GNS US 2025: Lessons from a 52 Year Old Cheerleader: Connection, Communication & Collaboration

Clara Song, MD

Narrator:

Welcoming Doctor Clara Song. Neonatal intensivist with the Southern California Permanente Medical Group, Doctor Song leads simulation based training for critical neonatal events and organizes Permanente Medical Group Grand Rounds in neonatal perinatal medicine across 16 NICUS in Southern California and Hawaii. She is board certified in General Pediatrics and Neonatal Perinatal Medicine, and holds a Lean Six Sigma Black belt.

Her interests focus on digital education and systems improvement. Previously, she served as Director of Education and Advocacy at the University of Oklahoma Health Sciences Center, where she pioneered simulation based neonatal resuscitation training. Doctor song was the inaugural Chair of TECaN, the Trainees and Early Career Neonatologist group. She currently chairs the executive Committee of the American Academy of Pediatrics section on Neonatal Perinatal Medicine, and has held multiple leadership roles supporting innovation and career development in neonatology.

Please welcome Doctor Song.

Doctor Song:

Okay. So I know it's after lunch. We're still in the postprandial kind of lull here. All I want you to know from this slide is that I am a Star Wars fan.

Also, I also want you to know that not. Yes, yes, Star Wars fans that. Yes. So that not everyone, really welcomes this unsolicited advice. So just, you know, take it with a grain of salt. Whatever helps you, helps you, whatever you don't need to know. You don't need to know. Right. Because you're all experts and leaders here.

So Doctor Patrick Winston from MIT, he was a professor of AI and computer science back in the 70s. He was a pioneer. I also was a pioneer, I guess, but he was a real true pioneer, and he said mainly that it is your ideas that are very important, but more importantly, it's how you express those ideas that really suggest what kind of success you will have in life.

And he was most remembered for this annual communication lecture that he gave at MIT for over 40 years, which was also published by MIT press. So travel back in time with me a little bit. We're going to go back to 1989. I was at a very small high school, newly formed. This is the first ever varsity song leading squad.

There was only five of us. I'm going to say cheerleading just for ease and. You know, not any miscommunication. So the next year, our senior year, we doubled in size to ten, and then we won our nationals, our first nationals ever in Florida. Before I go any further, is there anyone here who does understand high school sports and cheerleading?

Yes. Woo. Okay. Yes. Yes okay. But there's a significant amount of people who do not I realize that this is global. So in high school, especially my high school, I went to a very small Catholic private high school. They're very invested in their sports. Right. And this is how many students get to college, you know, on you know, scholarships for sports.

So the cheerleaders are pretty important. We're the inspiration. Like we get the crowd going, you know, we figure out and watch what's happening. So this is where I learned. And I was telling Teresa earlier, I was also don't mean to brag, but high school valedictorian, if you know what that is, that's pretty important too. But that's not what I remember.

I remember being a cheerleader, and this is where I learned that every form of communication, all conversations, are based on teamwork. And it's essentially a presentation of your ideas and their ideas. So the key is to go all in, right, to go full out what we call full out in the dance world, because teamwork really does make the dreamwork.

That's why they say that. All right. So I will assume based on all of what I've seen today, this basic assumption, we do this for every simulation based training. You know, just so that we know I know you are all smart. You're capable, you want to do your best. And we're just going to go review kind of foundational, maybe some obvious things that we forget over the time as we become experts and so highly skilled in our field.

So as I said, there was, simulation based training is where myheart is right now. I'm at Kaiser Permanente and I lead a group to team train all of the 16 neonatal, units in Southern California and Hawaii. And this is my team. We have a train the trainer program. We train essentially once a month.

Right. I'm also the chair, the current chair of the neonatal section over at the AAP. So that's a much bigger team and a different sense of communication. So connection communication and collaboration. Let's walk through three. What in the 80s was pretty common. Cheers. So if you remember it, go along. If you don't no problem I'll explain it on the way.

So we always start every cheer like so has anybody seen a cheerleading movie or Netflix. Right. And we say ready okay. That's right okay. So this one is shoot for two. Shoot for two. Oh, you know there's one shoot for two, right. What is this for this basketball. Right. Okay. But we don't say shoot for three. Right. Shoot for three would be better because that's more.

But we say shoot for two. And the reason is and let me indulge me a little bit while I go through memory lane. This is, yes, the winning routine. I'm short, so I'm always on one end or the other. But we're doing this kind of thing and, am I in the middle? Yeah, we've got the little shuffle.

