6 • 2019 • Developmental Observer A Novice Trainer's Look: Shining Moments and Early Lessons Learned Dalia Silberstein, PhD Israel NIDCAP Training Center In this article I share my personal perspective on what NIDCAP training means to me. Not any training, but specifically that in which I became a NIDCAP trainer; in which my trainees and I did that very special journey for the first time. The article does not bring an all-encompassing perspective of that experience, but rather a few salient revelations that became important lessons for me. It does not propose a generalizable view of what NIDCAP training is or should be, nor pretends to offer clear-cut guidelines to the new Trainer. And yet, it might provide others the possibility to appraise and reflect on their own training experiences. The freedom to reflect "Freedom is nothing else but a chance to be better". — Albert Camus NIDCAP practice is about observing, articulating what you observed, and reflecting on it. The NIDCAP observation write- up, and its depiction of infant behavior in terms of the infant's strengths and sensitivities, developmental goals and suggestions for care, is no doubt one of the main "outputs" of a NIDCAP observation. A good write-up allows us to actually depict in our mind the intricacies and complexities that took place between the infant and the caregiver, and to grasp the infant's behavioral flow in a smooth, natural and logical way- even when we have not actually witnessed it. A NIDCAP write-up, thus provides a unique and quite structured window to infant behavior. Howev- er, it is the reflective process intrinsic to an observation - whether it is written or spoken - that affords us a window to the observ- er's (i.e., the trainee's) soul. I captured the wholeness and richness of the learning process involved in NIDCAP training, only when the trainees' reflec- tions were articulated and shared with me. Although I cherished reflection and have always felt affinity to the reflective processes involved in NIDCAP work, it was while guiding my trainees through the Advanced Practicum that I distinctly felt there is a hidden magic to it. Even when the trainees made huge progress and excelled in their observations and write-ups, it was only when they reflected about them that I felt their more vivid and multifaceted "selves" emerged. It was indeed in the reflections they shared that I more readily perceived each trainee's freedom to relate to her own experiences, insights and feelings in regard to the observation performed. That hidden magic of the reflection component of training, lays in the fact that when articulating it, trainees do not follow a specific structure or script, nor are constrained to address a par- ticular theme, or compelled to consider each and every aspect of the caregiving interaction. Quite the opposite. I prefer to think of the reflection piece of training as the one in which I prompt my trainees to actually "go wild"; the part in which they decide what they are focusing on – whether on their own feelings, the infant's experience, the family constellation, the caregiver's input, the environment, the shining moments they will cherish forever, or perhaps the mismatches they would rather not have witnessed. Every thought and perception stemming from an observation is certainly legitimate and beneficial for developing a trainee's reflective competences, and to deepen our understand- ing of each caregiving situation. The framework for reflection involved in the NIDCAP training process, and even more so, the formal requirement to write those reflections down, is a crucial component of training for a wide variety of reasons, one of them being the liberating experience it affords both to the trainee and the trainer. And yet, is a sense of liberation at all important for infant care in the NIDCAP approach? As we constantly evolve and improve our practice as healthcare professionals, we look for innovative techniques, refine our skills, and acquire new compe- tence. Nevertheless, for many of us the ability to reflect has not traditionally been an integral part of our training nor has been cultivated and respected as an important professional attribute. Even today, and in spite of the continuous evolution of our professions and work places, reflective abilities are not necessarily a valued component in a health professional's identity. Reflection on our own practice requires some dose of intro- spection, sensitivity, tolerance, open-mindedness, and readiness to slow down. It demands our readiness to abandon our zone of comfort and requires our willingness to look at a situation anew. It turns out that as NIDCAP professionals and trainers, we might often be invested in conveying a not so popular message in the intensive care scenario: that reflection is a fundamental tenet of good neonatal care. In this context, the reflective experi- ence afforded by NIDCAP training might well be the trainee's first "exercise" of an open and genuine reflection. By genuine, I mean taking the liberty and affording the time to wonder and to question, to think out of the box, to be humble and honest enough to be able to see both the lights and the shadows in each caregiving interaction. From left to right: gretchen Lawhon, master trainer, Adi Freund-Azaria, MOT, Abigail Marashli, RN, BN, Liat Michli, BPT, Andy Levy, RN, MN, Ita Litmanovitz, MD and Trainer, Dalia Silberstein, RN, PhD and Trainer. Developmental Observer • 2019 • 7 My first experiences as a NIDCAP trainer taught me that to foster and protect the trainee's liberty to think and reflect, is one of the trainer's more rewarding roles. "Tribal" power "Individually, we are one drop. Together, we are an ocean". — Ryunosuke Satoro My initial perception was that NIDCAP training is a learning and personal growth process that takes place essentially between two people: the trainee and the trainer. However, in my first