Mystery of the x-ray overexposure: an innovative risk and media communication mentoring workshop.
This paper describes a unique, integrated professional development workshop that was recently designed and conducted for Army Nuclear Medical Science Officers (NMSOs) to further hone their special expertise in health physics (radiation safety), while developing their skills in both risk and media communications. The 2-day workshop, held in conjunction with the Annual Force Health Protection Conference, was a collaborative effort, bringing together health physics, mentoring/coaching, risk communication, and public affairs experts. The key to a highly successful training event was the amplification of individual and group NMSO self-awareness, the study of a real-world Army health physics radiation case study, and the practical use of effective risk and media communication principles. The workshop was also an effective group mentoring experience for all of the officers. Other force health protection practitioners may benefit from the lessons learned from the development and implementation of this truly innovative professional development vehicle, and can use it as a template for their own professional groups or organizations.
In order to accomplish this very ambitious training event, a highly diverse group of experts was brought together to both design and conduct the workshop. The leader of the cadre was the career field leader for the Army's roughly 60 NMSOs (lead author M. A. Melanson). An independent consultant was contracted to assist with the self-awareness, mentoring, and coaching portion of the training. To provide risk communication expertise, a senior risk communicator from the Army Public Health Command (Provisional) (APHC(P)) partnered in the effort. The APHC(P) public affairs officer was also invited to craft the media communication piece of the exercise. Finally, 2 health physicists, one civilian and one NMSO, also participated in the development and implementation of the workshop case study.
Twenty-four Army NMSOs registered for and attended the 2-day workshop. They included both junior and senior officers from the Active Army, the Army Reserves, and the Army National Guard, and represented a diverse cross section of the specialty. The demographics were 6 lieutenants, 12 captains, 3 majors, and 3 lieutenant colonels. The officers came from various stateside and overseas duty stations and accounted for roughly half of the Army's inventory of NMSOs.
GOAL OF THE WORKSHOP
The workshop goal was to provide the NMSO participants with an integrated learning opportunity based upon a real world case study, enhancing individual and group health physics expertise while providing practical risk communication and media communication training. The cadre also wanted to foster a supportive learning environment that would allow individual and group self-awareness and foster individual and group mentoring.
The workshop was a preliminary conference to the Army's Annual Force Health Protection Conference (FHPC), a premier military public health conference. It was scheduled to unfold over 2 consecutive days, just before the opening of the main FHPC. In addition to being an icebreaker and warm-up for the participants, the first day allowed the NMSOs to increase their own self-awareness while also learning about the overall group and its individual members. The enhancements of individual and group awareness resulted in an increased understanding and mutual respect among the individuals. This served to facilitate the group learning efforts planned for the second day.
On the second day, the participants applied their newly found self and group awareness to solve a complex health physics problem based upon a real world radiation overexposure case study. Once organized into small groups each led by a senior officer, the NMSOs were presented with the case study and then began to collect critical information to determine what actually happened. Once the case study was solved, the next phase was preparation to explain the risks of the alleged radiation overexposure incident to nonscientists. The culmination of the workshop was 2 role playing exercises where 2 selected participants either explained the radiation risks to an actor playing the alleged overexposed Soldier, or conducted a staged media interview with a simulated news reporter.
Design of the workshop's 2 interrelated parts occurred concurrently. As the workshop leader worked closely with the mentoring and coaching consultant to design the self and group awareness day, he simultaneously worked with the health physics experts to convert the real world overexposure incident into a daylong exercise while partnering with the risk and media communication subject matter experts to plan the 2 role playing exercises. Fortunately, the workshop leader had an existing good working relationship with the entire workshop cadre which greatly facilitated this ambitious integrated effort.
Design of Day 1--Self and Group Awareness
The mentoring and coaching consultant was briefed on the overall goal of the workshop's first day: self and group awareness. The cadre leader also expressed his desire to use the Myers-Briggs Type Indicators (MBTI) (CPP Inc, Mountain View, CA), a popular and useful self-awareness tool. The consultant then suggested that the use of the MBTI could be bolstered by the addition of training about Emotional Intelligence Competencies (EICs).