Right, because we've got Doyle in the middle, and her job is to get us square and center. Right. We want to start strong. So start strong in a presentation or really in a conversation, whether it's with one person, ten people, a thousand people, you kind of want a first off or we have to disclose but also acknowledge, acknowledge the other person, acknowledge who I am.

And just like many of the speakers do today, you acknowledge and have gratitude right at the start, right? And you say, this is who I am. And I'd really like to thank either you who I'm speaking to or the people who came before me, or whoever taught me whatever it is that I know. So start strong. Have a strong foundation.

Practice, right? We practice hours and hours. I think I practice more than I actually study, right? It goes all year long. We're going through the summer 4 to 6 hours a day, every day, 2 to 3 hours. So all year long. So really more than homework. So practicing and understanding that it's a learning process. It's going to happen forever right.

We're learning. We're lifelong learners. I want to make a mention of something called the GEMBA walk because I've also studied and Lean Six Sigma, which is very helpful for team building and improving change. So the GEMBA Walk is where you kind of walk the floor of where all the action is happening, right? We don't want to be at the top of whatever ivory tower we think we may or may not deserve to be at, but just walk around and see what is actually happening with the people who need this information.

Right. We just heard, you know, consumermisconception, misperception is a really big issue. So we've got to walk the walk on what it is that they're seeing from their side. Okay. Walk the walk. Understand by seeing other people's perspectives. Right. Seems pretty normal. Seems pretty like duh. But it is. It's not as easy. You know, in practice.

Okay. Who knows? This next one, popularized by a nice movie called Bring It On. Yes. Be aggressive, be be aggressive. Right. Be. You can't say okay be be. Yeah yeah. That's right. Oh you finish it off for me I love it. So this is this is a strong start right. You got to like really good at it. Who am I I'm here right.

It isn't like oh we're going to do a little. Yeah. You you want a strong start. You want a strong foundation. You want to start strong and you want to end strong, okay. Because then, you know, the middle part might get a little messy and that's all right. Right. But you want to know where you are and what your intentions are and when you're going to end up okay.

Okay. So here watch the faces Mostly the mouths. We call that facials right. And dancing like we are all in this team is like they've got their heart in it. They've got their arms and legs. Their heads are moving and you can see it on your face. So the goal really is, to focus, pay attention when you can just be all in whatever that means for you, right?

Bring your best self every single time. Go full out. When we dance and practice, we say, oh, we're going to mark it right? We just like mark the steps, be aggressive. Right? But go full out means like that’s. Every practice you go full out as if you're going to have that competition day. Okay, be all in, go full out, trust your gut.

Just bring your whole self, whoever that might be. Your best self.

Okay. We're going through a formation change here all along. We're all going in different directions. Everybody's doing something different. And then we come together. I like this kick line all together. Right. So the point of this is that, you know, just be open because there's lots of different ways to get to the same idea or the same kind of common ground.

Right? I like to think that I'm usually right and I'm probably usually right. Right. Like, why wouldn't I be right? But then that other person is probably usually right too. They think that they're right. So we're all right. We just have to understand that we're coming from it in different directions. Okay, so this is a little bit of a commercial pause.

The bluff is the bottom line up front. You know when you're doing a presentation we like a bottom line up front right. For different kinds of learners and different kinds of communicators. So as you've seen in many of these expert presenters, you saw something at the top, right? This is what this shows. And this is all the supporting data at the bottom.

We don't want like too much in there. We want to be able to focus because it's either death by details or death by PowerPoint. Right. We need to know at the minimum the bottom line up front, so many of the slides have already looked like this. Right. You got the theme at the top.

And then our goal is to get our message across without challenging the cognitive load of our recipient. Right of the audience. Right. Don't challenge people. Right. You know, eliminate the excess if you can. So remember I try to remember this, like what I see on my computer screen may not be what they see on the projector. Right.

So we try to help whoever is learning, that's the GEMBA walk. So like, you know don't do blue on black. Right. We don't need a bruise. Consider like QR codes. Yeah. That might be easier if they want to follow along or for later. I always, I always emphasize media, if you can, to replace words like it's sometimes not possible, sometimes it is, you know, but it is a thousand words.

And then again, decreased cognitive load on people. We don't want to stress anybody out. Where am I supposed to look? Emphasize right. Emphasize that okay. Quick question. This is not a poll. This is just a hands up sometimes I feel like the conversation could have gone better. That's me. Anybody else? Me too. Yes. Me too. Anybody's like, know all my conversations are great.

