building the bandwagon

wagonwheel

One of the most difficult things about promoting wellness is simply wedging your foot in the door. This problem is not unique to wellness. Just ask any educator who, in the middle of an impassioned lecture, looks up and realizes that half the audience is buried in their smartphones. In the classes that I teach for our medical students, I spend a lot of time talking about preconceived notions, labels, and loaded terms that have an astonishing ability to immediately turn off any learner within a 500 yard radius.

If you’re still unsure as to what I’m referring, take a quick look at the table below and assess your own reactions to each of the following terms:

More Loaded Less Loaded
Wellness

Mindfulness

Meditation

Deep-Breathing

Reflection

Burnout

Stress

Career Longevity

Debriefing

Time-Management*

*Less loaded, but more boring

Let’s take, for example, the word wellness. In popular parlance, wellness already has a strong association with alternative lifestyles, holistic medicine, homeopathy, and a generally all-organic, tobacco-free, eco-friendly attitude. Most of this is dismissed as harmless in the best-case scenario (and as primitive and misguided as leeching in the worst-case). Physicians can be particularly dismissive, having been indoctrinated from a young age to value evidence-based medicine above all else.

So we start with this basic problem of the already loaded term, wellness. On top of that, many discussions related to wellness quickly delve into an over-sharing of feelings, which is guaranteed to turn off anyone who is still paying attention after you introduced the topic of your lecture. Residents (who are arguably the most in need of formal wellness education) are perhaps the worst offenders. Residents are caught in the middle—that is, they have graduated from the more emotionally-focused classes of medical school, but have not yet accumulated the experience of their attendings to fully realize the important of self-care.

Our most fundamental task then, is simply to get people to pay attention. Not to turn them into wellness gurus or regular meditators, but only to get them to look up from their smartphones for just a few minutes and really listen. Every behavior has four elements: the correct knowledge, adequate skill, a supportive environment, and the attitude or commitment to do it. Our first job then, is to bring our audience from what may be an affective level of zero to at least a one. Without even that basic commitment, you can teach and support till you’re blue in the face, but your learners will never truly change their attitudes or behaviors—even if it’s in their best interest.

So how then do we go about building the bandwagon and getting our learners on board with us?

Presentation matters. Being transparent and acknowledging the affective barriers discussed above can mitigate a lot of the initial knee-jerk reaction from your audience. For example, during my classes with our medical students I discuss the decision to change the name of the course to “Perspectives in Emergency Medicine,” substituting the work perspectives for mindfulness. I acknowledge any initial reticence the students may have about taking a class on mindfulness and use that as a jumping off point to explore other attitudes related to wellness.

You probably only have one shot, so get it right. Learners get very suspicious very quickly. Once you lose their interest, you’re probably not getting it back any time soon. Pilot your material with a more forgiving (or at least less permanent) audience if you can. For example, test out your curriculum with medical students rotating through a four-week clerkship prior to trying it out on the residents, who will be sticking around for the next three to four years.

People listen to hard data. Or at least hard people. Evidence-based medicine is all the rage, may as well make your arguments using scientific evidence too. The more neutral and objective you can make your case, the greater chance you might capture even the skeptics out there.

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