6 2 discussion case study diversity dilemmas

Tackling Diversity in Case Discussions

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• Case Teaching
• Diversity, Equity, and Inclusion

C ompanies with diverse teams—and diverse leaders—perform better and  are more profitable . Yet many executives remain uncertain about what the secret sauce is for achieving the right balance of diversity, equity, and inclusion.

This confusion is shared by business educators, who not only struggle to  adequately represent diversity in course materials , but also are apprehensive about conducting class discussions around diversity issues.

PRACTICAL TIPS ON FACILITATING DIVERSITY DISCUSSIONS

Zoe Kinias provides some practical advice for leading discussions in class on diversity, equity, and inclusion topics:

Be vulnerable ourselves. “There’s actually a lovely case on Microsoft about how Satya Nadella has done a great job of demonstrating to others how he would rather learn than be right,” says Kinias. “We can model this and encourage it in our classrooms.”

Ask the right questions. How do I ask the right questions to encourage additional input? How can I ask the questions in a way that enables empathy as opposed to defense? It’s subtle, says Kinias, but it’s about exploring other perspectives rather than establishing who is right.

Avoid the token trap. It can be tempting to ask the minority person or one of the few members of underrepresented groups to speak on behalf of their group. If they want to speak to their experience, this is of course important to encourage, says Kinias. But it can also be powerful when members of the majority group are able bring in their perspectives, “because they are aware as they talk with other folks and are generally empathetic.”

Get on common ground. Empathy is hugely important for handling these conversations, says Kinias. “Before we get into the details of the challenges with respect to a particular social identity or group status, I ask everyone to remember a time when they’ve been an insider and also a time when they’ve been an outsider. No matter what our demographic characteristics, everyone has felt both of those. Enabling everyone to recall what that feels like can help to set up for empathy.”

Find balance. Raising awareness of the particular challenges that members of underrepresented groups can face without problematizing their experience is an important thing to carefully balance.

Designate support. INSEAD instituted diversity, equity, and inclusion (DEI) representatives within MBA classes. These student representatives add additional perspectives and support to help maximize the management of these conversations and increase the learning.

Having tough conversations with students on diversity issues and interpreting business cases through the lenses of gender and race are not skills most educators are taught. Business schools must do a better job of providing adequate resources for professors—such as gender-specific leadership training, professional mentors, and variety in teaching tools—or provide incentives to diversify their course materials.

In schools where this support is lacking, faculty should lead the way. “Educators who take the responsibility of developing future leaders seriously can do a lot on their own,” says Zoe Kinias, Associate Professor of organizational behavior at INSEAD and the Academic Director of INSEAD’s Gender Initiative.

INSEAD hosts gender balance teaching sessions for faculty in the school’s campuses in both Singapore and Fontainebleau. “We are trying to help to facilitate some general awareness and also have conversations about what to do in some of these challenging situations for faculty of all disciplines,” she says.

Emphasizing That Leadership Is Diverse

Students at INSEAD want more diverse case protagonists. “This is something we hear in our face-to-face interactions and also something we saw in [a recent] gender climate survey,” says Kinias.

In addition to ensuring that a variety of case protagonists are presented to students, Kinias says, it’s equally important to use cases that highlight challenges for members of underrepresented groups as well as ones that show that there are diverse ways of enacting leadership. “This could be a male protagonist who has a bit of a softer side or has work/life challenges he’s coping with, as opposed to just sticking with stereotype-reinforcing protagonists from diverse backgrounds.”

Another way to bring these issues forward in class is to embed opportunities to discuss this kind of content. In an entrepreneurship class, for instance, have a discussion with students about the lack of well-funded female entrepreneurs. Bring in female guest speakers. Really challenge the class to think about what could be different in the scenarios being discussed, Kinias suggests.

Classroom management is also important. Educators need to learn more about issues concerning stereotypes, microaggressions, and subtle power signaling. They must also be able to introduce questions along these lines and respond effectively when students bring them up, says Kinias.

“Every conversation we have—especially on issues that I teach around ethics and corporate responsibility—if we’re honest and engaged in it candidly, should take students to a point where they are potentially uncomfortable.” Nien-hê Hsieh

Tips for Leading Class Discussions Through a Diverse Lens

Exposing students to a greater variety of leaders and management styles not only helps to develop them into future leaders who value inclusivity, but also prepares them to be more comfortable addressing these issues.

“This has a lot to do with psychological safety,” says Kinias. “We’re trying to create an environment in which students are expanding their perspective and exploring ideas. It’s OK not to have the answers in the beginning, but rather focus on engaging in exploratory conversations that involve trying to learn from each other within the classroom context.”

Cases, whether directly focused on diversity issues or not, help students to think through the challenges of managing with respect to diversity and also find solutions. In his ethics and corporate accountability classes at Harvard Business School, Professor Nien-hê Hsieh uses a case he wrote on the well-known Google diversity dispute in which the tech giant fired a top engineer who wrote a memo critical of the company’s diversity efforts.

“The case is meant to examine two sides of the issue—if we think that diversity of opinion and open debate is important for innovation on the one hand, how do you then navigate that while at the same time wanting to ensure that the way people engage in conversations and the general culture in which people engage with one another is one in which people feel comfortable and not threatened,” says Hsieh. “That’s a general issue that all organizations face.”

The case also touches on gender equity challenges in the context of Google, tech firms, and the workplace more generally, as well as how we think about free speech in a way that creates balance and a safe environment for people to engage with one another. An extension of that effort involves looking more generally at issues of race and how to achieve more racial equity, he says. “I also want students to understand, at least in the American context, the extent to which workers are or are not protected with regard to free speech, and other things as well.”

Be Willing to Be Uncomfortable

In navigating difficult classroom discussions, an educator may be inclined to flag them, call them out in advance, and then remind the group to engage respectfully, says Hsieh. However, that can actually be counterproductive.

“Every conversation we have—especially on issues that I teach around ethics and corporate responsibility—if we’re honest and engaged in it candidly, should take students to a point where they are potentially uncomfortable,” he explains. “In that sense, we don’t want to single this out as something different. If we’re really trying to get at these issues and learn about them and learn more about ourselves, we have to be willing to open ourselves up to engage in difficult conversations and be willing to accept the possibility that people may say things that we really disagree with, and be careful about how we talk about things.”

Be an Advocate for Respectful Discourse

Hsieh makes sure to instill this culture of respect right from the start. If a sensitivity or personal experience does require acknowledgement, he creates space for that in the moment by reminding the class to approach it in the same spirit of openness, engagement, and respect as they do in all conversations. He also lets students know there are standards for how they should engage.

“It’s good for students to engage and debate with one another,” he says. “My role as an instructor is to create the space for that to happen, but also knowing when to stop.”

Be Clear About Objectives

Hsieh also ensures he is clear about his objectives for every discussion.  What are the challenges or questions that we want to understand?  “It’s not just learning about something,” he says. “It’s actually learning what they can do or how they can effect change or make judgements.”

Be a Good Listener

Once objectives are clear, educators should listen. “When a student knows I’m actively listening, that’s the first step for opening up the environment for students to have these kinds of difficult conversations,” says Hsieh. “And by active listening I mean being willing to give them the benefit of the doubt and really trying to understand where they’re coming from. Not simply imposing my own lens on what they’re saying.”

Be Careful About the Kinds of Questions You Ask

Both in terms of opening up the discussion and also in terms of follow up, educators should be mindful about the questions they ask. “A question we ask [as educators] is in a sense a permission to speak on a certain topic,” he says. “Being precise in what we’re asking students to engage with actually comes from being very precise with the questions.”

“We’re trying to create an environment in which students are defending their perspective and exploring ideas. It’s OK not to have the answers in the beginning, but rather focus on engaging in exploratory conversations that really involve trying to learn from each other with the classroom context.” Zoe Kinias

Making Business Leadership More Inclusive

The most effective use of class time is for students to do something they can’t do on their own, “where students come together, and by the end of class, collectively as a group, have come to some greater understanding,” says Hsieh. “And individually, we have come to something—either we’ve understood ourselves better or something about each other better.”

Educators—and business schools—worldwide who are taking strides toward more diversity and inclusivity are making progress, says Kinias.

“We are energized, and this has enabled us to engage with the students and with our colleagues in a way that can really improve the situation across all of our schools,” she says. “Really, we are trying to make business leadership more inclusive through the students whose lives we touch while they’re at our school. I’m optimistic that we are moving in the right direction.”

Colleen Ammerman works with the faculty leadership of the Harvard Business School Race, Gender & Equity Initiative to support a research community and a platform for disseminating practice-relevant insights for advancing equity, diversity, and inclusion in organizations. She is a member of the Life & Leadership After HBS research team, an ongoing longitudinal study of Harvard Business School alumni which examines the influence of gender and race on their life and career outcomes. She is also coauthor, with Boris Groysberg, of Glass Half Broken: Shattering the Barriers That Still Hold Women Back at Work (Harvard Business Review Press 2021).

Zoe Kinias  is an associate professor of organizational behavior at INSEAD and the academic director of INSEAD’s Gender Initiative. She is also a member of the INSEAD Randomized Control Trials Lab. Her teaching topics focus on leadership development, social issues at the intersection of business and society, and psychological research in applied/business contexts.