Yeah. Okay. Yeah. Like me too. Right. Okay. Okay. So last year.

People love this year. And I don't know why. Wait. I did it too fast. Everybody loves this cheer. It's secret. Cheerleaders don't love this year. But we do it because people love this cheer so much. So it's. You got spirit. Yeah. Yeah, you got spirit. Yeah, yeah. You got what what what what? Imagine ten people around me. What what what you got spirit.

Oh, somebody knows it. That is, like, such a crowd pleaser. Okay, so look at what's happening here. This is it. We're back to the beginning. That's Doyle off center. Did you see her lips move, she's saying. Something at the beginning, right? She's our junior most member, Doyle. But she's the tallest and she's the center. And she's supposed to get us like, right at our strong start.

But she says at the beginning, she says, go, girls. I love you guys. Right? Anybody can step up to be a leader. You guys are already leaders in this group, but you can be the inspiration that other people need.

Okay, some of us did a high kick. Some of us are doing these fouettes .Not Everybody can do those turns right now. Remember this is 1991. So like pretty much all the girls can do these now. But back then it was a really big deal okay. So yeah right. It was a big deal. So you want to emphasize what's different about all of us and then raise that up.

Right. We don't all be the same. That's so boring. So another commercial break here. So along the lines of what Patrick Winston said, there is something called the Mehrabian communication model. And this essentially says is that the way that you communicate an idea is much more heavily remembered than what exactly you say. We're not saying that the words aren't important or that the content isn't very important, but what people will remember is just as the great Maya Angelou said, people will always remember how you made them feel right?

They might forget the other stuff. So what I try to remember is I try to remember to look at the people I'm speaking to. Right? I kind of do like a three part situation back and forth, up and down. If you get a little bit nervous, you can kind of do the trick with the ice water, adjust your space and make sure you're, you know, looking at everybody so you can be the inspiration that inspires you.

All right. So I've already been talking for more than ten minutes. And this is pre Twitter data ten minutes. Like I've lost half of you already I understand that. And this is my reminder to see if people have a pen and a paper. TLDR means too long. Didn't read right. So if you send emails that are too long, they might not be read.

So pen and a paper everyone. If we have time, we're going to do an exercise. And a think together. But we're going to shift over to the game changer which is teamwork. You don't need the paper now, but you will soon. Okay. So in the simulation space we understand that it is human error and communication that is the root cause of most things that go south.

They have known this for decades, right in the aerospace industry. This is data from 1981. Now in the neonatal space. We also know that this is a problem. Communication is the number one reason of the things that we know that have gone bad, right. And the Joint Commission has also over the decades, identified back in 2016 23 here that communication, teamwork, leadership and human factors, those are the top reasons for sentinel events and things that don't go the way that we'd hope.

Right. So what makes the team work? Well, it's the same stuff that makes the team break, because the fact is, is that we're all human. We all make mistakes, right? It’s going to happen? So it isn't about, you know, are we going to drop the ball? Is there going to be a fumble? Like a fumble is going to happen.

It happens to the greatest of all time, right. But it is how we react to that. How we keep going, how the team responds to keep an eye on number 21 and 23 here like this is the common goal we're going for and then 21. Goes eugh. Everybody needs a 21 to make that touchdown. Right okay, another quick question.

I know my communication style or my personality palette etc. something that shows how I react to the world and how I'd like to receive information from the world. Yes. Me too. Anyone? Yeah. No. Everybody's like, I don't know what you're talking about. Okay, a few of us, okay? I don't know what you're talking about. Okay, I like it. okay.

This is where the pen and paper come in handy. Okay, so this is what I call speaking to the rainbow. Different colors of communication. So this is what's called a pace communication scorecard. Now we'll delve down a little bit deeper. We'll do it together. What I'd like for you to do is make five rows and then a bottom line, because you're going to start making totals for those rows.

And then we need four columns. So what we want to do essentially is we're going to go across first and then we're going to go down. So we'll start this and I'll read through it with you. But just go with your gut. Like don't think too hard about these answers. So start reading for me if you will.

The first row. Now what we'll do is we'll read across together. And I would like for you to think of number four as most like you and number one as least like you. So if there's something in there that spontaneous, impetuous, impulsive, if that is totally like you, put a number four. If you're like, no, that's not me at all, put a number one.