Myers-Briggs Type Indicators
First developed in 1962, the MBTI was the product of collaboration between 2 psychologists, Katharine Briggs and her daughter, Isabel Briggs Myers. (1,2) The MBTI is directly based upon the cognitive theories of the famous psychologist Carl Gustav Jung. (3) Through the use of a questionnaire, the MBTI identifies and measures psychological preferences by which people perceive the world and make decisions. The questionnaire first determines how an individual gets his or her energy, either from looking inside or from interacting with others. Next, it assesses how a person prefers to receive information, by focus on details or by viewing the big picture. The survey then addresses how a person's decisions are made using this information, by using logic or relying on feelings. Lastly, the test reveals how the individual orients him or herself with respect to the rest of the world, by being regimented or by being flexible.
Emotional Intelligence Competencies
The theory of emotional intelligence stems from the seminal work by Dr Daniel Goleman (4,5) and is traceable to Charles Darwin's work on the role of emotions in survival and adaptation. (6) Mastery of emotional intelligence is the result of mastering key competencies designated as EICs. These EICs are broken into 2 large groups, Personal Competence and Social Competence. Subcompetencies under the category of Personal Competence include Self-awareness (emotional awareness, accurate self-assessment, self-confidence), Self-regulation (self-control, trustworthiness, conscientiousness, adaptability, innovativeness), and Self-motivation (achievement drive, commitment, initiative, optimism). The other group of competencies, Social Competence, includes Social Awareness (empathy, service orientation, developing others, leveraging diversity, and political awareness), and Social Skills (influence, communication, leadership, change catalyst, conflict management, building bonds, collaboration and cooperation, and teamwork). Given the goals of the workshop, the mentoring and coaching consultant recommended focusing on the following 6 EICs: Communication, Empathy, Developing Others, Self-Confidence, Teamwork, and Collaboration.
Throughout the day, interactive exercises or "games" were used to help understanding and awareness of self-awareness tools and to sustain individual and group participation. This made the day fun and memorable. Many of these games involved intentional pairing of junior officers with senior officers to facilitate flash mentoring. Along with this broad guidance, the consultant was also provided an overview of the second day, so that she was aware of the skills and insights necessary for the participants to work through and solve the radiation overexposure case study and complete the role playing exercises. The schedule of the first day is outlined in Figure 1.
Design of Day 2--The Radiation Overexposure Mystery
The second day was technical. The focus was on the investigation of a real world health physics case study and the preparation and delivery of both a risk communication message and the completion of a mock media interview. Given the central place of the case study in the second day of the workshop, the focus shifted to a summary of the actual alleged radiation overexposure incident.
The Case Study--A True Health Physics Mystery
The mystery to be solved by the participants was closely based on an actual potential radiation exposure incident that occurred in the summer/fall of 2008. A Soldier, an x-ray specialist with the 25th Infantry Division at Schofield Barracks, was scheduled to deploy to Iraq. As part of his preparation for deployment, the individual deployed with his unit to the National Training Center (NTC), Fort Irwin, California, for collective unit training. Upon arrival at Fort Irwin, the x-ray tech went to the post hospital to obtain a radiation dosimeter to wear while he simulated shooting radiographs while training in the field. He was given a radiation dosimeter, also referred to as a radiation badge, by the Fort Irwin Medical Department Activity (MEDDAC) Radiation Safety Officer (RSO) to wear during the 10 days that he trained at the NTC. Upon completion of the training, the deploying Soldier turned the dosimeter in at the Radiology Clinic of the Fort Irwin MEDDAC. The Soldier then subsequently deployed to Kuwait on his way to Iraq. Since the dosimeter was on a quarterly exchange cycle, it remained in the MEDDAC Department of Radiology, stored with the other dosimeters for a couple of months. Then, the badge was shipped to the US Army Dosimetry Center at Redstone Arsenal, Alabama, for processing.
When the dosimeter was read, it indicated that there was a dose over 40 times the allowable annual legal limit. Further, the reading was the largest radiation dose ever recorded in the over 50-year history of Army radiation dosimetry. Most important, this high level of radiation dose could pose a serious health risk if it had been actually received. The Army Dosimetry Center immediately notified the RSO at Fort Irwin MEDDAC, the Army RSO, and the Radiological Hygiene Consultant to the Army Surgeon General (author Melanson).