Nien-hê Hsieh  is a professor of business administration and Joseph L. Rice, III Faculty Fellow in the general management unit at Harvard Business School. His research concerns ethical issues in business and the responsibilities of global business leaders, and it centers on the question of whether and how managers are guided by not only considerations of economic efficiency, but also by values such as freedom and fairness and respect for basic rights.

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Case Study: What Does Diversity Mean in a Global Organization?

• David S. Lee

Needs may differ between headquarters and regional offices.

“We have a diversity problem.”

• DL David S. Lee  is a principal lecturer at the University of Hong Kong Business School, where he teaches, researches, and advises on topics related to ethics, fintech, and governance.

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Excerpt: Case Studies on Diversity & Social Justice Education

This text is an abridged excerpt from chapters 1 and 2 of Case Studies on Diversity and Social Justice Education , reproduced here with permission of Routledge

Samantha, a vivacious seventh grader at Hillside School, a middle school in the predominantly low-income mountainous outskirts of northern Virginia, loves science class. By all apparent accounts, Samantha has a gift for the sciences, too. She aces all of her quizzes and tests and regularly helps classmates who are struggling with experiments. 

This makes it particularly difficult for Ms. Grady to understand why Samantha rarely turns in her science homework. Wondering whether there was an issue at home, Ms. Grady has touched base several times with her colleagues who have Samantha’s younger siblings in their classes to see whether they were noticing similar patterns. To the contrary, she learned that her younger siblings always turn in their homework.

Ms. Grady has reached out to Samantha every way she knows how, from pleading with her to offering to give her more advanced work that might engage her in new ways. On several occasions she has asked Samantha why she rarely turns in her homework. 

“It’s nothing,” Samantha typically responds. “I’ll do it next time. I promise.”

Regardless of how often she calls Samantha’s parents, nobody answers. Imagine how successful Samantha could be if only her parents cared enough to support her education , Ms. Grady has often thought to herself. 

As a conscientious teacher, Ms. Grady wants to support Samantha. On the other hand, she has roomfuls of other students who also need her attention. And, when it comes down to it, Ms. Grady’s grading policy is clear: students are allowed to turn in one homework assignment one day late without penalty—she calls this her “life happens” rule; but in every other instance, failure to turn in homework results in a grade of “0” for that assignment. 

One day after school Ms. Grady approaches Mr. Burns, a social studies teacher at Hillside who had taken a particular interest in Samantha during the previous academic year. 

“I know,” Mr. Burns says. “Brilliant young woman. I had the same experience with her. I didn’t know what to think until I decided to pay her family a visit at home.” Having grown up in the area and attended Hillside as a low-income student, Mr. Burns bristled at some of his colleagues’ deficit-laden perceptions of the local community.

It never occurred to Ms. Grady to visit Samantha’s home. “Wow!” she responds, taken aback by her colleague’s “direct action” approach to student success. “What did you learn?”

“A lot ,” he answers, explaining that Samantha’s father finally found a steady job four months after the local mill shut down. As she has done for years, Samantha’s mother continues to piece together multiple jobs. “She usually sneaks in the door around 11 p.m., an hour or so after her husband, trying not to wake the kids,” Mr. Burns explains. 

“From the moment she gets home from school until her dad returns from work, she’s babysitting Francis and Kevin, her younger siblings. She’s busy taking them to the playground, cooking them dinner, helping them with their homework.”

“Well,” Ms. Grady reflects, “that explains why her siblings’ homework is always in on time and how well Samantha does helping her classmates with their work.”

“Now all I have to do is figure out what to do about Samantha’s grade. And I wonder how many of my other students are in similar situations,” Ms. Grady says.

There exists no magic formula for solving the conundrum in which Ms. Grady finds herself. This is why, in our estimation, we must develop and hone the sorts of competencies that help us to make sense out of real-life messiness. Otherwise, we risk allowing ourselves to be swayed by popular mythology (“poor people do not care enough about their children’s education”). We risk responding without a contoured understanding for why certain conditions exist in our classrooms and schools. 

We have the power to strengthen our abilities to create equitable learning environments and to maintain high expectations for all students by considering contextual factors in addition to the everyday practicalities of our work as we shape our professional practice. 

From the moment she gets home from school until her dad returns from work, she's babysitting Francis and Kevin, her younger siblings. She's busy taking them to the playground, cooking them dinner, helping them with their homework.

The Case Method

One tool—and, in our experience, a particularly effective one—for strengthening those abilities is what is commonly called the “case method.” The premise of the case method is that by analyzing real-life scenarios based on actual events, such as the situation involving Samantha and Ms. Grady, we can practice applying theoretical ideas (such as educational equity ) to on-the-ground professional practice.*

Our process for analyzing educational cases is comprised of seven steps. The steps are accumulative, building steadily and holistically toward a set of informed, mindful responses to often complex classroom and school situations.   

Step 1: Identify the Problem or Problems Posed by the Case 

Begin by naming the challenges or problems (or potential problems) that are explicit and immediately apparent to you. Once you have a grasp of those more obvious dynamics, try to dig a little deeper. Look for less explicit, not-so-obvious examples of existing or potential bias, inequity, interpersonal tensions, stereotypes, prejudices, or assumptions. What does the case tell us about school or classroom policy, about instructional practices or curricula, about individuals’ attitudes that might hint at something deeper than those surface-level biases and inequities? 

Step 2: Take Stock of Varying Perspectives

Our case has at least a couple of obvious stakeholders. Our first task, then, for Step 2 is, as best we can, to walk in Ms. Grady and Samantha’s shoes. How might they, given who they are in relation to one another, be experiencing the situation?

Complicating matters, despite being at the center of the scenario, Samantha and Ms. Grady are only two of many affected parties. Samantha’s parents, whose other two children, Frances and Kevin, also attend the school and in the future might even have Ms. Grady as a teacher, are involved. Then there are Samantha’s classmates, the “bystanders.” How might Ms. Grady’s decisions affect other students who are from families in poverty?   

Step 3: Consider Possible Challenges and Opportunities

Our next task is to imagine the potential challenges and opportunities presented by the case. Start with the individuals involved. We might surmise that Ms. Grady has an opportunity to develop a deeper understanding of low-income students—of both the hurdles they might face and the resiliencies they demonstrate. Of course, she also faces a number of challenges, not least of which is overcoming her own biases. What sorts of opportunities and challenges does the case present for Samantha? For her classmates?

We also want to consider the institutional challenges and opportunities. We might assume, by way of challenges, that Ms. Grady might not get a tremendous amount of support if she chose to enact a homework policy that did not conform to those of her colleagues. An institutional opportunity, on the other hand, might be the chance to collaborate toward more equitable school-wide policies and practices in order to more effectively engage low-income students and families.

Step 4: Imagine Equitable Outcomes 

[W]e turn, in Step 4, to imagining what a fair and equitable resolution to the situation might look like. This is a critical step, as Steps 5 through 7 are designed to facilitate the process of working toward the outcomes we define in Step 4.

First, it’s important to distinguish equitable outcomes from equal outcomes. Equality, as we see it, connotes sameness . Equity, on the other hand, connotes fairness . Equity takes context into account.

Second, remember to think both immediate term and long term . What can be resolved right now, on the spot, and what will equity look like once it is resolved? You might decide, for example, that Ms. Grady needs to find a different strategy right now to communicate with Samantha. Perhaps an equitable outcome would be professional development on socioeconomic issues for the teachers at Samantha’s school or a strengthened relationship between Ms. Grady and Samantha’s parents.

Finally, be specific . Identify very specific, on-the-ground outcomes. How, specifically, will things be different in that classroom and school if we commit to resolving the issue and all its complexities equitably? 

Step 5: Brainstorm Immediate-term Responses

Now that you have some equitable outcomes in mind, it is time to begin brainstorming strategies to get us there. What are some of the things you might do right now , if you were in Ms. Grady’s shoes, to achieve those outcomes? This is a brainstorm, remember, so do not overthink.  

All we are doing here is making a list. It’s an informed list, based on all the work we have been doing in the previous steps. But it is still just a list.

Step 6: Brainstorm Longer-term Policy and Practice Adjustments  

In Step 6 we turn to longer-term strategies, often for more substantive change. This is where we might brainstorm ways to bolster awareness about the sorts of challenges Samantha faces throughout the school, if that is one of our equitable outcomes. It is where we focus on things such as institutional culture, school-wide practices, or even district policy, if we believe they need to be altered in order to achieve our equitable outcomes.

Here, again, we’re brainstorming. Try not to self-censor. Just focus on recording whatever ideas come to mind based on Steps 1 through 5.

Step 7: Craft a Plan of Action

During this, the final step, we craft our brainstorms into a set of specific actions that will result in the equitable outcomes we imagined in Step 5. How would you respond in order to ensure, to the best of your knowledge and power, equity for everybody involved?

A Few Final Thoughts

We recognize, of course, that in the heat of the moment we do not always have time to sit down and think through the seven steps of a case analysis process. The point is not to memorize these steps. Instead, the idea is to use them to practice our skills by reflecting on classroom situations through a diversity and social justice lens. Practice enough, and that view will become second nature. 