And then, so on and so forth. For those four in that row, anything in the middle assign like a 2 or 3. Right. Kind of like you. Not so much. Right. That's a three and a two. So the next is stable, methodical, planner, cooperative, idealistic, sincere, rational, curious, complex 1 through 4. Second row. Adventurous. Daring. Hurried. Next. Traditional. Responsible.

Dependable. Next. Box. Faithful. Compassionate. Inspirational. Next box. Logical. Analytical. Loner. Third row. Loves. Excitement. Explorer. Unpredictable. Next box. Dutiful. Teacher. Industrious. Next box. Authentic. Empathic. Motivator. Next box. Intellectual. Inventive. Problem solver. Okay, we're going to the fourth row now. Ready? Still with me. Jokester. Energetic. Expedient. Next box makes rules. Orderly, well prepared. Next box. Supportive. Self award.

Caring. Next box. System. Thinker. Independent. Perfectionist. That might be all of us, right? Fifth row, bold, witty, risk taker. Next box. Loyal. Reliable. Likes. Structure. Next. Romantic. Flexible. Kind. Next box. Theoretical. Ingenious. Individualistic. Good. Okay, here we go. So each of these correlates with a certain color. And what I'd love for you to do now is to take each column and add the totals within each box.

Add or make a total from all the numbers in each box. These are the colors of communication here.

So we'll go over the first one; red if you had mostly. And you'll notice that maybe you have like 1 or 2 columns that have the highest number. Right. So if you had your highest number in the first column we're going to remember the red communication style. Right. And there may be 1 or 2 that are like even kind of tied.

So this is the adventure style. These are our innovators, our visionaries, our big picture thinkers. These people love a challenge. They're very action oriented. They love a bluff.. Right. So yellow is our responsibility type of communicators. They are traditional. They abide by the rules. They have a very strong work ethic. They know right and wrong. Then they have a very clear imagination of that, a little resistant to change, however dependable and punctual.

So the third row, if that was your highest score, this is a blue type of communicator. Blue is the harmony communicator. These are our people people. This is the glue of a team, right? These are the people that make sure everybody feels A-okay in a team, right? They are great at conversation. They really pay attention. They love the kids.

They love the dogs like the everybody loves a blue, right? Everybody needs a blue. So the green the green is curiosity. These are our engineers, our scientists. I see a lot of greens in here. I've already seen it. A little bit technical. They love a manual. Right. So they're going to read before they start jump into something they don't want to look stupid though.

That's kind of the nightmare of a green. So if you like Star Wars this is how I see people and Star Wars characters. But this is the MBTI. This is the Myers-Briggs personality chart. Okay. Someone's gone. Yeah, I see that right. So our adventure people, right. These innovators, very generous, spontaneous, witty. They kind of like jokes.

Right. So our classic adventure Star Wars type is Han Solo, right? Who doesn't love Han Solo? But he's a little bit messy. But he'll get the job done right. And he's going to break a rule if it doesn't make sense to him. Right. On the flip side, it's also Chewbacca. He's a little impatient, right? Sometimes. Maybe not the most, best at listening to people.

However, what Han and Chewbacca really like is a bluff, right? These are the people who just need the bottom line. If the emails too long, they probably won't get to the bottom of it. So you need to bold and underline things for a read. But they are great because every team needs to red, or else you won't be moving forward, right?

You're not going to have the vision. You won't be getting the thing done. So our responsibility people right? Again, the tradition, the rules, very productive. Every team also needs a yellow very, very important. They love a checklist they're going to anticipate and prep. This is if anybody knows is Luke Skywalker's uncle who took him in. Right. He's very into tradition.

He wanted Luke to take over the farm. You know, he's a strong, solid farmer. He's a worker. On the flip side, he's cousins with the Vader. Right. So he also loves a checklist. He likes structure the stormtroopers going a certain way. But he does not mess around very impatient. And these yellows really appreciate clear direct communication. They like organization.

If you just give them a bluff they're like, well, how am I going to do that? Like where are the details? What's next? Yes. Yeah I see some yellows here. Right. Okay. Blue, blue. Our harmony folks like I said, the people people right. Very great listeners. Every team also needs a blue. So the idealist is Luke Skywalker.

He's always worried about his friends. What action that I'm doing is going to affect my friends. And how do I, you know, how do I keep my friends all together? How do I team keep the team together? And he got this from his mother, right, Padme, she's also what's called the giver. Right.

