What really goes on in a doctoral Residency? University of Phoenix experience.

The Doctoral Residency

During three days of DOC/720R, the doctoral student formally began developing the doctoral dissertation.  The doctoral residency was a time for students and faculty to get together for "classes" and "daily assignments." There was a strict schedule with a specific deliverable: a Precis. 

We left the hotel at 7 am and attended classes until about 5 pm, with coffee and lunch breaks between meals served. We got back to the hotel around 6 pm.

Preparation. 

There was a requirement to prepare for the residency by reading some textbook chapters and literature. One of the program documents stated that it was "crucial to complete the Précis Development Worksheet" based on what we learned in RES/709 to assist in preparing for residency. There was a worksheet containing crucial questions to assist in thinking through and developing the core aspects of a feasible and sound dissertation study. Each student was required to submit a completed precis development worksheet before starting the first day's class.

Professors and other college staff were on hand when we got into class. We occupied modern classrooms on the second or third floor assigned to us. We had time to interact over the worksheets, critiquing one another's work. Then there was a meeting for all of us. The professors made some presentations, and there was a great deal of interaction among the faculty as they came and went in and out of classrooms. 

As you went up and down the elevator, you met Year 1, Year 2, etc. You could tell who was in Year X by the color of their sticker. There was a great deal of interaction with facilitators (as they preferred to be called) and students. Some of them preferred to be called by their first names. I insisted on calling them what I wanted to be called when it is my turn.

I recall ... our cohort facilitator. She became our group's anchor (more accurately, standard-bearer). She told us all the essential elements that we needed to master. She offered numerous valuable tips to assist us in producing the dissertation, qualitative vs. quantitative research, academic writing, IRB and ethical issues, and perception vs. reality. I will remember her for her motto: simplify, simplify, simplify, and finish, finish, finish; and to focus, focus, focus! 

We all knew that you either passed or failed after the three-day session. After putting in more time and spending the entire night at my computer desk editing big portions of my precis, I earned a pass by what I consider a "miracle." I would never forget those days or the suggestions I received about the dissertation process partly because I could see the facilitator and her animation about it.

Looking back

First, as the day drew near for my first doctoral residency, I was sitting at home in Lawton, Oklahoma, asking all these questions: What is the doctoral residency all about? What good is it to me? 

As the day drew closer, I prepared myself, booked my hotel room, and serviced my vehicle for the 6-hour journey. 

Then, the day was finally here! Six hours later, full of excitement, I was checking into the hotel. Someone was already standing at a desk with the University of Phoenix flag, if I may call it that. I registered and received my name tag for display on my chest, and it said something like: MacDonald, Year 1. 

There was also a 'meet and greet' after dinner. I and others paused for portrait photos.

So, after dinner, dressed like a future doctor of health administrator, I took my place at a round table in a seat reserved just for me (my name was written there!) There were four other students with me, and soon, the chatter filled the room. Soon I am also getting to know my neighbor. I am taking in everything, watching for something I did not expect to happen. Then, after the formal meeting, I poured some coffee and helped myself to the salad buffet. I learned that starting the next morning, we all will be fully engaged with school.

So what did I learn from the first residency? 

There, I gained a true appreciation for the value of a dissertation and the characteristics of an excellent study. I also gained knowledge through critiquing the work of my classmates. Some of my friends were well ahead of me in their dissertation process, while others lagged behind. Meeting and speaking with faculty aided me in contextualizing my doctoral journey. I was on the lookout for new information that I was unfamiliar with. I acquired a couple items. Most of all, I benefited from seeing, hearing, and touching people with whom I identified as peers and seniors. RES/720R was three days.

Knowledge Without Boundaries (KWB) Summit 2021

Presenting a Literature Systematic Review: A Collaborative Team Project - A Report.

Dr. MacDonald Chaava as Team Leader 

I received an email from University Research Leadership on February 2, 2021, asking me to lead a team to research the ramifications of COVID19 for K-12 education in the virtual environment. It was entirely up to the team to decide what to make of the project. The original two member team focused on the topic of emotional intelligence using a quantitative study design. The original idea was to publish in a journal or to produce a document the University of Phoenix could use in education courses.

The two members of the original team, including me continued to the end of the project. Along the way, three new members joined the team. Each member brought new energy and a different skillset to the team. As new members joined the team, we decided to revisit the earlier parameters (quantitative study on emotional intelligence) and we welcomed the ideas of the new members to give the team direction.

We were invited to present at Knowledge Without Boundaries (KWB). One colleague suggested a workshop style output and another one suggested a team presentation for KWB. We adopted the team presentation of a systematic literature review.

The team benefited from regular consultations with University Research Leaders, who provided the general direction and infused positive energy for our team to keep moving forward.