* Darling-Hammond, L. (2006) P owerful Teacher Education: Lessons from Exemplary Programs . San Francisco, CA: Jossey-Bass.

Apply the seven-step case method to another case—or to a case of your own with our toolkit. 

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Navigating Complex, Ethical Problems in Professional Life: a Guide to Teaching SMART Strategies for Decision-Making

Tristan mcintosh.

1 Bioethics Research Center, Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA

Alison L. Antes

James m. dubois.

This article demonstrates how instructors of professionalism and ethics training programs can integrate a professional decision-making tool in training curricula. This tool can help trainees understand how to apply professional decision-making strategies to address the threats posed by a variety of psychological and environmental factors when they are faced with complex professional and ethical situations. We begin by highlighting key decision-making frameworks and discussing factors that may undermine the use of professional decision-making strategies. Then, drawing upon findings from past research, we present the “SMART” professional decision-making framework: seeking help, managing emotions, anticipating consequences, recognizing rules and context, and testing assumptions and motives. Next, we present a vignette that poses a complex ethical and professional challenge and illustrate how each professional decision-making strategy could or should be used by characters in the case. To conclude, we review a series of educational practices and pedagogical tools intended to help trainers facilitate trainee learning, retention, and application of “SMART” decision-making strategies.

Our aim is to illustrate how to effectively educate professionals on ways to apply decision-making strategies when they are faced with complex professional and ethical issues. Appropriate and effective application of these strategies is a trainable skill that can be developed in individuals from a range of backgrounds, disciplines, and career stages. We first explore the complexities of professional decision-making in a research context and highlight an innovative compensatory strategy framework. Then, we present a case example of proper and improper application of these strategies when navigating complex professional and ethical situations. We then showcase pedagogical techniques intended to integrate these compensatory strategies into training activities and facilitate retention and application of these strategies. The term “trainees” is used throughout and refers to any individual, regardless of career stage, who learns from and takes part in training on professional decision-making strategies. In sum, the intent of the present effort is to describe how to provide trainees with strategy-based knowledge and skills needed for professional decision-making. These strategies ultimately serve to facilitate better ethical decision-making and professionalism.

Professional Decision-Making Frameworks

Professionals, including those who conduct research, regularly face complex circumstances that require professional decision-making skills. Although professionalism has been defined in multiple ways, for the purposes of the present effort, we define professionalism as integrating ethics and other relevant factors (e.g., competence, collegiality, institutional and departmental culture) needed to ensure public trust and achieve the goals of the profession (e.g., healing in medicine, generating new knowledge in research) ( Stern and Papadakis 2006 ; Swick 2000 ; van Mook et al. 2009 ). Unfortunately, the nature of situations professionals encounter and unconscious self-serving biases all professionals have may undermine the effectiveness of professional decision-making. Therefore, professional decision-making necessitates careful navigation and includes weighing different options to address the issue at hand, forecasting likely implications of actions, and gathering more information from multiple reliable sources ( Antes et al. 2010 ; Stenmark et al. 2011 ).

Two different frameworks of professional decision-making can be useful when professionals are confronted with these challenging circumstances: 1) a rational decision-making framework ( Goodwin et al. 1998 ; Oliveira 2007 ), and 2) a psychological framework ( DuBois et al. 2015a ; Mumford et al. 2008 ). Rational decision-making, also referred to as normative decision-making, is characterized by adherence to a set of established principles that guide decision-making, often in a group setting ( Hoch et al. 2001 ; Oliveira 2007 ). Specifically, rational decision-making involves the identification of key components of a situation and justifying decisions related to this situation when different viewpoints are in conflict with one another ( DuBois 2008b , 2013 ). Moreover, those who engage in rational decision-making analyze a number of possible alternative outcomes prior to making a definitive choice and make their decision based on the most likely and best possible outcome ( Hoch et al., 2001 ). This type of decision-making lends itself well to circumstances when professionals are unsure how to address an ethical dilemma, when a group is trying to establish best policies, or when there is disagreement among stakeholders on issues such as relevant facts and norms ( DuBois 2013 ). As it relates to ethical dilemmas, rational decision-making facilitates identification of key ethical concerns that society acknowledges as integral to rational discussions about ethical issues ( DuBois 2013 ).

The psychological framework related to professional decision-making is characterized by a confluence of situational complexities and self-serving biases that influence the way people frame and approach problems ( Bazerman and Moore 2013 ; Mumford et al. 2008 ). Oftentimes, a “correct” or “best” approach to these problems may not be apparent because of factors such as conflicting interests or needing to address concerns of multiple stakeholders ( Dana and Loewenstein 2003 ; Mumford et al. 2007 ; Weick et al. 2005 ). Being able to make sense of and effectively respond to these problems hinges on one’s ability to manage biases and attend to and utilize relevant information appropriately. This approach to professional decision-making lends itself well to situations in which professionals, when faced with complex ethical dilemmas, intend to take the best course of action but have difficulty doing so due to personal and environmental constraints ( Antes 2013 ). Such constraints may include complexity of social dynamics, heightened emotions, conscious and unconscious biases, uncertainty, and ambiguity.

The present effort will highlight strategies intended to facilitate the psychological framework of professional decision-making, as opposed to rational decision-making, because these strategies enable bias management and quality information integration, application, and synthesis. Moreover, these strategies are beneficial in situations where environmental constraints act to undermine an individual’s intent to take the best possible course of action. These strategies help professionals deal with moral distress, situational limitations (e.g., political tensions, increases in regulations, cultural differences), and internal limitations (e.g., ignoring key elements of a situation, self-centered thinking, unwarranted certainty) ( DuBois et al. 2016 , 2015b ).

In what follows, we will demonstrate the utility of a psychological decision-making framework within the context of the research profession, the SMART professional decision-making framework: s eeking help, m anaging emotions, a nticipating consequences, r ecognizing rules and context, and t esting assumptions and motives. Research provides a useful context for illustrating SMART strategy training because research frequently involves complexity, ambiguity, assumptions, stress, ethical considerations, and conflicts of interest. Further, ethics training is mandated for all federally-funded research trainees and many key personnel on grants involving human or animal subjects. We believe the SMART professional decision-making framework can add value to ethics training programs in research and other professions.

Constraints to Professional Decision-Making

Several factors can interfere with optimal professional decision-making. We discuss four factors that can be effectively addressed through the use of SMART decision-making strategies: Complexity, ambiguity, biases, and unusually high or negative emotions.

Professionals must carefully address and navigate complex and dynamic issues throughout their careers. For researchers, complexity often characterizes data management, mentoring relationships, protection of research participants, institutional hierarchies, and conflicts of interest ( Anderson et al. 2007 ; DuBois 2008a ; Jahnke and Asher 2014 ). These issues oftentimes involve multiple competing goals, guidelines, and stakeholder interests and are not simple to address ( Werhane 2008 ).

For example, a researcher may have competing interests between their funding agency’s research priorities and their own profession’s methodological norms and standards. These conflicting interests and complex relationships between funding agencies and researchers may undermine confidence in the quality of research being conducted if not appropriately managed ( Irwin 2009 ). Researchers are responsible for identifying and navigating conflicts of interest. Navigating conflicts of interest necessitates reconciling conflicting values, perspectives, and agendas of multiple stakeholders at the individual, institutional, governmental, and national levels. Failing to do so may result in public mistrust of research, harm to others, tarnished personal and professional relationships, or ruined careers. Thus, professional decision-making strategies can be applied when attempting to identify, prioritize, and reconcile complex stakeholder interests. The multifaceted nature of ethical and professional situations in a research context has the potential to derail professional decision-making if not handled appropriately.

Uncertainty

It is common for individuals in research fields to be exposed to new and unfamiliar environments and projects where considerable gaps in knowledge may exist. Uncertainty may arise when regulations grow in complexity over time, when a researcher moves into a new research space, or when a researcher moves to a new nation with a different culture or an unfamiliar set of rules and norms ( Antes et al. 2017 ; DuBois et al. 2016 ). Navigating social and professional life in a new culture, with a new language, and with possibly different ethical standards can be challenging and stressful.

Uncertainty may inadvertently lead to the misinterpretation of norms and other social and professional cues integral to making professional and ethical decisions ( Palazzo et al. 2012 ). This is because individuals may lack essential information needed for interpreting a given situation appropriately ( Sonenshein 2007 ), which may result in failure to think of long-term downstream consequences of their actions or failure to consider the entire range of possible courses of action. Moreover, “unknown unknowns” may result in a breakdown of quality professional decision making if help is not sought from other individuals or resources that are able to provide sound guidance on these issues.

For example, a lab manager may task a new postdoctoral fellow with collecting data from participants using a certain technique, but the postdoc may be unfamiliar with the standard procedures for doing so. Tense lab dynamics between the lab manager and other lab members may worsen this uncertainty by making it uncomfortable or difficult for the postdoc to seek help from another lab mate. Similarly, these lab dynamics may signal to the postdoc that limited or hostile communication is the norm in the lab, which may prompt the postdoc to proceed with their work in isolation. Failure to seek help due to social ambiguities may result in costly protocol violations or detrimental outcomes for both the participants and researchers involved. Without proper use of professional decision-making strategies, facing uncertainty or unfamiliar norms may lead to poor decision-making and negative consequences.