Warm, charismatic. So the blue is great at hugs, warm fuzzy things, you know, saying hello, making sure you feel included. You're seen you're recognizing and your heard again. We all need a blue green curiosity, right. These again are scientists are researchers. They love science fiction. If they're even going to read anything outside of the technical manuals or articles that they're reading right.

The classic green is Princess Leia, right? She's the captain. She's the general. She's the general of this army. She's very strategic. Also on the flip side, what could happen if you go to the dark side?

Emperor Palpatine, right. Also a mastermind classic. Green Greens love to talk. In theory. They love to learn, but it's very factual and logical, you know, not the small talk. They don't want the extra business, right? They are prepared to defend whatever stance that they have. So as I said, every team needs all of the colors in my team.

We've got three reds, we have two yellows, we have two greens. The one green is actually taking a video. So Jonathan's not in screen there. And then really you only need one blue like blue is the glue. If you got one blue you're good right. Thankfully we have a lot of blue is in pediatrics. So what makes the team work.

Well again as I said it's stuff that makes the team break. So this is where we learned that we tend to communicate the way our colors want to hear communication, because that's how we want to receive it. Right. But it's really easiest for connection if we communicate in the way that others want to receive it. And maybe we don't know what their color is.

So we kind of have to sprinkle all the colors in there. So this is a recent email I sent not too long ago as again, in the AAP, I have a really big team. I have lots of people I have to speak to you. This is a team of about 60, so I usually start out with a greeting, an exclamation point Blues.

Love an exclamation point, right? I'm excited to see you. And then reds are like, I'm going to skip that part. Just tell me where I need to be when’s the start and when’s  the finish right? And how long a bold and an underline the greens need. Like the reasoning why? Like why are you emailing me? What is the point of this whole thing?

And the yellows want a checklist, right? They want some detail and direction. Right? And then again, the bold for the reds. The yellows. Like, where are the rest of the details here? Don't worry, I got you. I'm going to put more details and I'm going to send it on this day. Yeah. And the greens are like, well why are we doing this Blues.

Huge thanks. Thank you so much I do see you I appreciate you yellows. Like where am I supposed to look. Where's my checklist? Where's my link. There it is. Right. And always end with the blue I always recommend start and stop with the blue. Right. The strong start and strong finish. So in a presentation your slide might look like this.

This is a red slide they really don't need anymore. But you can't do this the whole talk right. Because your yellows will be like stressed out. Where is my information. Right. So the yellows include the bluff but also some checklists, some detail for them. Not too much you know, because then you will overload.

I've seen a lot of green slides today. Right. We’ve got the bluff. We got a couple checklists, but we also have the data right a graph a bar or something. Right. And this is all the blues need right. These are the thank yous. Thank you so much. So cute okay I also did learn this a lot from social media.

But my time is already up. So I'm going to keep going. So the teamwork becomes dreamwork when you have all sorts of voices and you honor each one of them. So this team has been together for over 35 years. I know this is for the Blues. This is the original five. We're still together, we still hang out.

We're on a WhatsApp thread. And so remember that every communication, no matter if it's between two people or if it's between you and a thousand people, it requires teamwork in some capacity. Right? It is teamwork that makes a dreamwork. And the stuff that makes the team also breaks a team. But it's how you communicate that is the game changer.

So as a strong end I recommend as everyone has already done like remind us of your bluff, remind us of the take home message or your key points that you were saying, and then say, this is how you know, this is how you contact me. Really. I just want you to remember, go all out, do your best.

Sometimes the middle gets kind of messy, but you know, what you need to do is just remember. Stick the end. Right? That's it. And this is how you get in touch with me. And we have had a call to action more than a few times. So this is my call to action to you and a message of inspiration and hope.

Oh, can we get that louder? Yes. So this is your summit version for neo stars. This is the rise of what you are now known as the Neo-Summit Stars. Newborns await sustenance. A brave alliance of rebel neo summit stars are poised to respond to this mysterious broadcast. The sound of intrauterine growth restriction and feeding intolerance. Neo stars are dispatched to deliver the knowledge and tools for newborn nutritional needs, while training for productive teamwork and the precise communication of the Jedi Order.

Meanwhile, prematurity and extrauterine growth challenges rage throughout the star system, threatening to undermine the game changing skill of the dauntless NeoStars who remain determined to educate and communicate.

May the force be with us. Thank you.