Ekstasis Peer Consultation

Ekstasis is a peer consultation model for educators, brought to you by the University of Minnesota North Memorial Family Medicine Residency Program. It gets its name from the process of the presenter standing outside of the deliberations. The presenter is present and listening, but does not participate.

The model's reflective learning environment provides a venue for group building among peers, promotes a collegial atmosphere, and brings out the richness of the faculty group. It also creates opportunities for educators to build an inventory of local resources for educational activities.

Ekstasis structure and process

The Ekstasis model is structured to allow for deliberate reflection. Action steps can be kept as future faculty development activities for the group.

  • Group size
  • Process
  • Things to watch out for
  • Group size

    The structure is intended for small groups with an ideal size of five to eight participants. If there are more than eight participants, another Ekstasis group can be created. Or, the discussion can be held in a fishbowl format. It’s recommended to have peers from across various disciplines participate for an improved discussion.

  • Process

    1. Decide on a presenter. Then, appoint a facilitator to keep participants within the parameters of the session and a time keeper to manage time.

    2. Presenter presents the case. Possible questions to answer in case presentation (5 minutes):

    • Who are major people involved?
    • What are the formal relationships? Prior interactions?
    • Where is the senior authority on the issue?
    • What has the presenter done or decided not to do so far?
    • What would success look like to the presenter?

    3. Team asks fact-based questions. It's important to only ask fact-based questions in this step. Avoid problem solving (10 minutes)

    4. Team does diagnostic brainstorming while presenter watches and listens. Some possible questions to ask and discuss (15 minutes):

    • What are the stakes?
    • What are the underlying or hidden issues?
    • What are the technical issues?
    • What options are off the table?
    • How has the presenter contributed to the problem?
    • What interpretations have the presenter been unwilling to consider?
    • Why is the presenter concerned about the situation?

    5. Team does action steps brainstorming while presenter watches and listens. Suggested action steps* (15 minutes):

    • Doing the right thing
    • Doing the thing right
    • The right person to do it

    6. Reflections by presenter (5 minutes)

    *The action steps were borrowed from the article "A framework for developing excellence as a clinical educator."

  • Things to watch out for

    The following are some of the things to be careful about when a case is being presented and discussions are being held:

    • Presenter dominates the conversation, defending and explaining
    • Presenter may hide real stakes and anxieties
    • Team jumps too quickly to solutions, especially technical solutions
    • Team may be afraid to tell the presenter “bad” news
    • Team arrives at a consensus too soon
    • Everyone wallows around in the facts

Frequently Asked Questions

CAN THE PRESENTER JUMP IN DURING THE DELIBERATIONS?
No. The deliberate reflection is accomplished when the presenter is not part of the discussion, but is listening to the discussions. There is also a tendency for the presenter to come up with explanations to justify an action that can derail the discussion.

WHAT IS THE OPTIMAL GROUP SIZE?
The optimal group size is eight. If the group size far exceeds eight, we recommend a fishbowl model

HOW DO YOU ENSURE THAT THE PRESENTER IS NOT BLAMED?
Participants in the group discussion need to focus inwards, and use “I” statements. They should also ensure that there is no blaming of the presenter or the learner.

CAN WE HAVE MORE TIME IN THE MODEL?
It is recommended that the facilitator sticks to the time limits to ensure meaningful deliberations rather than endless philosophizing. This also ensures that participants are engaged in the model.

WHAT ARE THE GROUND RULES FOR RUNNING EKSTASIS?

  • Leadership creates buy-in to the process and need for peer consultations.
  • Groups dynamics are conducive to respectful deliberations.
  • The presenter should not be let off the hook. There is sometimes a tendency among colleagues to find excuses. Maintaining the structure of Ekstasis helps to create the appropriate deliberative process.
  • Keep the focus on the presenter.
  • Ensure that all the participants participate in the deliberations.
  • This is not a Morbidity & Mortality review of a clinical scenario. The emphasis should be on the educational milieu.

WHAT DO YOU DO IF YOU'RE STUCK?
One suggestion is to refer back to sample questions as a way to get the conversation going again.

WHAT IF YOU FINISH EARLY IN THE SECTION?
If you do finish early, and have exhausted all potential questions, you can move to the next section.

WHY DO WE NEED SECTIONS?
The sections are to maintain fidelity to the model and to ensure that the presenter goes into the deliberate listener mode. It is also to concentrate the discussion in specific areas.

IS IT OK FOR STUDENTS/RESIDENTS TO ATTEND THE SESSIONS?
We recommend keeping it at peer levels for an open conversation to occur. We also recommend a multidisciplinary model (when possible).

HOW DO WE GET PEOPLE TO PRESENT IN EKSTASIS?
We recommend local champions and senior faculty to be the initial presenters. Subsequently, the presenters can be decided alphabetically, on a first-come, first-served basis, or other arrangement, with an option for a faculty to ‘jump the line’ if needed.