Despite even the best intentions to maintain objectivity, professionals may be subject to unconscious biases when processing information ( Hammond et al. 1998 ; Kahneman 2003 ; Palazzo et al. 2012 ). This poses a considerable challenge to professionals who aim to accurately and objectively process available information relevant to a given situation and to make a sensible, unbiased decision ( Bazerman and Moore 2013 ). Many of these judgment errors, or cognitive distortions, are automatic, making it challenging for individuals to fully understand the negative influence of biases on decision-making and information processing ( Kahneman 2003 ; Moore and Loewenstein 2004 ). Biases such as rationalization ( Davis et al. 2007 ; DuBois et al. 2015a ), tunnel vision ( Posavac et al. 2010 ), self-preservation ( Bandura et al. 1996 ; Oreg and Bayazit 2009 ), rigorous adherence to the status-quo ( Samuelson and Zeckhauser 1988 ), and diffusion of responsibility ( Voelpel et al. 2008 ) may contribute to flawed decision-making on the part of professionals.

To illustrate, a researcher may cut corners during the informed consent process as they think to themselves, “nobody reads consent forms anyway” (i.e., assuming the worst) ( DuBois et al. 2015a ). In yet another example, a researcher may decide to drop outliers from a dataset without reporting it as they think to themselves, “it’s not like I fabricated any data” (i.e., euphemistic comparison). Both of these examples depict poor professionalism. These biased behaviors may occur subconsciously or be actively justified by an individual as in the cases above ( DuBois et al. 2015a ). Regardless, the characters in these examples failed to utilize professional decision-making strategies that could have helped inoculate against the effects of detrimental self-serving biases.

While professional decision-making requires a certain degree of objective and rational thought in order to be successful, professionals are not always rational and objective in their approach to making decisions ( Kahneman et al. 2011 ; Tenbrunsel et al. 2010 ). It is easy to see how heightened emotions could undermine professional decision-making, for example, when working long hours, applying for intensely competitive grant funding, dealing with a difficult colleague, or trying to impress a world-famous and notably erudite senior faculty member. Stress, negative emotions, or intense emotions left unregulated or unacknowledged have been shown to lessen the cognitive resources needed for effective professional decision-making ( Gino et al. 2011 ; Haidt 2001 ; Mead et al. 2009 ). When cognitive resources are depleted, reasoning is impaired and individuals tend to make hasty, biased decisions ( Angie et al. 2011 ; Bazerman and Moore 2013 ; Gross 2013 ). Professional decision-making strategies can help counteract these effects.

SMART Strategies

Despite obstacles to effective professional decision-making, certain compensatory strategies exist that enable professionals to help offset these obstacles. Taking a structured approach to making these decisions can help professionals effectively apply strategies that guide ethical decision-making, bias management, and quality information processing ( Bornstein and Emler 2001 ; DuBois et al. 2018 ; Thiel et al. 2012 ). Furthermore, this systematized thought process balances the aforementioned constraints that can negatively influence professional decision-making ( DuBois et al. 2015b ).

Building on the sensemaking work of Mumford ( Mumford et al. 2008 ) and the bias reduction work of Gibbs ( Gibbs et al. 1995 ), DuBois and his colleagues ( DuBois 2014 ; DuBois et al. 2015b ) in the Professionalism and Integrity in Research Program (P.I. Program) developed a structured decision-making aid to help professionals remember and recall a comprehensive set of compensatory strategies. Strategy-based training has proven to be effective in developing cognitive skills ( Clapham 1997 ), and has met success in increasing professional decision-making in the P.I. Program ( DuBois et al. 2018 ). These strategies shape professional decision-making and help professionals work through ethical dilemmas. Professional decision-making strategies comprise the acronym “SMART”, and encompass five domains: Seek help, Manage emotions, Anticipate consequences, Recognize rules and context, and Test assumptions and motives. Table 1 depicts key dimensions of each strategy and reflection questions that can be used to apply each strategy. While these strategies have distinct components, they are related to one another and conceptually overlap. Each professional decision-making strategy is described in detail below.

SMART strategies

Seeking Help

This strategy is characterized by 1) gathering information such as facts, options, and potential outcomes, 2) requesting the mediation of an objective third party, and 3) asking for and welcoming feedback and correction. By deliberately processing context-relevant information and consulting with objective others, it is possible to correct for biases and challenge initial assumptions ( Sonenshein 2007 ). This allows the information that may have been formerly disregarded or misconstrued to be revealed and utilized effectively ( Mumford et al. 2008 ). When attempting to apply this strategy, professionals should reflect on questions such as, “Do I welcome feedback or input from others?”, “Where could I seek additional unbiased, objective information or opinions?”, or “Have I owned up to mistakes and apologized to all involved to move forward?”

Managing Emotions

The strategy of managing stress and emotion is characterized by 1) identifying the emotions being experienced, 2) managing those emotions, and 3) acknowledging both positive and negative emotions such as excitement and anxiety. When attempting to apply this strategy, professionals should ask themselves questions such as, “What are my emotional reactions to this situation?”, “How are my emotions influencing my decision-making?”, “Would taking a timeout or a deep breath help the situation?”

Anticipating Consequences

The strategy of anticipating consequences is characterized by 1) anticipating consequences to both oneself and others, 2) anticipating both long-term and short-term consequences, 3) anticipating both positive and negative consequences, 4) considering formal and informal responses, and 5) managing and mitigating risk. When attempting to apply this strategy, professionals should reflect on questions such as, “What are the likely short- and long-term outcomes of a variety of choices?”, “Who will be affected by my decisions and how?” and “How can risks be minimized and benefits be maximized?”

Recognizing Rules and Context

This strategy is characterized by 1) recognizing formal rules, such as laws and policies, 2) recognizing informal rules, such as social norms, and 3) recognizing the power dynamics of individuals involved in a given situation. Professionals attempting to apply this strategy should ask themselves, “What are the causes of the problem in this situation that I can change?”, “What ethical principles, laws, or regulations apply in this situation?”, and “Who are the decision-makers in this situation?”

Testing Assumptions and Motives

This strategy is characterized by 1) addressing the possibility you might be making faulty assumptions, 2) examining your motives compared to the motives of others, and 3) comparing your assumptions and motives with those of others in an empathetic manner. When attempting to apply this strategy, professionals should reflect on questions such as, “Could I be making faulty assumptions about the intentions of others?”, “What are my motives?”, and “How will others view my choices?”

Not only have compensatory strategies been demonstrated to be a helpful tool for high-quality professional decision-making, but these strategies are also learnable, trainable, and applicable to a wide variety of challenges and situations ( DuBois et al. 2015b ; Kligyte et al. 2008 ). The generalizability of strategies is noteworthy because they apply across contexts (e.g., human subjects research, animal research, translational research) and challenges faced by professionals (e.g., compliance, personnel management, integrity, bias). Moreover, these compensatory strategies, when applied correctly, can facilitate more critical analysis of a problem, improve information gathering and information evaluation, and contribute to better decision-making that leads individuals to make more professional and ethical decisions ( DuBois et al. 2015b ; Thiel et al. 2012 ).

Compensatory Strategy Case Application

Below we present a case with an ethical, professional dilemma and discuss how each SMART strategy can be properly applied in this example. We then caution against flawed application of these SMART strategies and highlight potential pitfalls to effective strategy application. It should be noted that, while the main character in the following case is a research assistant, applying the SMART strategies is a skill that can be learned and utilized by individuals across career stages and professions. The dilemma is as follows:

Sara is a new research assistant in the social science lab of Dr Jackson. She recently emigrated from China. Knowing that Sara is great with quantitative data analysis, Dr. Jackson asked her to run some statistics on data gathered by other research assistants on a National Science Foundation (NSF) grant that Dr. Jackson received two years ago. She ran the statistics, but none of Dr. Jackson’s hypotheses were confirmed. She thinks the study was simply under-powered. When she speaks with Dr. Jackson, he tells her she is mistaken and he asks her to run the tests again. She does so with the same results as before. This time, Dr. Jackson is angry, calls her incompetent, and says he will give her one more chance before he hires a new research assistant to run the statistics. Sara is fearful that she will lose her student visa if she loses her funded position. She drops several outliers and changes the data for several subjects and produces results that Dr. Jackson likes very much.

The above illustration is a great teaching case because, at first glance, Sara appears to be a victim: Dr. Jackson did not help her to do good work; rather, he bullied her to get the results he wanted. At the same time, the case perfectly illustrates a failure to use good decision-making strategies in a stressful situation with competing interests where few good options readily present themselves. Sara made a very bad decision: she committed research misconduct through her data falsification, the project was federally-funded, and now she and her institution could be prosecuted for this federal crime. While not every difficult situation requires the use of every one of the SMART strategies, Sara may have benefited from using each of them.

