.7% of presentations…

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Don’t just sign on the dotted line: assessing fitness to drive

Assessing Fitness to Drive teaching session Sydney June 2017

Since my partner died in July 2015, I’ve been trying to find things that are positive and helpful to make a very horrible situation feel a little less senseless. One of these is raising awareness of the dangers of unfit drivers on the road.

The RACGP 15 conference was on in Melbourne in September and as part of the focus on social media, members of the Facebook group, GPs Down Under, were encouraged to prepare a Pecha Kucha talk on a topic about which we felt passionate.  A Pecha Kucha is a 6min 40sec talk comprising of 20 slides, each lasting 20 seconds.

put together a talk to try to raise awareness of the importance of the doctor’s role in assessing our patients’ fitness to drive. I also talk about the valuable “virtual” support that can come from online communities.

While it was not easy to do (had to do a few practice runs before I could do it without bursting into tears), I hope that by sharing my personal story in this way, it will help
encourage other doctors to be more mindful.  This might just result, indirectly at least, in someone’s husband, wife or child being spared. Of course, I have no way of knowing if it will, but the thought of this being a possibility gives me comfort.

If you have a spare 400 secs, I would really appreciate you watching the talk, and sharing it with your friends and colleagues if you feel this is appropriate, to help me spread this important (to me at least) message.

For further information, the September 2015 edition of the Victorian Institute of Forensic Medicine Clinical Communique is devoted to Fitness to Drive. It goes through 3 Coronial cases and is an interesting and informative read.

And Avant published a great article with a cautionary tale in August 2015

My video was featured on the KevinMD blog

On doctorportal:

On Meducation:

And on the official Pecha Kucha website:

I was a guest on the GP Show speaking about Assessing Fitness to Drive in March 2018, on which I shared practical tips for GPs on how to approach driving fitness



Facilitation Tips for Medical Educators, July 2015

bored studentsSo my group teaching session didn’t go so well – what do I do now?

When planning a workshop session, there are many things that can cause worry:  “Will anyone come?”, “Will I remember what to say?”, “Will the IT work?”, “Will the room set-up be suitable?”, “Will the group be responsive and engaged?”, “Will they realise how little I actually know about this topic and turn on me?”  (maybe this last one is just relevant to me?) and on the list goes.

While adequate preparation can help minimise mishaps (try to remember the 6 P’s – “Prior Preparation Prevents Piss-Poor Performance”), it is not always enough.

Things can and do go wrong for a variety of reasons, and the longer you’re in this game, the more “failures” you’ll accumulate. I use the term “failure” loosely, not limited to completely disastrous sessions in which lives are lost or spirits are broken, but to include those “sub-optimal” workshops – the sessions which, afterwards, as a facilitator, you don’t experience a mixture of relief, pride and joy, but instead feel disappointed and/or inadequate.

So what can you do with those feelings?  How can you make failure work for you?

I was recently contacted by Dr Rob Park, a Queensland-based medical educator who was co-facilitating a workshop session on social media.  The session was being run twice, on two consecutive days.

He called me on the Saturday night after the first session had he felt there were things that could have been done differently to improve the session. Luckily, I don’t have a social life, so talking to Rob was not an imposition. On the contrary, it was the highlight of my evening (I’m such a ME nerd!).

Rob explained that the group was challenging because of a general lack of engagement and interaction, combined with some adversarial comments and questions towards the end of the session.  Not uncommon problems, especially when speaking on a topic like social media, in which levels of knowledge of interest and experience vary so widely, and on which strong opinions are often held.   Rob and his co-presenters have excellent knowledge, experience and oodles of street cred on this topic, and had presented sessions on this topic before, which is a huge advantage. The trick was going to be in finding effective ways to encourage audience engagement and manage the naysayers.

It is a relatively uncommon, but fantastic learning experience, to have the chance to re-run such a session within a day or so.

In my opinion, Rob approached this learning opportunity in exactly the right way, and, having obtained his permission, I’d like to share what he did with you….

  • He recognised that the approach and/or content hadn’t worked well for the particular group.
  • He considered that it may have just been a really difficult group to engage and inspire (there are “dud” groups with which, no matter how experienced or talented you are, you cannot make a session sparkle) and therefore did not take it too personally.
  • While not over-personalising, he did, however, realise that a different approach/es might have resulted in a more positive outcome, and might be worth trying when he re-ran the session the following day.
  • He actively sought advice as to what these different approaches might be by discussing with an experienced colleague (in this case, by phoning me). We talked through what had happened and brainstormed alternative strategies.
  • He then put thought into how he could integrate some of these different techniques into the session.
  • He put these changes into practice the next day.
  • After the second session went very well, he reflected on why this was so.
  • He acknowledged that it was a different group and so the difference in outcome couldn’t entirely be attributed to the new facilitation techniques, while realising that, chances were, they made a significant difference.
  • He intends to keep this experience in mind when planning future teaching sessions.

Of course, there is no formula which will work every time (and how boring would that be!), and different techniques will lend themselves to different topics, audiences, group sizes etc.

The tips that Rob and I discussed to try manage the kind of challenges he faced are outlined below:

For groups who you are concerned might be quiet/ disengaged:

Get everyone talking at the beginning – either in pairs/ small groups or going around the large group if the groups is not too big/ time permits (“everyone talks once before anyone talks twice”).  Usually best for the discussion to be on something relevant to the topic such as their experiences and/or what they want to get out of the session.

For groups who are likely to have different levels of experience/ learning needs, especially when you have some flexibility in content:

Ask participants the one thing they want to get out of the session at the start, and consider whiteboarding the list.  Address each one either:

1) with an immediate answer (if quick and easy, and not covered later) or,

2) by saying it will be coming up in the workshop or,

3) by acknowledging that it is outside the scope of the session (preferably with information as to where to go to get more information and/or offering to talk to the person at the end of the session about it).

If the list has been whiteboarded, refer to it as you go – I like ticking the items off as they are covered, and checking that each has been covered adequately with the person who brought up the item (if I can remember who said what!).

For topics/ groups in which you expect to get resistance/ challenge/ negativity:

Try to get this out at the start and acknowledge/address head on, rather than wait until participants start making disparaging remarks/ adversarial questions later on.

Try to neutralise with (appropriate) humour when you can (I find self-deprecatory humour works best in such situations)

Recruit other audience members to pull the negative audience members into line if you can – the message is usually much more powerful if it comes from their peers.

For example, if I get a particular negative/ unhelpful question/ anecdote, I’ll often ask the rest of the group – “So what do others think?” or “Have others had experiences like this, or have yours been different?”

While this can work well, you do need to be a bit careful with this approach. I have run into trouble a couple of times. Once, two participants nearly ended up in fisticuffs. Another time, a participant ran off in tears and hid in a supply closet after a response from another participant. Mostly, however, it works well, and when it doesn’t – see it as another valuable lesson to be learned.

In summary:

When a session falls flat, it is natural to feel disheartened. Luckily, unlike in our clinical work, bad outcomes as a facilitator are rarely serious in the scheme of things.  However, just like in our clinical work, when things go wrong, engaging in root cause analysis, debriefing, feedback and formulation of specific actions for improvement, can be incredibly useful strategies.

I’ve learned so much more from my failures than my successes, and I now love nothing more than a “challenging” group so I can pull out a few extra tools from my facilitator’s toolbox.  Failure is never fun, but it can be your educational friend.

Thanks to Rob for approaching me for advice on this in the first place and for encouraging me to share these tips as a blog post.

I would love to hear your thoughts, experiences and tips – please comment below.