Our regular weekly 45 minute meetings were set for Wednesday afternoons. Our first two meetings were conducted using Teams, however, it became evident that the group was more familiar with Zoom. After that we met using Zoom every week.

Team attendance was up and down. Two members consistently attended all meetings, arriving on time and remaining to the end. One member only attended 40% of meetings but also completed all written team assignments on time.

Email and Teams provided the means for regular communication. Members viewed Teams threads as complicated, finding it challenging to follow the threads and to find files stored in Teams.

Once the subject for the literature review was identified, the team researched the literature to find articles published during the COVID19 pandemic in 2020 and 2021. From the initial search, each member identified a theme of interest to focus on for the KWB presentation. All themes were relevant to the impact of the pandemic on the transition to teaching and learning in the virtual environment.

As the team leader, I encountered some personal challenges and leadership headwinds. Perhaps my style of leadership contributed to some headwinds. For example, I proposed to use a reference manager called Mendeley. Each member was asked to familiarize themselves with the program and then to join a share point on Mendeley to store and have access to the same references in one place. The suggestion was accepted by members but not everyone was able to get on board. As team leader this experience was frustrating, but I decided to overlook it at the time. On the whole, team cohesion was high.

Work and School, Side By Side

I pointed out in one of my earlier posts that school and work are like two sides of the same coin. At this point, I have a point to make about this. I was so excited when a topic came up at work with the title Motivational Interviewing. Dr. Ben (not his real name) presented on this subject over a period of one hour via Webex. We saw PowerPoint slides as he presented. The similarity between what I showed at the start of my blog and this topic of MI is indeed striking.

The heart of the matter is behavior change in the health care setting. How do you as health care providers promote behavior change necessary for compliance and best outcomes in the hospital setting? MI constructs all target behavior change. They include Intrinsic Motivation, Stages of Change, and Social Learning Theory.

According to the presenter, researchers noticed that in the American system healthcare providers were more confrontational when attending to patients; hoping that aggressive behavior would motivate clients to change their behavior. Evidence pointed in the opposite direction, indicating strongly, that motivational interviewing rather than confrontational approach facilitates behavior change. Alongside this evidence the overlay of theories for Intrinsic motivation and stages of change that people go through.

According to the presenter, not much research has gone into this subject especially as it relates to a group setting. How do you apply the concepts that have been studied in individuals to the group setting and organizational change? I see this spot as potential for exploration. In my opinion, and based on the experience of more than fifteen years in the HIV field, organizations and communities share many of the characteristics of individuals in these communities. Whether or not there is research in this area is something I will have to explore in the coming days. (Jan 13, 2016)

Questions and Pieces of Advice

My doctoral journey professor said something that is worthy thinking about and writing down on this blog. Noting the fear of statistics expressed by two students in my class, particularly one that was convinced statistics are impersonal, boring, hard to deal with, and so forth, the professor pointed out that this is a common complaint among students at residency.

The professor's guidance on the matter is to remain objective especially as marketers and dissertation researchers. She admits there are times when we "yawn at statistics"; however, she totally emphasizes the importance of objectivity in our work, saying, "We should NOT let our personal preferences influence how we approach a research problem."  This got me really interested.

She raised three questions and pieces of advice for us to consider:
(a) If you plan a qualitative study for your research and the reason you give for taking a qualitative method, saying for example, "I hate statistics!" and/or "because it is easier than a quantitative method", then, according to her, "you will have a very difficult time persuading people that your methodology is appropriate." By people, she is probably talking about the dissertation committee first and foremost.
(b) If you plan a quantitative study for your dissertation and your reasoning is, "Because my instructor (or dissertation chair) told me" and/or "Because it is easier than a qualitative method", the road ahead could be long, messy and painful.
(c) If you do not have 3 to 5 peer reviewed sources that call for research about your specific topic with your proposed method, then it is highly advised to find them.

She adds this thought, "If you cannot find adequate support in the literature for your proposed work, STOP, drop, and rethink your methodology.

`My Dilemma

One week later and I am still thinking; I am not sure which way to go with my dissertation ideas. I wish the answer was easy. I envy those who made up their minds earlier based on their current occupations. Today, I had a new idea which could help me make forward movement if it has any water in it, as they say.

I am thinking of doing a basic research, one that explores a new idea to be titled: Empowering Patients through Strategic Questioning.  This is the same, in my opinion, as saying give patients space to specify their expectations and provide feedback all along the way through the health care system. More specifically that means all health care providers, including the receptionists should be trainined to treat patients as special stakeholders in the system rather than as customers.

