Input from community scholars & practitioners at a distance for #OCE2011
In preparation for the Online Community Enthusiasts’ gathering in Vancouver BC in May 2011, I asked people what they would like to contribute to our theme of excellent [online] community events. I summarized this input on the wall of our face‐to‐face gathering, and we spoke about it intermittently during the day. This document includes written input from several people. It begins with the abstract of a published paper shared by John Parboosingh (I don’t know copyright restrictions so have not shared the full document here). In each section I have specified who shared the ideas. One interesting pattern is the tension between space for emergence and structure.
Enhancing Practice Improvement by Facilitating Practitioner Interactivity: New Roles for Providers of Continuing Medical Education
I. John Parboosingh, MBChB, Professor Emeritus, University of Calgary
Virginia A. Reed, PhD, Research Associate Professor of Community & Family Medicine and Psychological & Brain Sciences, Dartmouth Medical School and Dartmouth College
James Caldwell Palmer, DMan, Clinical Faculty Instructor, Department of Family Medicine, University of Colorado School of Medicine
Henry H. Bernstein, DO, Professor of Pediatrics, Hofstra North Shore‐ LIJ School of Medicine, Hofstra University
Corresponding author information:
Virginia A. Reed, PhD
46 Centerra Parkway, Suite 330
Lebanon, NH 03755
Phone: 603‐653‐3449 Fax: 603‐653‐3452 E‐Mail: Virginia.A.Reed@Dartmouth.edu
Key words: continuing medical education, continuous professional development, practice improvement, communities of practice.
Lessons for Practice
- Conversations between practitioners in trusted relationships are used to align policies and guidelines with current experiences making them practice‐ready in a knowledge generation process that is owned by the practitioners.
- The quality of relationships and interactivity among practitioners can in part explain why some group practices respond more favorably to improvement initiatives than others.
- “Best practice” is typically pushed in traditional education sessions. In contrast, it is pulled through conversations in well‐facilitated communities of practice.
- Evidence suggests that formal training in how to facilitate communities of practice is necessary.
- Facilitation of communities of practice is a skill set CME providers should acquire as part of leadership development.
Research into networking and interactivity among practitioners is providing new information that has the potential to enhance the effectiveness of practice improvement initiatives. This commentary reviews the evidence that practitioner interactivity can facilitate emergent learning and behavior change that lead to practice improvements. Insights from learning theories provide a framework for understanding emergent learning as the product of interactions between individuals in trusted relationships as occurs in communities of practice. This framework helps explain why some groups respond more favorably to improvement initiatives than others. Failure to take advantage of practitioner interactivity may in part explain the disappointingly low mean rates of practice improvement reported in studies of the effectiveness of practice improvement projects.
Examples of improvement models in primary care settings that explicitly use relationship building and facilitation techniques to enhance practitioner interactivity are provided. Ingredients of a curriculum to teach relationship building in communities of practice and facilitation skills to enhance learning in small group education sessions are explored. Sufficient evidence exists to support the roles of relationships and interactivity in practice improvement initiatives such that we recommend the development of training programs to teach these skills to CME providers.
Hi Alice, (from John Parboosingh)
Re your request:
“Could you think back to some events you have experienced, which stand out in your mind as excellent, and send me your thoughts?”
I am reflecting on two groups or communities.
The first group is the Community of Facilitators of Education and Exchange (COFFEE) which is multidisciplinary group of 120 health care professionals which is described at http://www.coffee‐ab.ca/. The community is 4 years old and the shared practice has been focused on helping health care professionals and their leaders to establish (foster) strategic CoPs as a vehicle for high quality, safe and seamless care in health care teams.
COFFEE ran 5 (lunch time) webinars last year which can be found at http://www.coffee‐ab.ca/knowledge‐sharing.php. They were evaluated mainly by feedback and “happiness indices”, but we also included tangible evidence of engagement, such as participation in the discussions formally positioned at several points in each event, and requests for the literature and tools that were mentioned during the events.
The success factors, perceived by myself and confirmed with core members of COFFEE were:
- Integration of stories into the formal presentations and participants stories (mostly plants – ie., participants were invited beforehand to prepare a relevant (true) story and to present it during a discussion period).
- Visuals – have a talking head of all presenters and participants having access to the slides after the event. Also well made slides!
- Participants liked to know who was at the webinar and ‘chatted’ with each other in the chat section which was visible to all. In other words, the community feeling was important.
- Presenters – participants liked to have presenters who they had met and were credible to them. They preferred local speakers to external experts not known to them.
- Other Community activities were important. For instance, participants knew they could after an event, arrange a mentorship or sidebar conversation with a presenter, or invite them to a group meeting.
- A small number were inspired to become ‘professional CoP facilitators’ and are currently taking our multimedia 3 month long course which started mid March and which is described at http://www.coffee‐ab.ca/images/cop_newsletter_holiday_2010.pdf
This group has met by monthly conference calls. We have met each other at related meetings but have not seen the need for web conferencing. So what made these calls successful?
- The passion for the shared practice has been number 1.There is a pressing need for CME to find new directions, pressured by reports from Institute of Medicine.
- The diversity of the group. Each of us brings a different perspective and different literature on the issue.
- The timely decision, made last June, (after 18 months of talk) to write a position paper for the major CME providers’ journal – Journal of Continuing Education for Health Professionals. I think this decision rejuvenated a sagging What’s‐in‐it‐for‐me (WIIFME) level in the group. I have seen this before, when a decision to “do a project” brings the group back to life.