Given the magnitude of the dose and the complexity of the incident, the initial investigation was passed to the Command Radiation Safety Officer (CRSO) for Western Regional Medical Command (WMRC), another Nuclear Medical Science Officer. With guidance from the Radiological Hygiene Consultant, the WRMC CRSO obtained information about the radiation characteristics and output of the field medical x-ray system used by the deploying Soldier while he was training at the NTC. Information about the effective energy of the radiation on the exposed dosimeter was obtained from the Army Dosimetry Center. The deployed Soldier was contacted and interviewed by the Theater Radiation Safety Officer, another NMSO deployed to Iraq. During the interview, the potentially overexposed Soldier provided information about the number of times he fired the x-ray machine during the 10 days of NTC field training, where he was standing with respect to the x-ray machine, and whether or not he was wearing a lead apron.
Through further investigation, it was scientifically determined that the Soldier could not have received the dose on the dosimeter. First, the effective energy of the radiation dose on the radiation badge, a thermoluminescent dosimeter, was greater than the maximum energy of the field medical x-ray system. This proved that the x-ray machine could not have produced the massive radiation dose on the badge. Additionally, it would have taken over 700 shots of the x-ray system to have delivered the large magnitude dose measured on the dosimeter. Since the Soldier was not using any other radiation sources and had no other source of potential radiation exposure on the NTC, it was concluded that the badge was irradiated after it had been turned in to the Radiology Department at the Fort Irwin MEDDAC, but before the badge was sent to be processed about 2 months later. The theater RSO in Iraq met with the deployed x-ray tech to inform him that he did not receive this large dose of radiation, what his estimated radiation dose actually was, and to answer any questions that he might have. He was relieved to learn that he had not been overexposed to radiation and was safe.
With the determination that the badge was irradiated after it had been returned by the deploying x-ray technician, the question still remained as to how the dosimeter received such a high radiation dose. The Radiological Hygiene Consultant conducted a formal investigation into the incident. This investigation included going to Fort Irwin MEDDAC and interviewing the hospital staff. As it turned out, the effective energy of the radiation measured on the dosimeter was consistent with the fluoroscopy x-ray system located within the Fort Irwin MEDDAC X-Ray Department. Interestingly enough, over 15 minutes of deliberate fluoroscopy operation with the badge in the beam would have been required to produce the massive radiation dose. Unfortunately, the investigation could not ascertain who intentionally irradiated the dosimeter after the deploying Soldier turned it in and before it was sent to the Army Dosimetry Center for measurement.
Designing an Exercise to Solve the Overexposure Mystery
It was expected that after the events of the first day, the NMSOs would come together as a group and would be prepared for the next phase of the workshop. The schedule for the second day is shown in Figure 2. Before unveiling the case study, the ground rules of the day were explained. Next, the NMSOs were divided into 4 separate, 6-person groups, each lead by a senior field grade officer (lieutenant colonel or senior major). Once the groups were identified and allowed to reseat themselves with their leader and new teammates, an introduction of the real-world case study was given, providing the participants some, but not all of the information required to solve the mystery. The teams then had to process the initial information received, identify additional data that they needed, request this new information, incorporate all newly obtained data into their evolving understanding of the incident, and finally determine whether the overexposure was real or not (which it was not). After this, the 4 groups developed a plan to estimate and explain the radiation dose and risk to an actor playing the allegedly overexposed individual and another actor playing a news reporter investigating the incident. When each of the 4 groups had developed a plan to brief the incident, an individual from within one of the 4 groups was selected to play in the first role playing event, the risk communication exercise. After the risk communication role planning exercise was completed, the risk communication expert provided a half-hour presentation on risk communication, and also evaluated the first participant's performance in the role playing exercise.
With the risk communication exercise completed, the participant for the media communication exercise was selected and allowed a brief time with his or her group to finalize preparation for the mock media interview. As in the case of the previous role playing exercise, the participant performed the interview with the reporter. Once that was completed, the media communication expert delivered a lecture on effective media communication and critiqued the performance of the second participant. The last day concluded with an after-action review of both the second day and the entire workshop.
