When analyzing the Chinese character for the word listening, or Ting, one can begin to understand the true nature of the act. Ting comprises four elements: ears, eyes, mind, and heart (Fig. 1). The first three elements may seem obvious, as ears are needed to hear words, tones, and pace; whereas eyes are necessary to identify nonverbal cues, such as gestures and body language, which may provide additional context to the spoken words.1 Next, the mind refers to providing a speaker our undivided attention, along with the ability to analytically interpret what is being presented. The inclusion of the fourth element, heart, is where the Chinese character shows a deeper insight by acknowledging the role of empathy and understanding required for a listener to truly connect with any speaker. Ultimately, ting recognizes that listening requires more than simply opening our eyes and ears—it also requires opening our minds and hearts. Listening creates an opportunity to be present, ask better questions, collaborate more effectively, and improve relationships with one another.2Fig. 1.: Ting (to listen).The concept of ting calls on us to ask, when was the last time we listened with intensity? Doing so is especially difficult today because we are constantly battling miscellaneous notifications across phones, pagers, tablets, and laptops, on top of the stimuli from our surroundings. If only the body could filter out these sounds and sights (and screen e-mail inboxes for spam), listening comprehension would increase. In addition, with the rise of the hybrid work model, online/live-stream lectures, meetings, and conferences will likely persist, which will increase the presence of technology and notifications that draw attention away from the discussion at hand. It is unclear how or whether one’s listening skills will deteriorate as more time is spent juggling in-person tasks and online discussions, but listening skills that have already been developed must be adjusted to reflect the current environment. Given the evolving work model, reevaluating our listening skills becomes critical. The integrative listening model is a conceptual framework that depicts the four stages of listening: preparing to listen, the act of listening, listening performance assessment, and establishing new goals that make one a better listener (Fig. 2).3 In a circular fashion, preparing to listen focuses on analyzing the goals of the listener and screening for listening biases, such as preconceived notions about a topic or speaker. The act of listening refers to how one interprets what the speaker is saying and shows listening through traditional manners, such as maintaining eye contact.4 Assessing listening performance refers to receiving feedback from those in the same space through postpresentation conversations to determine one’s understanding of the primary message. Finally, establishing new goals is critical to identifying areas of weakness and creating a plan to overcome those concerns while maintaining successful listening skills.3Fig. 2.: Applying the listening process.We will expand on the first, third, and fourth stages because these steps are frequently left out of discussions related to listening, and we will incorporate strategies to assist with mastering the art of listening. In addition, we will discuss techniques to make someone feel heard after speaking. PREPARING TO LISTEN When discussing listening skills, most people initially think of active listening, such as paraphrasing and maintaining eye contact. These skills are necessary and critical for success; however, listening begins before the listening event. First, one must determine the context of the event and his or her specific listening goals, along with evaluating any potential listening biases. When this is complete, one can begin to predict what information will be discussed. This preparation will let the mind begin to focus on the content ahead and connect better to existing knowledge. Purpose and Goals Seemingly never-ending to-do lists can leave us moving from one meeting to the next with the sole purpose of checking it off the list and asking the ever-looming question, “What’s next?” How do we move away from this mindless checklist to a more meaningful effort? Fortunately, the five Ws—who, what, when, where, and why—can assist in reframing our purpose throughout the day. It is a common technique used in business to clarify purpose or, in reporting, to distribute essential information. Likewise, this model can be used before attending a meeting or presentation to establish the purpose and set the tone for the event. As an added benefit, this method does not require another block of time on the calendar; it can be conducted in the solitude of the stairwell en route to the auditorium or while preparing that inevitable second cup of coffee before Monday’s 6 am teaching conference. Running through this model before a meeting can create a more impactful conversation than showing up unfocused. To establish their speaking goals, presenters frequently include an overview at the beginning of presentations to guide their discussion, and agendas are often sent before meetings to ensure specific topics are discussed. Presenters are not the only ones who should have goals; listeners should have an objective too. A listening goal will assist with measuring current capabilities and maintaining an open yet focused mindset throughout the event. A goal is not uncommon, as they are often set unintentionally throughout the day. For instance, it is common to hear someone mention he or she is excited to learn more about a speaker’s work before an event. This is an example of a comprehensive learning goal because the individual wants to understand how the speaker conducts his or her research or performs a specific procedure. However, deliberately setting a goal before an event will help the listener better comprehend the material because he or she is actively trying to reach a clear objective. Understanding various types of listening—there are