Sara could have asked other research assistants, graduate students, or postdocs for help with addressing problems with analyses and strategies for approaching and communicating with Dr. Jackson. If issues with Dr. Jackson had been persistent overtime, Sara could have sought support from colleagues or other faculty members who could provide advice for navigating the troubling work relationship. Ideally, the environment in the department would allow Sara to feel comfortable approaching another faculty member or others for help. Sara could have referred to objective field standards for conducting the analyses and determining how to proceed after unsuccessful analyses. After conducting the initial analyses, Sara could have asked a member in her lab to re-run the analyses with her in attempt to address any potential mistakes. Doing so may have affirmed her initial findings and assuaged concerns that she had approached the analyses incorrectly. Sara could have involved a mediator, such as a university ombudsperson, to help find a viable solution if she was unable to do so after exhausting the aforementioned options. A more complete picture presents itself after seeking help and additional information, and more ethical and professional courses of action become more apparent.

Because of the threat the situation poses to Sara’s personal and professional goals, emotions run high in this scenario. Sara wishes to be successful in her career and education, maintain her position in the United States, and earn Dr. Jackson’s approval. Sara is also likely aware that Dr. Jackson wishes to maintain a successful reputation in his field, publish interesting findings, and be productive throughout his career. She should introspectively identify her emotional reactions of anxiety, fear, frustration, and stress. When Sara was chastised by Dr. Jackson, she could have taken a “time out” to calm down and acknowledge how her emotions could override taking a more rational approach to addressing the problem instead of hastily reacting to Dr. Jackson’s response. At a broader level, taking time to manage stress each day would help Sara cope with the pressures and day-to-day stressors of her work. By identifying and managing the range of emotions experienced when faced with ethical and professional situations, clearer and more thoughtful judgment is likely to result.

Considering both the long-term and short-term consequences for all possible individuals is central to making a quality professional and ethical decision. Specifically, Sara should consider how falsifying data could end up negatively impacting not only her career trajectory and her immediate ability to work in the United States, but the careers and reputations of Dr. Jackson, her fellow lab mates, and the university where she works. Data falsification also undermines public trust in the field and scientific enterprise more broadly. In addition to attempting to minimize risk, Sara could have also considered how to maximize the benefits of, or make the best of, the situation. Perhaps by addressing the limitations of the analytical approach and bringing the analysis issue to light, a learning opportunity for everyone in the lab could have presented itself, paving the way for smoother management of similar situations in the future. Forecasting downstream consequences for all individuals that could be impacted by a given course of action is essential to maximizing benefits and minimizing harm to oneself and others.

Taking time to identify formal laws and policies and informal professional and social norms will help elucidate the context in which an ethical or professional dilemma unfolds. Sara could have identified the causes of problems and tensions in the situation, including publication pressures, Sara being new to the job, job stressors, and the like. By doing so, she could have more concretely comprehended the factors that limit her choices and could have avoided tunnel vision or narrow-mindedness in approaching the problem. Sara could have taken time to reflect on relevant ethical principles and regulations as they relate to falsifying data. Doing so may have cued her to not manipulate the data to obtain certain findings.

For better or worse, Dr. Jackson is her supervisor, and she must figure out a way to navigate the interpersonal problem in the case: He is upset and has threatened to fire her. Some of the strategies described above under “Seeking Help” might assist her in navigating the political dimension of this situation. Additionally, if these strategies fail, she should recognize that Dr. Jackson’s lab is situated within a larger institutional context. She could have reached out to other individuals within the university (e.g., department chair, research integrity officer) who prioritize responsible research and mentoring after exhausting alternative courses of action. These individuals, in turn, could have provided support and helped Sara navigate a path forward. Realizing the entirety of the context opens up a wider realm of options in navigating this challenging and threatening situation.

Understanding the motives of oneself and others provides the opportunity to consider multiple perspectives and take steps to avoid biased decision-making. While it can be challenging when one feels affronted, it can be helpful to consider the perspective and motives of other parties in the situation. For example, Sara could have considered whether Dr. Jackson was having a stressful day and overreacted when she initially approached him. She could have better managed self-serving and self-protecting biases perpetuated by her fear of not being allowed to work in Dr. Jackson’s lab by acknowledging how they may be distorting her perception of the situation. Sara might have questioned whether her analysis was correct; perhaps she did make an error and the study was not underpowered. That is, Sara should have questioned her assumption that, if she did conduct the analyses correctly, falsifying data was the only available option that would allow her to keep her position. Seldom is professional decision-making served well by engaging in simplistic either-or thinking. It is likely that multiple alternate courses of action would have presented themselves if she had engaged these strategies. Being proactive in managing biases by engaging in self-reflection and considering the perspectives and motives of others is beneficial to quality professional decision-making.

Questioning one’s assumptions is also a classic emotion management strategy used in cognitive behavioral therapy. Sometimes just realizing that we are making assumptions about how others perceive the situation and about our limited options can relieve anxiety.

Evaluate and Revise

If one wishes to take these strategies a step further to engage in “SMART-ER” professional decision-making, they can: 1) Evaluate their decision and its outcomes and 2) Revise future behavior in similar situations. By acknowledging what did and did not work well in past situations and attempts at strategy use, modified and improved approaches to professional decision-making can be taken when faced with other professional and ethical challenges in the future.

Considerations for Applying SMART Strategies

While the SMART strategies are an excellent tool for professional decision-making, it is equally important to recognize the several important considerations when utilizing this approach. While a five-part decision-making aid has the opportunity to be highly useful for navigating complex, ambiguous professional situations, it is not a perfect algorithm or panacea for all ethical and professional conundrums. Given situational limitations and available contextual information, it may not always be possible to use each strategy fully, and challenges navigating the problem will still exist. Not all strategies will be equally applicable across all situations and may not be applied in the same order in all situations. However, SMART strategies are generalizable to myriad contexts, professions, and dilemmas and are not limited to major ethical transgressions such as fabrication, falsification, and plagiarism.

An additional consideration for using SMART strategies is that people may have a preference for or tendency to use one strategy over the others. While the SMART strategies are interrelated, over-attending to one strategy may result in biased or incomplete information gathering and information processing and, ultimately, sub-optimal professional decisions. When individuals face emotional, stressful, or ethically-charged situations, it is important that they consider and use multiple strategies to inform well-rounded decision-making. When educating trainees on SMART strategies, educators should encourage trainees to use a balanced approach and consider multiple strategies.

Perhaps one of the most considerable challenges educators may encounter is motivating trainees to use these compensatory strategies regularly. Simply teaching the strategies does not guarantee constructive application of strategies. In situations where individuals are overconfident or rushed to solve a problem that needs to be resolved quickly, immediately turning to the SMART strategies is unlikely to be an automatic course of action. Furthermore, if individuals engage in cognitive distortions in such a way that disengages from compliance or harms quality professional decision-making, they may fail to see the need or utility of SMART strategies ( DuBois et al. 2015a ). Educators should make professionals aware of how they might fall prey to these pitfalls.

A final consideration is that other mechanisms exist aside from training professionals to use SMART strategies that reinforce the recall and application of professional decision-making strategies. Such mechanisms include creating ethical and supportive organizational and departmental cultures, developing and enacting ethical leadership and management practices, and establishing institutional policies and procedures that reinforce the use of professional decision-making strategies.

Training SMART Strategies

Below, we examine practices that are useful in conducting professional decision-making training programs and creating pedagogical tools that can be implemented by a research ethics or professionalism course instructor. We focus on training practices designed for adult learners that support their professional growth and advancement ( Knowles et al. 2012 ). This is not an exhaustive list of considerations for designing and planning for an ethics or professionalism training program, and a systematic approach should be taken when developing any instructional program ( Antes 2014 ; Antes and DuBois 2014 ). Rather, the pedagogical practices described below were selected because of their implications for the transfer of complex skills, such as professional decision-making, to the workplace after training has occurred. That is, facilitating trainee learning, retention, and application of the content learned during training is essential to improving professional decision-making and making the training successful ( Noe 2013 ).

SMART Training Program Practices

Establish learning objectives.

Prior to presenting training content, provide trainees with stated objectives of the training program that define the expected outcomes of training and what it is they will be expected to accomplish as a result of completing the training ( Moore et al. 2008 ). Doing so alerts trainees to what is important and helps consolidate learning. Learning objectives have three components: 1) a statement of expected performance standard or outcome, 2) a statement of the quality or level of expected performance, and 3) a statement of the conditions when a trainee is expected to perform the skill learned in training ( Mager 1997 ). An example learning objective for a professional decision-making, or “SMART” strategies-focused, training is: Trainees will be able to apply professional decision-making strategies when they are faced with uncertain, complex, and high-stakes professional and ethical decisions in the workplace.

Create Meaningful Content

Explaining to trainees how a SMART strategies-focused training will directly benefit them and describing how training content is specifically linked to experiences in their profession will help garner buy-in from trainees ( Smith-Jentsch et al. 1996 ). Trainee dedication to achieving learning objectives is essential for learning and retention to occur and for transferring knowledge and skills to the work environment ( Goldstein and Ford 2002 ; Slavin 1990 ). To demonstrate the benefits of training, the content of training needs to be practically useful and applicable. This includes presenting content that is relevant to trainees’ professions and that addresses ethical and professional issues they have faced or are likely to face in their careers. Discussing a case or critical incident that the trainees have encountered, or something similar to what they have encountered, is an effective way to get them engaged with and derive meaning from training content.