- Collectively writing the 4000 word paper, including a section on supporting learning theories, brought up a few ‘conflicts and disagreements’ that never surfaced in earlier discussions. But it certainly raised our WIIFME levels.
- A very quick and positive response from the editor of the journal reinforced our identity as a Community. The article will be published in the summer edition of the journal (attached for your interest).
Dear Alice (from Bev Trayner)
How smart (and elegantly simple) to bring some ideas into the group beforehand!
OK.. so these are my thoughts...
Not sure what kind of "event" you are talking about...? A two week asynchronous event? A one hour synchronous event? A mix?
Also not sure of "excellence" to who? The people who attend it? Sponsors? Other stakeholders?
And in what time frame? The event itself? The feeling people have when they leave it i.e more trust and confidence with the others who also attended the event? The impact it eventually has on people's practice? influence on organizational outcomes? something that leads to a splinter group with other, new ‐ and possibly competing ‐ objectives?
i.e. excellent may depend on what time‐frame you are using and excellent to whom....
Context for my answer:
Given my uncertainty, this is the context I've set to answer your question:
A 90 minute synchronous event for up to 20 people ‐ across different countries. Excellent means excellent to the community members and facilitators. They judge it as excellent in the short and medium term.
What makes an online community event excellent?
- lots and lots of advance planning and rehearsing to get everyone up to speed with the technology and to iron out any unforeseen problems
- two back‐up plans for the technology ‐ and the technology access of different people ‐ plus facilitators who are ready to improvise
- good prep and team‐work with content leaders
- attention to time‐zones
- attention to where people are at in the call (e.g. is this in their work hours? family time?)
- space for all types of participation ‐ from full to periphery
- sound works for everyone
- content and process facilitators(s) working together
- live note‐taking by one or more participants in the call ‐ for those who can't hear for technology reasons, for people who drop out the call and have to come back, and for those who don't speak <English> as a first language
- the right people are invited to the event
- the topic and outcomes are what people are expecting
- people come away thinking they got high value for time
- there is a clear next step and people know their role
- smart enough facilitators to deal with the unpredictable
- readiness on behalf of facilitators and community members to reflect critically and openly on what did or didn't work
I'll be interested to see what everyone comes up with. And thanks for the question.
Working at the intersection between technology and connecting people
Alice: (from Grady McGonagill)
What makes an online community event excellent?
Some quick thoughts:
- Reasonably clear sense of purpose
- Commitment on the part of a critical mass of participants
- User‐friendly Web tools for communicating, documenting, uploading resources
- Some opportunity for at least occasional “direct” connection (phone, FTF)
- (in most cases) Active facilitation/leadership
- Questions to engage people before hand
- Strategies for engaging people after the event
Warm Regards, Grady
Grady McGonagill, Ed. D. McGonagill Consulting
Hi Alice (From Christina Merl)
- structure (excellent event design)
- clear distribution of roles
- clear instructions at the beginning
- discipline and timing (facilitator(s) need to be very disciplined, even more so online, I think)
- in online events (depending what sort of event) a chat area has proved very useful
- facilitator(s) need to take care that the chat conversation does not drift away too much from the topic and that participants can still concentrate on the speaker and topic
- facilitators should take up questions raised in the chat area so that participants have the feeling that they are involved
- I personally am not a fan of voice over (depending on event, of course) but people tend to talk too much, technology is always a problem, etc. (so depends on number of participants etc.)
Would be great if you shared insights!
Hi Alice (from Jenny Mackness)
Here are my rather quick thoughts. Happy to answer further questions if you have any.
"What makes an online community event excellent?"
- The atmosphere – when there is a palpable buzz ‘in the room’, and participants are excited about the topic and about interacting with each other.
- Clear instructions about access and event agenda and technology that works! (we don’t want to fall at the first hurdle)
- A friendly convenor – and an opening welcoming activity. Also friendly participants
- A critical mass of people to allow for enough interaction and peripheral participation
- Allows participants to have a voice and learning to emerge – there is a definite tendency for the teacher to talk too much in the online ‘classroom’. A monologue is not a good idea. Silence is fine – it allows thinking time.
- Raises as many questions as it answers – i.e. wets the appetite to go and learn more and leads to further topics of interest and learning – in other words – a learning dialogue – and the investment in time pays off
- Specific questions are answered where possible
- When the time whizzes by and you don’t want the discussion to end.
- There is expertise within the online group ‐ people to learn from
- The best practices of teaching are employed for any presentations.
Hi Alice (from Josien Kapma)
"what makes an online community event excellent?"
since you mentioned it is a f2f event, i am assuming that is what you mean?
I have warm memories of km4dev meetings. Probably because online and offline were expertly interwoven. Building on discussion threads, consciously remembering community members not present, social reporting out and picking up comments from outside to discuss...
It feels important to continue the informal mood and atmosphere that is used online.. so a homely venue, ample time for intros, role modeling of informality, open program. In fact, we have often used open space methods, that worked nice.
Recently in a more formal group, the program was decided after group consultation. Twitter was used to connect sub‐ sessions and provide a window in for those not present...
In fact, if the online exchanges are really good, a f2f meeting cannot fail...
I hope this is what you meant, and not online events?
Kind regards, josien kapma
Many of the conversations we had onsite were in small groups and not fully recorded. So it is great to have these insights from around the world to add to our learning from the event. Thanks everyone!