Additional Points to Ponder:

• Students, Stress and Learning

• Test and other Anxiety

• Learning Disability

• Intercultural Communication: A Short Course

 Students, Stress and Learning:

Learning in the medical school environment is full of pressure to perform and to coordinate a seemingly endless series of competing responsibilities.  Stress can be a great motivator, but finding the right balance for competing interests can become a continuous struggle.

Balance lies with maintaining a learning environment that is challenging but not threatening.Fellow students, faculty and advisement staff can play a role in creating this positive environment.  Either too much or too little stress can inhibit learning, remember that stress is defined differently for everyone.  Ineffective stress control mechanisms are often employed, however, because of a lack of understanding combined with a lack of confidence in an ability to perform.  “Defensive avoidance” is a common practice: where you avoid studying and avoid completing assignments in order to reduce stress.  A helpful intervention for defensive avoidance is “stress inoculation” whereby you make sure to have all course materials, timelines, and due dates, so that you know what to expect; also look for timely feedback on your performance and progress, which will result in a feeling of some control over course activities. 

Ask for this information if it is not immediately made available to you.  Much course material is available on course web sites, but there is little substitution for a face-to-face visit with your instructor. For more information, contact Cheri Koinis, M.Ed., Manager, Student Learning Support, BMSB B80, 272-8028, ckoinis@salud.unm.edu.

 Test and other anxiety:

(Adapted from Whitman, et al, 1997)

Test, or performance anxiety, is often related to inadequate course work preparation.  Along with improved study habits, time management, and monitoring of self talk, you can develop specific skills for coping directly with this anxiety.  The anxiety spiral is controlled through specific behavioral and cognitive techniques.  (O’Neil, 1979, p.127) 

I.       Understanding the anxiety spiral process. 

(Barrow, 1986, p.146)

Effective strategies for recognizing and controlling the anxiety spiral:

1.  Bibliotherapy.

Read books and articles describing the phenomenon of test anxiety.

Naming an emotional overload is often more than half the battle, as well as understanding that your condition is normal and shared by many other students.  When you learn to identify and control your self talk, you are well on the way to overcoming your anxiety. 

2.  Early Detection Training.

A.  Situational Cues.  You can learn to improve your ability to identify conditions when problems are likely to occur.  “Awareness that they are entering a troublesome situation can then cue them to begin using or preparing to use coping strategies.”  (Barrow, 1986, p.150)

B.  Physiological Cues.  Identified and learned through discussions, homework exercises, monitoring, role playing, and imagery exercises.  These cues can help you learn to “tune into what happens early in the anxiety spiral that can be a tip that anxiety is mounting.” Common cues:  “Butterflies” in stomach; fast heart rate; cold hands; perspiration; dry mouth; tense skeletal muscles, especially in the face, neck,                    shoulders, back, and stomach. (Barrow, 1986, p.151).  Learn to tune in to these changes, and adjust your behavior appropriately, as with relaxation exercises.

C.  Cognitive Cues.  This refers to an awareness of thought patterns that are associated with spiraling emotions.  Sometimes the unproductive or even negative thoughts can be identified before the physiological symptoms occur.  

D.  Behavioral Cues.  Certain behaviors are themselves the result of a spiraling string of emotions.  For example:

• anxiety about being evaluated might lead you to avoid all instances where this may occur, such as public speaking, tests, writing assignments.

• learn to recognize these avoidance behaviors, letting them serve as a cue to begin coping strategies.

II.      Beck’s Three-Tiered Approach to dealing with Irrational Beliefs:

According to Albert Ellis, irrational beliefs (Prichard, 1994, p.137) are often at the root of anxiety, especially for students.  Irrational beliefs are illogical and exaggerated thoughts including extreme and absolute words, such as: 

Self-talk is an important element underlying the experience of anxiety.  Once you learn to recognize negative or non-productive thought process, you can use Beck’s three-tiered method to alter the pattern.

Step 1:  Learn to recognize a negative thought process.

Step 2:  Identify faulty reasoning patterns in the automatic thoughts. For example:

dichotomous thinking: thinking in black or white, i.e. total success or failure

over generalization: difficulty with one test question means they will not be able to finish the whole test.

Step 3:  Then learn to control your thinking by stopping the automatic thoughts and thinking errors and identifying faulty thought themes.  This is accomplished by use of the “what would it mean to you.....” technique to draw out your belief system. What are the worst possible outcomes? As diagramed below.

• Learn to reorient your thinking to more positive expectations
• Humor can be useful to aid in changed thinking
• Relaxation training is also useful to calm the anxiety so you can focus on the present. 

• Remember:  It is important to find a coping strategy that works for you, own that method and use it appropriately.

Learning Disability:

 Formal Definition:      A permanent neurological disorder that affects the manner in which information is taken in or received, organized and remembered, and then retrieved or expressed. 

What this means for you as a student:  Learning disabilities may surface in an educational setting through the basic functions such as memory, oral expression, comprehension in lecture format, organization of thoughts and concepts, and retrieving information and expressing knowledge either verbally or in writing.  These processes show up in all academic areas of reading, writing, spelling, logical reasoning, math, oral communications. 

True learning disabilities do not go away, however, inconsistencies are common as students learn over time to compensate for their individual differences.  To fit the diagnostic criteria for a learning disability, intelligence must be measured at average or above.  Disability does not prevent learning, although some students may need special accommodations.  All academic areas are usually not affected, as students may show strength in some areas and weakness in others.  For example, a student may be strong in math, but weak in reading comprehension and writing, or may understand concepts well but do poorly on tests. 