Engage Multiple Pedagogical Activities

Pedagogical activities that occur during training reinforce key training concepts, help trainees derive meaning from training content, and facilitate active learning of professional decision-making skills. How trainees learn is equally as important as what trainees learn during training. Integrating case studies, individual reflection activities, think-pair-share exercises, and role plays into training fosters learning more than a traditional lecture format ( Bransford et al. 1999 ; DuBois 2013 ; Handelsman et al. 2004 ). These pedagogical activities vary in terms of their complexity and length, resulting in dynamic training content. Engaging trainees with these activities provides them with the opportunity to examine and connect their existing knowledge, experiences, and perspectives to the learning material. Table 2 provides a brief overview of how to implement various pedagogical activities, along with estimated level of complexity and duration.

Pedagogical activities

Case Studies

Applied to professionalism and research, case-based learning consists of using factual or fictional scenarios to illustrate examples of complex and ambiguous ethical and professional situations researchers may face ( Bagdasarov et al. 2013 ; Johnson et al. 2012 ; Kolodner 1992 ). Case-based learning helps trainees link course concepts to realistic, real-world scenarios by immersing themselves in these scenarios and exploring how to apply professional decision-making strategies ( Miller and Tanner 2015 ). The positive effects of case-based learning are magnified when trainees work together in small groups to collectively seek out important information, ask relevant questions, and find solutions to the problem ( Allen and Tanner 2002a ). This enables greater breadth and depth of understanding of decision-making strategies that can be used to address issues related to the case. Trainees can also use what they learned during this practice when applying these decision-making skills to a situation in the future that is similar. That is, trainees can draw upon their case-based knowledge to make sense of future professional and ethical situations and navigate these situations when they arise ( Kolodner et al. 2004 ).

Individual Reflection

Because of the personal and interpersonal nature of ethical and professional problems, reflecting on personal experiences and processing cases individually reinforces the knowledge base that influences ethical and professional decision-making ( Antes et al. 2012 ). Moreover, when professionals are confronted with ethical dilemmas, they are likely to draw upon personal experiences to make sense of the dilemma and generate solutions ( Mumford et al. 2000 ; Scott et al. 2005 ; Thiel et al. 2012 ). Drawing on past experiences allows professionals to consider important aspects of these past experiences such as causes and outcomes, which are essential for effective professional decision-making ( Stenmark et al. 2010 ).

Think-Pair-Share

Think-pair-share activities consist of having students initially think about a solution to a problem individually, then pairing with a neighboring student to exchange ideas, and finally reporting out to the larger group key points from their discussion ( Allen and Tanner 2002b ). Discussion between peers enhances understanding of complex subject matter even when both trainees are uncertain initially ( Smith et al. 2009 ). This may be due to the cognitive reasoning and communication skills needed to relay and justify perspectives about complex subject matter to others. Conversely, similar evaluative skills are needed to appraise the viewpoints of the other and determine if their explanation and rationale make sense in context.

Role plays are training activities where trainees take on the role of someone in a hypothetical scenario and model what it is like to have the perspective of that character ( Thiagarajan 1996 ). For example, trainees in a role play can model social interactions between characters faced with an ethical or professional dilemma regarding authorship, human subjects protections, mentor-trainee relationships, or data management ( DuBois 2013 ). Role plays enable trainees to learn how to identify, analyze, and resolve these dilemmas because they provide trainees with the opportunity to practice navigating these situations ( Chan 2012 ; DuBois 2013 ). This technique is particularly effective in trainings that involve exploration and acquisition of complex social skills, such as professional decision-making ( Noe 2013 ). Role play activities have been shown to be effective in ethics instruction ( Mumford et al. 2008 ). They can involve a select few volunteers who perform for the class while the remainder of trainees observe, or involve all trainees divided into small groups of two or three where all trainees take part in the role play activity. Role play activities have been shown to promote a deep understanding of the complexities involved with ethical and professional dilemmas ( Brummel et al. 2010 ).

In order to be effective, however, certain activities must take place before, during, and after the role play ( Noe 2013 ; Thiagarajan 1996 ). Specifically, before the role play, trainees should be provided with background information that gives context for the role play and a script with adequate detail for trainees to understand their role. During the role play, actors and observers should be able to hear and see one another, and trainees should be provided with a handout detailing the key issues of the role play scenario. After the role play has commenced, both actors and observers should debrief on their experience, how the role play relates to the concepts being taught in training, and key takeaways. Trainees should also be provided with feedback in order to reinforce what was learned during the role play experience ( Jackson and Back 2011 ).

Provide Practice Opportunities

Trainees will need multiple opportunities to practice applying the professional decision-making skills they are learning. Practice opportunities can take the form of the various pedagogical tools, as discussed above, including case studies, individual reflection, and role-play activities. These tools promote active learning and create a safe mechanism for trainees to experiment with SMART strategy application ( Bell and Kozlowski 2008 ). Instructors should also have trainees periodically recall the SMART strategies throughout training. This active recall will increase the likelihood of strategy use beyond practice during training.

Give Feedback

Immediately after each practice activity, instructors should provide feedback to trainees by noting what was done well and where there are opportunities for change or improvement. Feedback should be specific and frequent in order to convey to trainees what resulted in poor professional decision-making performance and good professional decision-making performance ( Gagné and Medsker 1996 ). Carefully guiding feedback-oriented discussions can further enhance learning, retention, and application of SMART strategies.

Professionals across various fields, especially in research contexts, encounter complex situations involving multiple stakeholders that necessitate professional decision-making skills. Fortunately, these skills are trainable, and the SMART strategies decision tool helps facilitate professional decision-making skill retention and application. In the present effort, we approach professional decision-making using a compensatory strategy framework and showcase how each of the SMART strategies could be applied to a scenario involving a professional dilemma. We also discuss how to maximize the effects of a SMART strategy-oriented training program and highlight pedagogical tools to guide SMART strategy education.

This paper provides a guide for educators and institutions with the goal of integrating training on professional decision-making skills into their curriculum. We provide educators with a robust understanding of the steps involved in mitigating negative effects of self-serving biases and making sense of complex professional dilemmas. Additionally, we discuss the individual-level and environmental-level constraints that influence the way problems are framed and approached, and the strategies that individuals can use to counteract the negative effects of these constraints on decision-making. Educators can take this understanding, along with the knowledge of effective training and pedagogical practices, to create training content that prepares its trainees to effectively navigate multifaceted professional issues they may face in their careers.

Acknowledgments

We would like to thank John Gibbs, John Chibnall, Raymond Tait, Michael Mumford, Shane Connelly, and Lynn Devenport for their insight and prior work that led to many of the ideas discussed in this manuscript.

Funding/Support This paper was supported by the National Center for Advancing Translational Sciences (UL1 TR002345). The development of the Professionalism and Integrity in Research Program (PI) was funded by a supplement to the Washington University Clinical and Translational Science award (UL1 TR000448). The U.S. Office of Research Integrity provided funding to conduct outcome assessment of the PI Program (ORIIR140007). The effort of ALA was supported by the National Human Genome Research Institute (K01HG008990).

Conflict of Interest The authors declare that they have no conflicts of interest.

