October 23, 2013By Lance Baily

How To Overcome Camera-Shy Simulation Learners

A stranger shows up unannounced at your house Saturday morning with a camera crew.  He requests to video an immediate interview in your house about your greatest weaknesses. Would you let them in without a single hesitation?

Now, do you expect your simulation learners to answer that question any differently?

Simulation asks a lot from learners, much more than just acting professionally and performing well. They must also knowingly enter and maintain legitimacy of an unknown and fabricated environment.  All of which must be done under the watchful eye of peers and supervisors (or faculty).  And sometimes that watchful eye is the only element putting learners over the edge.

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So if we do not relax the anxiety that some learners have about being video taped, they will only ever provide whatever mental commitment is left after the “you are on camera” thought process continues to occur.  And then we aren’t utilizing simulation to the full potential of the learner, the lab, the facilitator or the program. So how to cure the camera shy?

Having worked for years in the film business I have had the opportunity to work on dozens of documentary productions.  The amount of work that usually goes into capturing a single shot can be staggering.  Hiring a crew, scouting a location, securing interviews, renting equipment, planning logistics, crafting food services and keeping everyone motivated is a job in-and-of itself.  With the right training and experience, almost anyone could do that portion of the job.  But to tell a new story, one that was unique and breath-taking to the audience, a documentary film-maker must have something no one else does: access.

Getting unfiltered access to a subject means building a relationship of trust, one where everyone is so comfortable with each other (and the camera) that normal everyday business is just unfolding as usual.  With that kind of access, with that kind of trust, no one is worried about the camera, about being recorded, watched or analyzed.  So while some individuals will not be camera shy, most learners will benefit from the additional training necessary to adjust into a recorded environment.

An individual uncomfortable with being filmed is consciously spending mental energy devoted to remembering they are on camera while trying to do other things.  Alternatively, great actors provide an example of individuals who have accepted and let go of the fact that they are being filmed. You can literally see their complete mental energy dealing with whatever moment their character is currently faced with.   A performance unfolds as real as any in that moment, with flaws wonderfully adding to the character’s third dimension.

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There are two key avenues to combat the “I hate being on camera” issue.  First we have to build a supportive yet intoxicating space for the learners to share themselves unconsciously.

Creating a supportive environment where learners know they will not be punished for making mistakes is an overarching and long-term process.  A feeling of safety is not something that can be created on the spot. Rather, building security should be initiated weeks or even months before a person steps foot into the simulation lab.  In a few weeks I will post my articles about how to build a supportive yet constructively critical environment for learners and how to build program legitimacy, discussing the struggles and benefits of long-term program development.

By creating an intoxicating space learners become so focused on the work and needs of the patient that they literally forget that they are “on camera”.  This too will be discussed in length in my upcoming article “Real Simulation”.

Secondly, we have to provide learners with a way to overcome stage fright by lessoning the stigmata of power that comes from a camera, without removing its authority.  Spending years learning from Hollywood masters about the art of documentary film production, I can share two ways to lessen the power of the camera (yet in our case not removing the authority it has to expand perspective).

The first of these techniques is easy for supervisors/faculty: always have a camera around.  Bring a camera and hand it off to someone to record morning staff meetings, or record classes in the Nursing school by setting a camera on a tripod in the corner.  Some individuals become nervous around a camera because they are not often recorded.  This technique is heavily used by professional documentarians to acclimate subjects who under normal circumstances perform actions or speech that is NOT being recorded for a wider audience.  If the presence of the camera makes the subject nervous or uncomfortable they will not be their ‘normal self’ and the footage will not reflect the story the film-maker organically witnesses unfolding before them.

One of my professors at UC: Santa Cruz regularly brought a video camera to a subjects house and set it up for dozens of encounters without ever pushing the record button.  The presence of the camera was provided for the subject to become comfortable with that presence.  And so by having a camera around and recording (even though no one will ever watch the footage) learners are casually provided opportunities to become accustom to the camera’s presence, lessening its power to affect their mental states later on.  Imagine a learner responding to the fact that they will be recorded in simulation and saying “how is that different from any other day around here?” Now you have more access to their concentrated performance!

Camera fear can be eased with yet another powerful technique that may be more difficult for your faculty/supervisors to deal with: showing their own ‘difficult-to-share’ simulation experiences. In chapter twelve of the helpful book High-Fidelity Patient Simulation in Nursing Education Keston et al suggest that:

“Students frequently find high-fidelity patient simulation intimidating and anxiety provoking.  Providing an orientation to high-fidelity patient simulation may decrease their apprehension.  Having students watch former students or instructors caring for the simulated patient can provide the current students with an understanding of what is expected.”

I would take this thought one step further.  Imagine allowing learners to see you or another supervisor entering into an unknown simulation scenario where a mistake is clearly made.  Wow! While you become immediately more human (and more trustworthy) to the learners, simulation instantly becomes a safe space to discover and explore healthcare without fear of everlasting consequences.  As the group watches you (or another supervisor/faculty member) unknowingly error they begin to realize the video recording can help provide an unbiased perspective on the moment in question. However, it is important to remember that as the learner group gains empowerment by “sitting on this side of the fence” you must keep their discussion free from negative based criticism.

So to wrap-up, you are guaranteed with every learner group to have at least one individual uncomfortable with the idea of being recorded.  Program legitimacy and specially trained facilitators who are aware of this issue are crucial to building a foundation for easily undoing this knot of anxiety.  But you can also lessen the power the camera holds in these individuals minds with two techniques common to film-making:

1) Make the camera a visible and unwavering presence in their day-to-day activities.

2) Showing how the camera provides a benefit to all ranges of healthcare professionals that provides an expanded yet unbiased perspective.  And yes, demonstrating to learners how the camera and the simulation process an help everyone, even supervisors/faculty such as yourself!

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