Indicators that could suggest the presence of a learning disability:

Indicators are varied and individual, some may include: working hard in class and feeling you know the material, yet still doing poorly on tests; consistently overloading on course schedule, or taking courses without planning; poor self management skills; repeating classes, withdrawing from or taking incomplete in many courses; high levels of test anxiety, finding there is not enough time to complete tests; academic history of special education support; anger and frustration because of spending large amounts of study time with lower results than peers.

What kinds of help are available?    You are the best source of information on your learning needs.  Some accommodations are simple: additional time for academic tasks, help with providing alternate formats for studying options.  

More information:  At UNM School of Medicine, make an appointment with Cheri Koinis, M.Ed., Manager, Student Learning Support (SLS), 272-8028, or ckoinis@salud.unm.edu. 

Students are formally evaluated at the UNM Learning Support Services, Center for Academic Program Support, Zimmerman Library (277-8291);   Disabled Student Services, 2021 Mesa Vista Hall (277-3506); and Equal Opportunity Programs, 1821 Roma, NE, UNM (277-5251).         

Intercultural Communication:  A Short Course

1.         What is communication?

Communication is a process involving the exchange of information.  Successful communication requires a transmission of meaning, and that understanding and acceptance also occur.  The role of receiver and sender is interchangeable because the roles keep changing and interchanging.  Because the ultimate goal of communication is acceptance of the message, some modification of original message, using feedback both on the part of the receiver and the sender may occur.  This is especially true of cross cultural communication. It is essential that you check for meaning and understanding.

2.         Communication and the classroom.

Communication is natural among people but misunderstandings are common.  The classroom is one of the worst places for misunderstanding to occur.  According to Stanley (1987) disastrous consequences may occur, such as: damaged relationships between learner and instructor, loss of confidence in the learner, loss of the instructor’s credibility, and confusion, disappointment, or despair on both sides.

Communication Style: Learner and Instructor It is important to realize that the communication style of your instructor can conflict with your preferred communication style. (Phillips, 1983)  For example, important differences can include:          

• wait time between utterances (how fast or slow do you talk?)

• how a person gains attention    

• how a person acknowledges that a message has been understood (verbal, and non-verbal)

• how people take turns in a conversation

Pay attention to both classroom and tutorial communications, between faculty and fellow students.  Miscues can lead to inappropriate responses on the part of both students and instructor, a seeming uncooperative atmosphere, and subsequent potential for lack of respect. Whereas good communication can build trust, shared decision-making, good peer learning and teaching, and confident learners.

3.         Barriers to effective communication.

 Stanley (1987) describes some barriers to effective communication in the classroom:

• Poor listening.  On the part of instructor (sender) or student (listener).

• Information overload.  Student or instructor (receiver) may become overloaded with information and the pace of presentation.

• Poor sequencing of presentation.  A jumbled presentation can interrupt the learner’s concentration.

• Semantics.  The use of language without precise meaning.  A lack of clarity in presentation.  Statements that are too general may cause misunderstandings of content.

• Distancing.  The instructor may appear too distant from learners.  A misunderstanding of intention may result in loss of content on the part of learners.

• Mental set and trained incapacities.  The practice of selective retention on the part of learners.   People tend to retain information that relates to something they already know, or that fits their belief or mental system by training.

• Anxiety and fear.  This is especially true of learners that have been out of the classroom for many years.

• Lack of interest.  A problem of motivation for the subject content.

• Outside distraction.  Problems with the learning environment.

• Lack of background information.  This involves learner characteristics that can impact your learning.  

• Self Concept/Self Image.  Learner and instructor comparing themselves to one another and forming judgments can affect communication in the learning environment. Conflict may arise if the learner feels threatened by the instructor’s attitude, expectations, or classroom communication style.

4.       Intercultural Communication.

Defining culture: A social system consisting of learned behaviors, artistic traditions, technological achievements, communicative techniques, religious beliefs, philosophical concepts, even genetic characteristics.  (Sitaram, 1976, pg.19) 

Defining intercultural communication: Interaction between members of differing cultures, creating the possibility that the value systems of the interacting members are so different that real understanding is quite difficult. 

Elements of communication that may be affected by culture: Perception, information retention, pitch, articulation, intelligibility, translation, and dialect.

Non-verbal factors in intercultural communication.

Personal space--that distance characteristically kept between people in various cultures; symbolic of the nature & extent of relationships between people.

Smile--shows pleasure, almost universal in meaning (also frowns), can also be used to indicate scorn, ridicule, or contempt. Can also signify discomfort or embarrassment.

Posture--associated with a person’s frame of mind and general attitude about themselves, varies by culture.

Smell--associated with type of food consumed, among other things.

Eye contact--very basic and varies by culture; can show respect either looking straight  at another or looking away depending on cultural context.

Touch--specific to culture; closer personal space cultures touch more to communicate.

5.       Communication and medicine; cultural competence in health care. 

            Good communication between patient and health provider is essential for providing and receiving good health care. The practitioner brings a wealth of medical knowledge to the clinical setting, but only the patient really knows what their symptoms are, how long the duration and how intense, and other pertinent diagnostic information.  Patients need to feel comfortable in the health care setting, in order to communicate freely and honestly with the health practitioners.  It can be helpful to verify communications and ask patients what their concerns are, and to be aware of family needs.