Overview

Jeff Belkora developed SLCT in the context of helping people think, talk, and write about medical decisions.

SLCT stands for

1. Scribing
2. Laddering
3. Checking
4. Triaging

These steps are used to develop a written issue or question list, such as a list of questions for your doctor.

An additional step, categorizing, can be used to add a logical flow to a SLCT-generated issue list.

SLCT can be combined with the SCOPED process and S5 model for even more specific and detailed critical reflection.

Description

SLCT can be self-administered or facilitated by a person or software program.

SLCT is based on the idea that your agenda – your questions, concerns, goals, and priorities – form an iceberg. The tip of the iceberg is visible above water, but most of the iceberg is under the waterline.

You can generally access  the top-of-mind issues at the tip of the iceberg. You are conscious of these issues and can articulate them. Due to memory constraints, you may find 7 +/- 2 issues at the tip of the iceberg. The SLCT process invites you to articulate these issues, and then attempts to surface the rest of the iceberg as described below.

The process begins with scribing, the practice of simply writing, with minimal paraphrasing or summarizing, what is on your mind. This part of the process resembles free associating or brainstorming.

Next is laddering. This step uses the Ladder of Inference, a model by Chris Argyris and colleagues. The idea is to elaborate on the issues written down in the scribing step. The elaboration should lead to more specific, concrete statements, illustrated with examples. In this step, implicit thinking is made explicit.

The third step emphasizes checking whether the issue list under development has incorporated a sufficient breadth of thinking. As the name suggests, a checklist can be useful to stimulate thinking about categories of topics. For example, when applied to medical question-listing, Jeff Belkora uses the SCOPED model as a checklist for expanding the range of topics considered.

The fourth step is triaging or prioritizing the list of issues under development. In this step, participants identify those issues that are strategic or material to the situation at hand, because their resolution will drive different courses of action. For example, the degree to which cancer cells have escaped a localized area in the body may affect whether a patient adds chemotherapy to surgery.

Strategic issues should be highest priority. Other issues may be tactically relevant, in that their resolution can lead to different outcomes, but if they would not drive different courses of action, then they are lower  priority. For example, a patient who has decided the benefits of chemotherapy outweigh the risks may then focus on the tactical issue of which chemotherapy regimen will be most tolerable.

Operational or logistical issues may be of interest to satisfy curiosity and facilitate planning, but by definition they are barely relevant to the long-term outcome, and certainly not material to major decisions. These should be lowest priority.