• Allen D, & Tanner K (2002a). Answers worth waiting for: One second is hardly enough . Cell Biology Education , 1 , 3–5. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Allen D, & Tanner K (2002b). Approaches to cell biology teaching: Questions about questions . Cell Biology Education , 1 , 63–67. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Anderson MS, Horn AS, Risbey KR, Ronning EA, De Vries R, & Martinson BC (2007). What do mentoring and training in the responsible conduct of research have to do with scientists' misbehavior? Findings from a National Survey of NIH-funded scientists . Academic Medicine: Journal of The Association of American Medical Colleges , 82 , 853–860. 10.1097/ACM.0b013e31812f764c. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Angie AD, Connelly S, Waples EP, & Kligyte V (2011). The influence of discrete emotions on judgement and decision-making: A meta-analytic review . Cognition & Emotion , 25 , 1393–1422. [ PubMed ] [ Google Scholar ]
• Antes AL (2013). An ethics instructor’s guide to sensemaking as a framework for case-based learning (Vol. 1 ): Office of Research Integrity. [ Google Scholar ]
• Antes AL (2014). A systematic approach to instruction in research ethics . Accountability in Research: Policies and Quality Assurance , 21 , 50–67. 10.1080/08989621.2013.822269. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Antes AL, & DuBois JM (2014). Aligning objectives and assessment in responsible conduct of research instruction . Journal Of Microbiology & Biology Education , 15 , 108–116. 10.1128/jmbe.v15i2.852. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Antes AL, Wang X, Mumford MD, Brown RP, Connelly S, & Devenport L (2010). Evaluating the effects that existing instruction on responsible conduct of research has on ethical decision making . Academic Medicine: Journal of the Association of American Medical Colleges , 85 , 519–526. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Antes AL, Thiel CE, Martin LE, Stenmark CK, Connelly S, Devenport LD, & Mumford MD (2012). Applying cases to solve ethical problems: The significance of positive and process-oriented reflection . Ethics & Behavior , 22 , 113–130. 10.1080/10508422.2012.655646. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Antes AL, English T, Baldwin KA, & DuBois JM (2017). The role of culture and acculturation in researchers' perceptions of rules in science . Science and Engineering Ethics , 24 , 1–31. 10.1007/s11948-017-9876-4. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bagdasarov Z, Thiel CE, Johnson JF, Connelly S, Harkrider LN, Devenport LD, & Mumford MD (2013). Case-based ethics instruction: The influence of contextual and individual factors in case content on ethical decision-making . Science and Engineering Ethics , 19 , 1305–1322. 10.1007/s11948-012-9414-3. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bandura A, Barbaranelli C, & Caprara GV (1996). Mechanisms of moral disengagement in the exercise of moral agency . Journal of Personality and Social Psychology , 71 , 364–374. 10.1037/0022-3514.80.1.125. [ CrossRef ] [ Google Scholar ]
• Bazerman MH, & Moore DA (2013). Judgment in managerial decision making (8th ed.). New York: Wiley. [ Google Scholar ]
• Bell BS, & Kozlowski SW (2008). Active learning: Effects of core training design elements on self-regulatory processes, learning, and adaptability . Journal of Applied Psychology , 93 , 296–316. [ PubMed ] [ Google Scholar ]
• Bornstein BH, & Emler AC (2001). Rationality in medical decision making: A review of the literature on doctors’ decision-making biases . Journal of Evaluation in Clinical Practice , 7 , 97–107. [ PubMed ] [ Google Scholar ]
• Bransford JD, Brown A, & Cocking R (1999). How people learn: Mind, brain, experience, and school . Washington, DC: National Research Council. [ Google Scholar ]
• Brummel BJ, Gunsalus C, Anderson KL, & Loui MC (2010). Development of role-play scenarios for teaching responsible conduct of research . Science and Engineering Ethics , 16 , 573–589. [ PubMed ] [ Google Scholar ]
• Chan ZC (2012). Role-playing in the problem-based learning class . Nurse Education in Practice , 12 , 21–27. [ PubMed ] [ Google Scholar ]
• Clapham MM (1997). Ideational skills training: A key element in creativity training programs . Creativity Research Journal , 10 , 33–44. [ Google Scholar ]
• Dana J, & Loewenstein G (2003). A social science perspective on gifts to physicians from industry . Journal of the American Medical Association , 290 , 252–255. 10.1001/jama.290.2.252. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Davis MS, Riske-Morris M, & Diaz SR (2007). Causal factors implicated in research misconduct: Evidence from ORI case files . Science and Engineering Ethics , 13 , 395–414. 10.1007/s11948-007-9045-2. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• DuBois JM (2008a). Identifying and managing conflicts of interest. In Ethics in mental health research: Principles, guidance, and cases (1st ed., pp. 202–224). Oxford, New York: Oxford University Press. [ Google Scholar ]
• DuBois JM (2008b). Solving ethical problems: Analyzing ethics cases and justifying decisions : New York: Oxford University Press. [ Google Scholar ]
• DuBois JM (2013). ORI casebook: Stories about researchers worth discussing .
• DuBois JM (2014). Strategies for professional decision making: The SMART approach . St. Louis: Professionalism and Integrity in Research Progra. [ Google Scholar ]
• DuBois JM, Chibnall JT, & Gibbs JC (2015a). Compliance disengagement in research: Development and validation of a new measure . Science and Engineering Ethics , 22 , 965–988. 10.1007/s11948-015-9681-x. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• DuBois JM, Chibnall JT, Tait RC, Vander Wal JS, Baldwin KA, Antes AL, & Mumford MD (2015b). Professional decision-making in research (PDR): The validity of a new measure . Science and Engineering Ethics , 22 , 391–416. 10.1007/s11948-015-9667-8. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• DuBois JM, Chibnall JT, Tait RC, & Vander Wal JS (2016). Lessons from researcher rehab . Nature , 534 , 173–175. [ PubMed ] [ Google Scholar ]
• DuBois JM, Chibnall JT, Tait RC, & Vander Wal JS (2018). The professionalism and integrity in research program: Description and preliminary outcomes . Academic Medicine , 93 , 586–592. 10.1097/acm.0000000000001804. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gagné RM, & Medsker KL (1996). The conditions of learning: Training applications . Fort Worth, TX: Harcourt-Brace. [ Google Scholar ]
• Gibbs JC, Potter G, & Goldstein A (1995). The EQUIP program: Teaching youth to think and act responsibly . Champaign, IL: Research Press. [ Google Scholar ]
• Gino F, Schweitzer ME, Mead NL, & Ariely D (2011). Unable to resist temptation: How self-control depletion promotes unethical behavior . Organizational Behavior and Human Decision Processes , 115 , 191–203. 10.1016/j.obhdp.2011.03.001. [ CrossRef ] [ Google Scholar ]
• Goldstein IL, & Ford KJ (2002). Training in organizations: Needs assessment, development, and evaluation (4th ed.). Belmont, CA: Wadsworth/Thomson Learning. [ Google Scholar ]
• Goodwin P, Wright G, & Phillips LD (1998). Decision analysis for management judgment . Chichester, England: John Wiley & Sons, Ltd.. [ Google Scholar ]
• Gross JJ (2013). Emotion regulation: Taking stock and moving forward . Emotion , 13 , 359–365. 10.1037/a0032135. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Haidt J (2001). The emotional dog and its rational tail: A social intuitionist approach to moral judgment . Psychological Review , 108 , 814–834. 10.1037//0033-295x.108.4.814. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hammond JS, Keeney RL, & Raiffa H (1998). The hidden traps in decision making . Harvard Business Review , 76 , 47–58. [ PubMed ] [ Google Scholar ]
• Handelsman J, Ebert-May D, Beichner R, Bruns P, Chang A, DeHaan R, Gentile J, Lauffer S, Stewart J, Tilghman S, & Wood W (2004). Scientific teaching . Science , 304 , 521–522. [ PubMed ] [ Google Scholar ]
• Hoch, Kunreuther H, & Gunther R (2001). Wharton on making decisions . New York: John Wiley & Sons, Inc.. [ Google Scholar ]
• Irwin RS (2009). The role of conflict of interest in reporting of scientific information . Chest , 136 , 253–259. 10.1378/chest.09-0890. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jackson VA,& Back AL (2011). Teaching communication skills using role-play: An experience-based guide for educators . Journal of Palliative Medicine , 14 , 775–780. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Jahnke LM, & Asher A (2014). The problem of data: Data management and curation practices among university researchers . In Council on Library and Information Resources Retrieved from http://www.clir.org/pubs/reports/pub154/problem-of-data . [ Google Scholar ]
• Johnson JF, Bagdasarov Z, Connelly S, Harkrider LN, Devenport LD, Mumford MD, & Thiel CE (2012). Case-based ethics education: The impact of cause complexity and outcome favorability on ethicality . Journal of Empirical Research on Human Research Ethics , 7 , 63–77. 10.1525/jer.2012.7.3.63. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kahneman D (2003). A perspective on judgment and choice - mapping bounded rationality . American Psychologist , 58 , 697–720.i 10.1037/0003-066x.58.9.697. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kahneman D, Lovallo D, & Sibony O (2011). Before You Make That Big Decision … Harvard Business Review , 89 , 50–60. Retrieved from <Go to ISI>://WOS:000290694700034. [ PubMed ] [ Google Scholar ]
• Kligyte V, Marcy RT, Waples EP, Sevier ST, Godfrey ES, Mumford MD, & Hougen DF (2008). Application of a sensemaking approach to ethics training in the physical sciences and engineering . Science and Engineering Ethics , 14 , 251–278. 10.1007/s11948-007-9048-z. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Knowles MS, Holton III EF, & Swanson RA (2012). The adult learner (7th ed.). Oxford: Butterworth-Heinemann. [ Google Scholar ]
• Kolodner JL (1992). An introduction to case-based reasoning . Artificial Intelligence Review , 6 , 3–34. [ Google Scholar ]
• Kolodner JL, Owensby JN, & Guzdial M (2004). Case-based learning aids . Handbook of Research on Educational Communications and Technology , 2 , 829–861. [ Google Scholar ]
• Mager RF (1997). Preparing instructional objectives (5th ed. ed.). Belmont: Lake Publishing. [ Google Scholar ]
• Mead NL, Baumeister RF, Gino F, Schweitzer ME, & Ariely D (2009). Too tired to tell the truth: Self-control resource depletion and dishonesty . Journal of Experimental Social Psychology , 45 , 594–597. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Miller S, & Tanner KD (2015). A portal into biology education: An annotated list of commonly encountered terms . CBE—Life Sciences Education , 14 , fe2. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Moore DA, & Loewenstein G (2004). Self-interest, automaticity, and the psychology of conflict of interest . Social Justice Research , 17 , 189–202. [ Google Scholar ]
• Moore S, Ellsworth JB, & Kaufman R (2008). Objectives—Are they useful? A quick assessment . Performance Improvement Quarterly , 47 , 41–47. [ Google Scholar ]
• Mumford MD, Zaccaro SJ, Harding FD, Jacobs TO, & Fleishman EA (2000). Leadership skills for a changing world: Solving complex social problems . The Leadership Quarterly , 11 , 11–35. [ Google Scholar ]
• Mumford MD, Friedrich TL, Caughron JJ, & Byrne CL (2007). Leader cognition in real-world settings: How do leaders think about crises? The Leadership Quarterly , 18 , 515–543. 10.1016/j.leaqua.2007.09.002. [ CrossRef ] [ Google Scholar ]
• Mumford MD, Connelly S, Brown RP, Murphy ST, Hill JH, Antes AL, Waples EP, & Devenport LD (2008). A sensemaking approach to ethics training for scientists: Preliminary evidence of training effectiveness . Ethics & Behavior , 18 , 315–339. 10.1080/10508420802487815. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Noe RA (2013). Employee training and development (6th ed.): McGraw-Hill. [ Google Scholar ]
• Oliveira A (2007). A discussion of rational and psychological decision-making theories and models: The search for a cultural-ethical decision-making model . Electronic Journal of Business Ethics and Organization Studies , 12 , 12–13. [ Google Scholar ]
• Oreg S, & Bayazit M (2009). Prone to bias: Development of a bias taxonomy from an individual differences perspective . Review of General Psychology , 13 , 175–193. [ Google Scholar ]
• Palazzo G, Krings F, & Hoffrage U (2012). Ethical blindness . Journal of Business Ethics , 109 , 323–338. 10.1007/s10551-011-1130-4. [ CrossRef ] [ Google Scholar ]
• Posavac SS, Kardes FR, & Brakus JJ (2010). Focus induced tunnel vision in managerial judgment and decision making: The peril and the antidote . Organizational Behavior and Human Decision Processes , 113 , 102–111. [ Google Scholar ]
• Samuelson W, & Zeckhauser R (1988). Status quo bias in decision making . Journal of Risk and Uncertainty , 1 , 7–59. [ Google Scholar ]
• Scott GM, Lonergan DC, & Mumford MD (2005). Conceptual combination: Alternative knowledge structures, alternative heuristics . Creativity Research Journal , 17 , 79–98. [ Google Scholar ]
• Slavin RE (1990). Cooperative learning: Theory, research, and practice . Englewood Cliffs, NJ: Prentice-Hall. [ Google Scholar ]
• Smith MK, Wood WB, Adams WK, Wieman C, Knight JK, Guild N, & Su TT (2009). Why peer discussion improves student performance on in-class concept questions . Science , 323 , 122–124. [ PubMed ] [ Google Scholar ]
• Smith-Jentsch KA, Jentsch FG, Payne SC, & Salas E (1996). Can pretraining experiences explain individual differences in learning? Journal of Applied Psychology , 81 , 110–116. [ Google Scholar ]
• Sonenshein S (2007). The role of construction, intuition, and justification in responding to ethical issues at work: The sensemaking-intuition model . Academy of Management Review , 32 , 1022–1040. [ Google Scholar ]
• Stenmark CK, Antes AL, Wang X, Caughron JJ, Thiel CE, & Mumford MD (2010). Strategies in forecasting outcomes in ethical decision-making: Identifying and analyzing the causes of the problem . Ethics & Behavior , 20 , 110–127. doi:Pii 920034165. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Stenmark CK, Antes AL, Thiel CE, Caughron JJ, Wang XQ, & Mumford MD (2011). Consequences identification in forecasting and ethical decision-making . Journal of Empirical Research on Human Research Ethics , 6 , 25–32. 10.1525/jer.2011.6.1.25. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stern DT, & Papadakis M (2006). The developing physician—Becoming a professional . New England Journal of Medicine , 355 , 1794–1799. [ PubMed ] [ Google Scholar ]
• Swick HM (2000). Toward a normative definition of medical professionalism . Academic Medicine , 75 , 612–616. [ PubMed ] [ Google Scholar ]
• Tenbrunsel AE, Diekmann KA, Wade-Benzoni KA, & Bazerman MH (2010). The ethical mirage: A temporal explanation as to why we are not as ethical as we think we are . Research in Organizational Behavior: An Annual Series of Analytical Essays and Critical Reviews , 30 , 153–173. 10.1016/j.riob.2010.08.004. [ CrossRef ] [ Google Scholar ]
• Thiagarajan S (1996). Instructional games, simulations, and role-plays. In Craig R (Ed.), The ASTD training and development handbook (4th ed.). New York: McGraw-Hill. [ Google Scholar ]
• Thiel CE, Bagdasarov Z, Harkrider LN, Johnson JF, & Mumford MD (2012). Leader ethical decision-making in organizations: Strategies for sensemaking . Journal of Business Ethics , 107 , 49–64. 10.1007/s10551-012-1299-1. [ CrossRef ] [ Google Scholar ]
• van Mook WNKA, van Luijk SJ, O'Sullivan H, Wass V, Harm Zwaveling J, Schuwirth LW, & van der Vleuten CP (2009). The concepts of professionalism and professional behaviour: Conflicts in both definition and learning outcomes . European Journal of International Medicine , 20 , e85–e89. 10.1016/j.ejim.2008.10.006. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Voelpel SC, Eckhoff RA, & Förster J (2008). David against goliath? Group size and bystander effects in virtual knowledge sharing . Human Relations , 61 , 271–295. [ Google Scholar ]
• Weick KE, Sutcliffe KM, & Obstfeld D (2005). Organizing and the process of sensemaking . Organization Science , 16 , 409–421. 10.1287/orsc.1050.0133. [ CrossRef ] [ Google Scholar ]
• Werhane PH (2008). Mental models, moral imagination and system thinking in the age of globalization . Journal of Business Ethics , 78 , 463–474. [ Google Scholar ]