experience as a trainer, the power of group work became clearly apparent. It turned out to be a critical - yet quite unexpected - ingredient of the training process. Our first group of trainees' ability to function as a consolidat- ed group was one of the group's decisive strengths. Regardless of each trainee's professional and individual characteristics, the group managed to make progress in a well- coordinated fashion. Much energy is invested by trainees who undertake NIDCAP training and integrate it in their already demanding personal and profes- sional lives. I believe this essential energy was maintained by virtue of the trainees becoming a group moving forward together. There was a "tribal" atmosphere to this initial NIDCAP training experience which enabled mutual motivation, reinforce- ment and support. While each trainee managed to keep her individuality and to personally imprint the process, they sponta- neously maintained an emphasis on the group's common goals. It seems to me that fostering the power of our trainees as a group is an important part of our role as trainers as well. After all, NIDCAP care is about strengthening individualities (the infant's, the family's, the trainee's) while reinforcing a sense of belonging and being held. A microcosm in each Advanced Practicum (AP) "If everyone would look for that uniqueness then we would have a very colorful world". —Michael Schenker I learned that a fraction of life's complexities is represented in each and every Advanced Practicum experience. When read- ing our trainees' APs, it was as if each of them provided me with a fine telescope to look into a delicate, detailed and ever chang- ing microcosm that, otherwise, would remain distant and out of sight. It is in fact the emerging story of an infant within his or her family that is captured in that sequence of observations that conforms to the Practicum. As such, the AP provides both the trainee and the trainer with the opportunity to look closer at that microcosm and, if fortunate enough, to be able to contribute to a better beginning for that family. At some point, I intently tried to capture that ultimate single essence I believed there was in each observation and each AP I read. At a first glance, that may seem like an inappropriate simplistic approach to a complex phenomenon. Yet, this kind of "synthetic" thinking, in which I tried to identify the core, the very essence of each infant-caregiver interaction, was extremely helpful for me. I thought it could perhaps be so for my trainees also. I learnt that the mental exercise of giving an imaginary title to the observed interaction, contributes to the reflection process. For I realized that even long and complex essays have titles; deep and intricate poems have titles; refined and detailed research studies are given a title. In my view, giving that imaginary title - to what is observed and experienced in NIDCAP observa- tions - does not necessarily reduce our understanding or lacks the possibility of a broader insight, but rather helps us to focus our reflection on the topics we would like to emphasize in the train- ing process. Thus, when observing an infant or while reflecting and giving feedback on a NIDCAP write-up, I often asked my- self, and prompted my trainees to ask themselves: "what was the infant's main message"; " is there something the infant is saying sound and clear?"; "what would be the headline for the infant's story in this specific observation?". There was therefore an essence to capture by each trainee in each of their APs. For one trainee, it was about finding the strength to engage in a new and fresh relationship after experienc- ing the loss of the baby she originally attempted to follow and support. For another, it was about developing the endurance and resources that were necessary to sensitively guide and sup- port a baby girl that did medically well, yet had a very prolonged hospitalization. For a third trainee, it was about the challenges of supporting a baby whose parents spent limited time in the NICU, and about the concerns that arose during the home visit. And still for another trainee, it was about creating the necessary confidence and closeness to properly support a single mother of twin girls. The construction of dialogue "Give me the gift of a listening heart". —King Solomon We bring our own perceptions and mental working models to the NIDCAP training process. As trainers, we need to be careful and have a better understanding of our trainees' perceptions, while also making our own ones explicit without assuming they would be taken for granted. The process of giving written feedback to observation write-ups provided me with an excellent opportunity to learn that. Trainees seemed to be quite unfamil- iar with discussing a text (the write-up) to which many margin notes and topics for reflection were added. Coming, as most of us do, from formal educational systems in which the neater and less corrected a piece of work is, the better - I realized they were challenged by my notes and commentaries. They seemed to think that their work might not be good enough if they got notes and remarks. That required from me to further elaborate and explain my own perception of what is a good fundament for trainer-trainee exchanges. I consider margin notes and com- ments as an intrinsic part of the training process. They are to be viewed as still another way to develop an open, free and creative "dialogue" between a trainee and a trainer. This might prove especially meaningful and useful when a trainee and a trainer are able to share only limited time together at the bedside or in face-to-face conversations, as is the case in many training experiences. There are actual persons behind my reflections. They are Abigail, Andy, Adi and Liat - our NIDCAP trainees – and Ita, my NIDCAP companion, co-trainer, and Training Center co- director. I have learned from them all.