Many professionals have said this, but it is worthy saying again. The hospital is the one place where people generally hate to go; it is the one place where they may be forced to stay against their will; the patient expects hotel quality service, and above all, expects to pay little or nothing for services provided. In fact, the hospital can be a place of emotional, physical, and spiritual turmoil. Many people coming to the hospital are afraid of what might happen or what diagnosis may be made while in the hospital. All the years I practiced as a medical laboratory technologist I was aware of the dichotomy of health care ministry.

A lady came to the laboratory once wanting to know if she was pregnant. The urine test came out positive and I recall her words as she sat in the chair with a blank stare. '"Why?" In that moment, her life came to a standstill; she was totally transformed.  I also recall on so many occasions when a person's life was touched this way or that way by all manner of issues. Cancer, HIV, diabetes, high blood pressure, and other issues affecting the human body.

The last thing one wants to find in the hospital are workers who do not care; especially the reception desk that happens to be the face of the hospital. Tenderness and empathy should accompany all those working in the health care system. Doctors, nurses, technicians, pharmacist, and non professionals too. Whoever works in the health care system should be trained to deal with patients with a degree of sensitivity.

Having said that, it is easy to overlook the fact that workers in the hospital are almost always working under pressure. This is the dichotomy I refer to. To be able to care requires someone who also feels cared for. Nurses and doctors also need to be cared for. Oftentimes as a patient we may forget that health care workers have needs too. It is not hard to see this problem multiplying itself many times over in the system where one patient is not the last one, and where some patients have challenging characters.

What are your expectations?

This question can be applied in an empowering way. Health care providers should not provoke patients to fear; instead they should learn to de-escalate tensions and fears patients may have. Some fun, some humor, some empathy can come out of the initial contact.
By asking this question (What are your expectations?) of patients as they walk into the hospital, the provider can empower the patient to consider not only what he or she might get out of the system for themselves but also what they may contribute to the system.
I have noticed in some of the good clinics that at the reception desk they have a video playing showing diseases and how to go about diagnosing and treating them. This, in my opinion, was not empowering the patient; it reinforced fears that a person might have already. What do people really need when they come to the reception desk? I suspect many patients would say they want to be heard. They want to tell their stories.

An Idea to be Tested

This morning I was thinking about my dissertation and came up with an idea while I was half asleep. This idea is raw and has not been researched to see if someone else has already thought of it. In the coming few hours I will find out if someone has done similar work. The idea is to ask persons feeling unwell, going to the hospital, "What are your expectations?" and synthesize their answers. This is all the idea. It is really simple, actually too simple, I thought. But, in the context of the United States health care system there is nothing simple. I also expect that such findings would have significant implications on how health services are organized and carried out. So, here are some of my hypotheses:
Hypothesis 1: There is a noticeable difference in responses based on demographics
Hypothesis 2: There is significant similarity in responses based on 3 factors, economic status, race, and political affiliation
Hypothesis 3: Fundamental expectations are similar for all people going to hospital to get help.

Some permutations of this idea are as follows:

1. What if I could ask each of those people shortly after their return from hospital, "Were your expectations met?"
2. What if I returned at 3 month intervals for one year to the same individuals to find out their perspectives on health services based on the original interaction that they had with the hospital/ clinic?
3. What if I did exactly the same at two locations in the United States, at a rural clinic and in the urban setting?

This idea sounds simple enough to carry out. If I were to get a All Clear signal I might consider the permutations later in design stage when I am sitting down at my desk. I think it is a good idea to trace some of the thoughts in my mind. So, where does this idea originate?

For more than 15 years I was part of the Africa Facilitation Team, taking the message of HIV/AIDS to parts of Sub-Sahara Africa. We helped organize communities and trained community counselors across Africa using the Community Counseling model developed by the Salvation Army Chikankata hospital (1988) that later became the UNDP's model of Community Capacity Enhancement through Community Conversation (CCE-CC). The model promotes participatory approaches to solving community problems with community ownership of the issues and solutions as a key component.

The most important part of this process asks the participants, What are your expectations?  Most meetings started with expectations and ended with a review of those expectations and achievements. By matching expectations and achievements it was possible to set aside a parking lot where unmet expectations could be stored for later. A good facilitator keeps an eye on the expectations of the participants. Some expectations were realistic while others were unrealistic.

The other thing is that the facilitator also had expectations. The mix of participant and facilitator expectations was always interesting and worthwhile exploring. That mix formed the basis for successful meetings. One of the expectations of a facilitator might be that all participants would remain in the meeting until the end. Expectations are very important in any relationship especially in the patient-doctor or patient-nurse situation. The worst thing is for people to assume things about others; to assume that we know what people expect in a relationship can lead to disaster. Asking is not hard; however, in the health care system everyone is generally very busy and preoccupied. People are preoccupied with things that may not even be related to the patient sitting in front of them at that moment.