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Essentials of Mental Health Nursing

Student resources, chapter 6: diversity issues within mental health care, case study: paranoid schizophrenia.

Aamina is a 22-year-old female.  She was born in Karachi in Pakistan, but she was brought over to Northern Ireland when she was two years old with her two older brothers by their parents. There were no reported problems in her childhood and she met all her developmental milestones.  However, her parents were noted to put a lot of pressure on their children to study and do well academically. Aamina did very well at school, and was 18, in her first year studying philosophy at The University of Cambridge, when she became unwell. She started to fall behind with her university work and lost interest in socialising, choosing to stay in her bedroom alone. Aamina became very private and isolative, and she would not allow anyone access to her room.  Her behaviour became irritable and defensive. Her Personal Tutor at the University contacted her parents with these concerns. However, they were very dismissive and refused to accept that anything was wrong. Therefore, Aamina received no formal mental health assessment.

Index Offence

On 30 January 2013, Aamina invited fellow student and friend Vorana back her room so they could study together. Later that evening, Aamina was found by the police wandering the street covered in blood shouting repeatedly: ‘Jakata is coming, Jakata is the highest order, and I have obeyed his orders.’

The police brought Aamina to the Cambridge Mental Health Unit under Section 136 of the Mental Health Act 1983 [as amended]. When the police went back to check Aamina’s room they found Vorana dead. She had been stabbed seven times.

Aamina was subsequently convicted of the manslaughter of Vorana on the grounds of diminished responsibility and diagnosed with Paranoid Schizophrenia. She was sent to a high secure hospital under section 37/41 of the Mental Health Act 1983 [as amended] where she remains an inpatient.

Past Psychiatric Care   

On admission Aamina was nursed in seclusion owing to her unpredictable and violent behaviour towards staff and fellow patients. Despite attempts to nurse Aamina on the ward, on each occasion she became violent and attacked staff or fellow patients.  She appeared to show no insight into her illness or index offence.

Current Presentation

Aamina has been in long-term seclusion for the past 18 months. Her family have recently requested to visit her every Thursday; this has not yet been facilitated. They have also asked if they can bring her homemade Halal food when they visit. She has also expressed a wish to practice her Muslim religion. Nursing staff insist on her wearing a ‘strong suit’ 1  while in seclusion, as Aamina has been known to self-harm. Aamina becomes very distressed being forced to wear this suit, as it does not cover all of her legs.

What would you do any why to facilitate Aamina to practice her religion in this situation?

1  A ‘strong suit’ is a piece of clothing that cannot be ripped.  The patient wears this in lieu of their own clothing. It is used when there is a potential that individuals may use their clothing to ligature.

›  Possible answer

• Ensure that a finger food Halal diet is ordered for Aamina, as she may not be allowed cutlery in seclusion. 
• Nurses should adhere to local policies in regards to food being brought into the hospital from visitors. The policy would need to be explained to Aamina and her family.  
• If Aamiina is too unwell to receive a visit from her family, staff should care plan access to a telephone thus allowing her to maintain contact with her family.   
• Ensure Aamina has access to an Imam.
• Obtain a bespoke ‘strong suit’ for Aamina that covers her legs, and constantly assess whether this is actually required. 
• Aamina must prey facing to Mecca. Therefore, the ward should obtain a qibla compas (or qiblah) that points in the direction of Mecca. This will enable staff to enter the seclusion room during a seclusion review and mark a stop on the seclusion room floor that points in the direction of Mecca thus orientating Aamina during her prayers. 
• Before performing certain rituals, most importantly before prayers, Muslims are expected to perform a form of purification, known as ablution or ‘wudu’ in Arabic. This involves washing the hands, face, arms and feet with water. Given that Aamina is in seclusion, she may not have access to running water. Therefore, to allow her to meet this ritual and to maintain her safety, staff need to provide her with fresh water in a disposable cardboard pulp kidney dish bowl before her prayers.