The Step-Back Consultation

In the last few years, Dr. Robert Kegan, from the Harvard Macy Institute for Physician Educators, has pioneered a new model of group consultation called the “step-back consultation.”

This process will be used to discuss your proposal’s goals, objectives, methodology, and evaluation, as well as any issues or obstacles you face.

You should approach this with an eye to sharing, learning, and benefitting from the group to refine and improve your projects.

This is how it works — 9 approximately 30-minute consultations per project

1. The presenter will describe the proposal’s goals, objectives, methods, and assessment plan in 10 minutes (eg. elevator speech; SBAR).

This is also an opportunity to describe whatever obstacles you face or questions you have about your project.

2. The rest of the group may ask only clarifying questions of the presenter and hear answers for no more than five minutes.

3. For the next 10–15 minutes, the presenter “steps back”, becoming an observer.

The group takes on “ownership” of the proposal as if it is theirs.

The presenter’s job is to remain silent and observe actively. He/she may keep notes of ideas and internal reactions.

4. For the same 10–15 minutes, the rest of the group takes on the project as if it were theirs. What are they going to do? How will they prioritize? What obstacles do they see? How will they overcome them? What would they add to advance the work?

5. For the last 5 minutes, the presenter is brought back into the conversation.

He/she can say what it was like to sit back and experience others temporarily taking on their project. What did it lead him/her to think about? What did he/she learn?

What’s the idea of having the presenter talk so little?

In Bob Kegan’s words, “the more the presenter talks the more he/she will shape the discourse in the room to resemble the way he/she is already thinking. New ideas don’t get in. Since the goal of the consultation is for new ideas to get in, the presenter needs to be warned that the role of the silent listener is perhaps a very difficult one.

Those presenting their projects will inevitably feel that those responding “don’t really understand”; “need more details”; “would not be saying these ridiculous things if they only understood my context better”; etc. etc.

The presenter should remember that feelings reflect how difficult it is for new ideas to work their way into their mindset.

The goal is for the presenter is to get a few ideas out of the many that will emerge and that he/she thinks will be worth some further consideration.