The doctor may be thinking of an issue relating to Continuing Medical Education (CME), or family conflict going on, or something in the past or future. What if the first question the reception desk at the clinic asked a patient was, What are your expectations today? instead of asking the patient What is your problem? That, I think, would be huge, if the question was asked in earnest. The health care system is full of contradictions.  How often does a patient approach a clinic thinking, I am going to see the doctor; he or she will ask me What can I do for you? Instead, the patient finds a waiting room that is filled with waiting patients and a set of cold forms waiting to be filled in and a near absent minded receptionist behind a large computer screen. Unlike in the 7-Eleven where the shop assistant shouts a "Welcome to 7-Eleven" and asks you later, Is that all for you today?, in the clinic the nurse might say nothing to welcome you and nothing at the end of the encounter. The health care system trains doctors and other professionals in expensive colleges through a rigorous process and curricula.

It is unusual to find a doctor waiting at the reception desk (as a receptionist); instead, one usually finds a non medical professional stationed at the reception desk. She or he is the face of the clinic. The patient has to put on two different hats, first to meet the non medical professional and another to meet the medical personnel. No matter how one thinks of it this is a troubling scenario when the receptionist asks you in a loud voice in front of all those patients in the waiting room, What is your problem today? What are you supposed to say? I have pain in my abdomen? Is that true or is there a more private situation going on? What happens if you lie to the receptionist? ... What if the receptionist was trained simply to ask, What are your expectations today? This question can be modified without losing its essence.

I have been to see a doctor; I am partly reflecting upon some of my experiences. As a doctoral student I criss-cross barriers as a patient and a provider. In my work I am a Clinical Quality Improvement Coordinator. That means an added relationship to the health care system. In my previous careers I trained laboratory technicians and in future I will probably return to training. This idea would be great if it is cleared for me to carry forward.

[August 20, 2021. I never carried this idea forward. Instead I did something different for my dissertation.]

In Search of Inspiration for a Doctoral Dissertation

I revisited my old writings from years ago when I was searching for a topic for my doctoral dissertation.

Over a weekend, I took a break from my classes and went to Washington DC for some family business. While there, I was also on the lookout for a suitable topic for my doctoral dissertation. But I found it difficult to settle on one idea, as there were too many options in my mind and none of them seemed clear enough to settle on.

After my last post, I traveled to Washington DC and returned to Lawton over three days. I flew into the Reagan National Airport on a Wednesday morning, and started back for Lawton that same evening, driving a rented truck.

I say this because I found an excellent time to reflect on my doctoral journey, especially on the aeroplane on my way to DC.  I took with me a recent Reader's Digest and found time to go through the articles. I told myself to listen, to look out, to pay attention, and to keep my mind open so that I could get the inspiration for my doctoral dissertation. I wrote down the main ideas that came to me along the way.

The first series of thoughts came to me out of the Reader's Digest. They are as follows, not in any particular order of importance:-

On page 8 of the Reader's Digest (Dec 2015/ Jan 2016 edition) there is a letter written by Judy of Utah where she explains why she studies Memory. The reasons include her experiences with her parents. Memories linger for a long time in our minds; however, we can choose what to do with those memories.  In my mind, I was inspired to look for a subject in my memory rather than go out there looking for something new to study, no matter how appealing it might appear to me. I must find a subject that means a whole lot to me.  By searching through my memory bank I might find one. On page 9 I wrote, "A subject I'll study not just now but always." On the inside of the back cover, I wrote, "A subject/topic I have been interested in for a long time."

The other inspiration coming out of the Reader's Digest was in the form of a question: Do I want to be remembered?  The context of this inspiration is a story on page 112 about Forever Memory.  Simon Parkin wrote these words, "What if our recollections could live on long after we were gone?"  In the article, the fundamental question is whether or not we would like to be remembered when we are dead and long buried. Surprisingly, my response was neither yes nor no; I turned the question to my doctoral subject: What is it I want to leave behind as my heritage and gift to the world? What knowledge, what thought?

In a matter of one week since my first blog post, I have come up with a SWOT analysis of sorts.  My strengths, weaknesses, opportunities and threats. Of these I looked first at my strengths, things I know I am good at... things I have accomplished in my life and things that brighten my heart when I think of them. They include my work in community counselling and community capacity enhancement; training and development, and my love for academics.  These are the practical things I have done as a person of faith as my contribution to the world.

As these relate to health care and to current issues in health care, I wrote down the following points: Leadership studies; Finance, Planning, Monitoring and Evaluation; Management training, Team dynamic, transformational leadership, relational leadership, patient satisfaction, and measurement.

I am spending quality time in a deep soul search for the topic that I will cover for my doctoral dissertation. I am looking for something I have always loved to know and do; I am looking for a subject I am willing to keep on studying always, and one on which I can write many articles starting very soon. As of today, I have not yet identified the topic for my doctoral dissertation.