Day 1--Self and Group Awareness
The first day of the workshop proceeded pretty much as planned. The participants were enthusiastic about the agenda for the entire workshop, especially the second day. As the career field leader for the Army NMSOs explained the relevance and importance of the first day's activities to successful completion of the case study on the second day, he also affirmed the importance of self and group awareness in effective Army officer leadership. The mixture of lectures and games served to sustain individual and group interest, and helped the participants relax and remain focused on the workshop. Throughout the day, COL Melanson reminded the group that they, as scientists, were very different from most members of the general public and individuals who work in the news media, and that they should keep this in mind as they prepared briefings for the second day. At the end of the first day, an after-action review was held (without the consultant present) and the feedback was constructive. While the attendees enjoyed the day, they would have preferred to have more time to delve into the Emotional Intelligence Competencies since many were already familiar with the Myer-Briggs Type Indicators.
[FIGURE 3 OMITTED]
Day 2--Solving and Explaining the Radiation Mystery
As expected, the group of attendees was comfortable with each other and warmed-up for the second day's activities. Everyone was told that they had a chance to be selected to engage in one of the 2 role playing exercises; this risk of being "put on the hot seat" helped to sustain individual participation and focus. The conference room was then rearranged to facilitate the exercise as shown in the conceptual presentation of Figure 3. Group tables were rearranged so the 4 groups could face each other. The controllers who had designed the case study exercise were placed in the front right corner and were prepared to respond to written questions from the groups. Each table was given a courier to deliver written questions to the controllers. The workshop leader served as the exercise conductor and timekeeper to help keep everything on schedule. A separate table was placed in the center of the room to serve as a "fishbowl," where the 2 role-playing exercises would play out while the other participants silently watched. Once the case study summary was presented, the exercise commenced. There was a slight delay as the groups got organized, but they quickly began asking additional questions of the controllers.
Periodically throughout the morning, the conductor would stop the exercise and conduct a "reset," which involved the conductor asking each of the groups what they had learned from asking questions of the controllers. At first the groups were unhappy about this since it interrupted their individual group's momentum and there was an innate desire to outperform the other groups and not share what they had learned. The workshop leader explained that the goal of the exercise was not to "beat" the other teams. The goal of the exercise was to ensure that whoever was selected for each of the 2 role-playing exercises was completely prepared to succeed. After the explanation, the groups no longer focused on outplaying the other groups. Just before the lunch break, the 4 groups had fully investigated the case study and had all of their facts. Over a working lunch, the groups prepared their information for briefing the potentially overexposed Soldier and the news reporter.
After lunch, the workshop shifted to the 2 role-playing exercises. This began by selecting the first participant. The conductor had thought about randomly selecting the player, however, the decision was made to select a senior company grade officer with prior risk communication training in order to maximize success and provide a positive example for the others observing the exercise. Two actors were involved in the first role-playing exercise: one of the controllers played the Soldier (he also was the theater RSO in Iraq who actually briefed the possibly overexposed individual), and the risk communication expert played the Soldier's wife. Overall, the first participant did very well. She showed genuine empathy and calmly explained the situation and the process that she used to come to the conclusion that the Soldier was not overexposed. Unfortunately, her overreliance on calculations to estimate the Soldier's dose did not resonate well with either the Soldier or his wife, and ultimately limited the effectiveness of the risk communication message. Once the risk communication exercise was completed, the risk communicator gave a short briefing on effective risk communication and highlighted the positive and negative aspects of the role-playing exchange. The key points of the risk communication training were defining risk communication as an interactive process, the importance of empathy, and the fact that risk is a combination of the magnitude of actual hazard plus the degree of personal outrage of the person subjected to the risk. (7) Elements of successful risk communication include the credibility and the skill of the risk communicator and the effectiveness of the risk message. Credibility is first built upon empathy, then it rests upon honesty and openness. Finally, trust and credibility rests upon dedication and commitment on the part of the risk communicator, and ultimately his or her competence. (8) The audience was also warned to avoid humor and jargon.
