July 2022 Communication Tip
Community of Practice
Happy New Academic Year. With July comes our new fellows, new housestaff, new students, new faculty and staff, new teams, and renewed hopes to keep doing better. In this month’s Communication Tip, I want to focus on how we can rely on each other to promote our serious illness communication skills.
I have written in this column frequently about the concept of practice – the work of improving our communication skills is one of ongoing effort, expanding our spectrum of communication comfort, trying out new skills, and literally practicing over and over again skills that are so important to improve but impossible to master.
To the idea of individual clinical practice, I want to add the concept of community. In our teams, our programs, our clinics, our meetings—all refreshed each July with new learners-- we have what can be called a “Community of Practice.” This concept was coined in 1991 by cognitive anthropologist Jean Lave and education theorist Etienne Wenger when they were studying apprenticeship as a learning model (https://wenger-trayner.com/introduction-to-communities-of-practice/). A community of practice is a group of people who “share a concern or a passion for something they do and learn how to do it better as they interact regularly.” A community of practice is like a “living curriculum” which benefits learners of all experience levels.
As communicators, we learn by watching and listening to our colleagues, in addition to reflecting on our own experiences. Our work as communicators in healthcare makes us a community of practice that includes its three defining characteristics:
- A shared domain of interest. It’s not just that we all work at UCSF; as communicators in healthcare, we have “an identity defined by a shared domain of interest,” with shared competence that distinguishes members of our community from others. Not everyone at any job is working hard to improve their ability to listen generously, to speak so the other can truly understand, to illicit what matters most to our patients, to hold safe space for others to experience the realities of fear, loss, hope, and healing.
- The Community. In pursing our interest in serious illness communication, we “engage in joint activities and discussions [rounds, case conferences], help each other [team-based care, referrals and consultation], and share information [APEX!].” We build relationships with each other that allow us to learn from each other.
- The Practice. We are practitioners and “develop a shared repertoire of resources: experiences, stories, tools, ways of addressing recurring problems.” We develop and improve our workflows, our best practices, and hear the stories over lunch, in the charting room, in hallways, at rounds, and in journals.
So, as we launch the 2022-23 academic year, I invite all of us in this Community of Communication Practice to listen to each other. How do your friends and colleagues talk to patients and families? What impact do their words have? How do you see them listening? How do we talk to each other in meetings? How do we ask for help or share our successes?
Don’t just borrow APEX dot phrases or learn about a new medicine from a colleague. We can try saying something you heard another clinician use in a tough discussion with a patient. We can share what works for you. We can learn to use inclusive language that allows all to feel safe. This year, I look forward to us all continuing to deepen our understanding and improve our communication skills through our interactions with and learning from each other.
And, when you think of it over the course of this year, please take a moment to email me examples of communication skills and habits that work for you… over the phone, in My Chart communications, on Jabber, Teams, or Volte, in the clinic, tumor board, or at the bedside. I’ll look forward to publishing them here for our community of practice.
All my best,
Mike