Help Me With This Difficult Conversation!

Engaging in a crucial or difficult conversation is an inevitable aspect of professional life including preceptor-learner relationships. This blog posting offers a summary of the book Crucial Conversations: Tools for Talking When the Stakes are High with a focus on preceptor-learner interactions and navigating challenging dialogues. 

These dialogues involve two or more people engaged in discussions where the stakes are high, opinions differ, and emotions run deep. Topics may include absenteeism, missed opportunities, poor communication, unsafe practice, disrespectful behavior or speech, or defensiveness during feedback sessions.

Ideally, this difficult conversation takes place face-to-face. Dialogue is important, and it is vital to have a free flow of meaningful ideas between two people and an honest, open expression of opinions, shared feelings, and articulations of theories.

Why are these discussions so difficult? None of us wants to be the “bad guy,” cause hurt feelings, or harm a relationship. We may not know what to say or how to act when we are under pressure, or when the learner acts defensively. These conversations are uncomfortable. There is also a high risk that the more crucial the conversation, the more likely it will be handled poorly. Thus, planning is essential and anticipating potential issues and even rehearsing your approach may be helpful.

Preparation is key:

• Determine your goals and the outcome you hope to have. Ask yourself what you want to accomplish by the end of the conversation.

• Ensure your intentions are good and consider the learner’s perspective. Hear what they have to say and assume their intentions are good as well.

• Manage your emotions and have a plan to conduct a smooth meeting.

• Identify the problems that led to the meeting. Avoid addressing all the issues at one meeting and choose the most serious.

• Be mindful of triggers, so you stay calm, remove defensiveness, and avoid feeling intimidated by the learner.
  

Once prepared, initiate the conversation in a private space. Depending on the topic, it may be helpful to include another pharmacist to document the conversation.

During the conversation:

• It is crucial to maintain a focus on learning.

• Use open-ended questions to ascertain the circumstances leading to the issue.

• Notice what is happening around you and make sure the conversation is staying in a safe psychological space.

• Keep emotions in check and help the learner do the same. Tone, how the conversation is set up, and body language all play a part here.   

• Clearly state your mutual purpose, look for points of agreement and, in an unemotional way, state what you see and how you want the conversation to end.

• Encourage the learner to stay in the dialogue by avoiding defensiveness or silence. The goal is to stay in the ‘sweet spot’ of shared meaning to ensure both parties understand each other’s perspective.

• If emotions escalate, restate your intentions, and bring the conversation back to a constructive place.
  

Action plan:

• Offer assistance to resolve the problem and find a solution together.

• Plan and outline expectations for the remainder of the rotation.

• End with an agreed upon follow-up plan. Ensure everyone knows who does what, by when, and consequences for future issues.

• Encourage the learner.
  

Not every rotation is free of difficult conversations. Patient care should never be compromised for the sake of peace with a learner. Use the learner’s orientation as a time to set expectations for the rotation and establish boundaries. Learners need to be accountable and aware of their progress, including violations of expectations. Contact the Office of Experiential Education with concerns or for assistance at any time.

Also, check out the Student Response to Help Me With This Difficult Conversation post for a learner's perspective on crucial conversations.