Next, the exercise immediately shifted to the mock media interview. The second "contestant" was selected by the workshop leader. This individual was a seasoned, midcareer major who had recently returned from a deployment to Iraq. The public affairs officer played the role of the reporter and started the interview on a positive note. Then, however, she shifted to a more adversarial posture, implying that the Army system for monitoring Soldiers was flawed and her impression that the interviewee was hiding something. Although the second participant got flustered, he still managed to maintain his composure and completed the interview. As in the case of the risk communication exercise, the role-playing was followed by a lecture on effective media communication that also critiqued the performance of the second participant. The media communication training explained the similarities and differences between risk communication and media communication. Both need planning and preparation and use effective communication techniques. Risk communication focuses on addressing concerns, whereas public affairs explains the message of the organization. In public affairs, it is important to stay on the record, to stay in one's lane, and to avoid speculating on hypothetical questions. Also, it was stressed that one must never lie. Tips included preparing messages in advance and rehearsing them, stating these messages up front, and keeping them simple. The importance of "speaking with one voice," that is a consistent message was also emphasized. The audience was told that it was proper to say "I don't know," but that one should commit to finding out the answer and providing it later. The public affairs officer also stressed the importance of setting the record straight and correcting reporter errors.
In order to wrap-up the exercise, the conductor presented the resolution of the actual case study to the participants. Coincidentally, all of the key players involved in the real incident were actually present and part of the cadre for the second day's exercise. An impromptu chronological walk-through of the incident was done. Finally, after-action reviews were held with the group for the second day, and then for the entire workshop. Feedback from the group was overwhelmingly positive. The only complaint was the decision to have the participants work over the lunch period on both days.
This paper presents an innovative training workshop that combined self and group awareness with the completion of a real world radiation overexposure case study to enhance the technical skills of the attending Army Nuclear Medical Science Officers. It also included 2 role-playing exercises to learn and practice effective risk communication and media communication techniques. The workshop was structured to allow a supportive learning environment that was conducive to individual and group mentoring.
As previously stated, the feedback from the participants was overwhelmingly positive. Other public health practitioners may find this innovative professional development approach useful, and may wish to use the design of this work-shop to further their own professional development.
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COL Mark A. Melanson, MS, USA
Lori S. Geckle
Lyn C. Kukral
Michele Costanza, PhD
COL Melanson is Director, Armed Forces Radiobiology Research Institute, Bethesda, Maryland, and the Radiological Hygiene Consultant to The Army Surgeon General.
Ms Geckle is Senior Health Risk Communication and Environmental Protection Specialist, Health Risk Communication Program, US Army Public Health Command (Provisional), Aberdeen Proving Ground, Maryland.
Ms Kukral is the public affairs officer at the US Army Public Health Command (Provisional), Aberdeen Proving Ground, Maryland.
Dr Costanza is owner of MultiGen Coaching, specializing in organizational development and training.
Figure 1. Schedule for day 1, group and self awareness. 0800-0830 Welcome. Logistics of Room and Workshop. Purpose and Objectives. Introductions. 0830-1000 Administration of the MBTI Questionnaire. Overview of Personality Type Theory and MBTI. 1000-1015 Break 1015-1115 MBTI Debrief. Validation of Personality Types. 1115-1200 Emotional Intelligence Competencies 1200-1300 Working Lunch: Stress and Type 1300-1400 Communication and Empathy 1400-1415 Break 1415-1500 Developing Others 1500-1600 Self-Confidence Tools and Strategies; Teamwork and Collaboration 1600-1615 Wrap Up 1615-1645 After Action Review Figure 2. Schedule for day 2, radiation overexposure case study. 0800-0815 Group Assignments and Group Assembly 0815-0830 Introduction of Radiation Overexposure Case Study 0830-1100 Groups Work on Case Study and Gather Information 1100-1230 Open Discussion and Presentation of the "Solution" 1230-1400 Lunch and Group Preparations for Role Playing Exercises 1400-1430 First Exercise Participant Selected and Group /Assistance in Final Preparation 1430-1445 Risk Communication Role Playing Exercise 1445-1515 Risk Communication Training and Feedback 1515-1545 Second Exercise Participant Selected and Group Assistance in Final Preparation 1545-1600 Medic Communication Role Playing Exercise 1600-1630 Media Communication Training and Feedback 1630-1700 After Action Review
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|Author:||Melanson, Mark A.; Geckle, Lori S.; Kukral, Lyn C.; Costanza, Michele|
|Publication:||U.S. Army Medical Department Journal|
|Date:||Apr 1, 2010|
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