more than 10—can assist in identifying a goal. The most frequent and core types of listening are comprehensive, empathetic/therapeutic, evaluative/critical, and pseudolistening. Pseudolistening, or pretending to listen without comprehension, is one of the reasons why listening goals should be established. Empathetic/therapeutic listening focuses on listening for an individual’s emotions to respond in a supportive manner and may be used while working with co-workers or patients going through a sensitive situation. Evaluative/critical listening occurs when the goal is to analyze the message and formulate an opinion.3 This type of listening is common when discussing research, particularly in journal clubs, and reviewing new medical devices or drugs. One can quickly go through the different types of listening to assist with formulating a goal. This would lead the listener to approach a listening event with a prepared and focused mindset. Listening Bias Although we may like to believe that we do not have biases, it is critical to recognize we do—and it may affect our ability to listen. Listening biases vary and may range from assuming full knowledge of the topic being discussed, suspecting the speaker cannot contribute anything new, or dismissing a speaker based on age or race. Other biases, such as the atmosphere of the event or personal psychological state, are commonly forgotten when evaluating oneself for biases.4 How well can one learn when in a bad mood or hungry? If the listener enters a meeting in a bad mood, he or she may view new ideas as terrible, even though some ideas may be feasible. Although this is a simple example, the outcome may have long-lasting impact, such as team members being hesitant to speak up in the future, loss of productivity, or a tense work environment that inhibits creativity. Therefore, check-ins regarding biases should not be confined to the traditional sense, such as gender bias, but should also measure factors such as mental and physical wellness. After determining potential biases, taking action to minimize their effect is necessary to avoid distracted listening.5 Organizations can also assist in reducing potential biases through education and creating a culture that values the contributions of each member. However, it is also critical to recognize that each member may have his or her own ideas about a topic, and during a listening event, new concepts may conflict with one’s original thoughts. A listening gap may occur when the listener distorts new concepts to better match his or her own original ideas. Imagine that a design team at a company devises a new product that they believe will change how people communicate with one another. As with any product development, the team asks a sample of people for their thoughts and the design team decides to modify the product based on the feedback. However, if the design team would have removed their preconceived notion of the product changing the way people communicate, they would have actually heard loud and clear that the sample group actually said they would never use the product—regardless of any modifications.5 Organizations can help ensure that thorough discussions exist after a listening event by asking their teams to prepare thoughts before a meeting to avoid group-think and to further promote different perspectives on the material presented. Connect and Predict We have now identified two aspects of preparing ourselves to listen: determine a purpose and a goal and identify potential biases. Now, we can proceed to the third step: connect and predict. At one point or another, we have all scrolled through our phones while waiting for someone to start a meeting or presentation. As much as we wish we could flip on a switch and be fully engaged with the material when presented, our bodies are not that efficient—we need a few minutes to warm up. A sprinter does not attempt to run a race without engaging in a sequence of smaller activities to prime his or her mind and body to perform. As listeners, we must conduct our own series of actions to warm up our minds and bodies to listen, and this should begin with two questions: “What do I currently understand about the topic (connect)?” and “What do I think we will discuss today (predict)?” Questions are a common technique used by presenters to get their audience ready to listen, but we do not need to wait for the speaker to engage us. Regardless of whether one is right or wrong in his or her predictions, the exercise itself will help prime the brain with a current understanding of the topic and prepare it to process new information as it is presented. ASSESSMENT AND NEW GOALS Feedback is necessary to improve technique and skills, and it can be provided through self-assessment or externally from a colleague or mentor. Self-assessment is as essential as feedback from a mentor because it is immediate and offers insight into areas a mentor may miss. Furthermore, self-assessment can be conducted during or after an event in preparation for the next opportunity.6 For example, a ballerina practices in front of a mirror and with a coach. The coach can offer advice and feedback once the dance is complete, but the mirror’s feedback is instantaneous. During a presentation, the mind can wander and lose focus, but remembering the listening goal can help the speaker regroup, just like the mirror. Immediately after a presentation, the listener will know whether he or she has met the listening goal and can further discuss areas of deficiency, along with internal reflection with the peer or mentor. Mentors are in a unique position to guide because they have been through the process and can provide feedback and lessons learned to their mentees. On the television singing show “The Voice,” contestants are paired with a celebrity singer who can best guide them throughout the show. The celebrity vocalist provides feedback on the contestant’s ability to perform, and the relationship between mentor and mentee fosters new ideas using existing styles, techniques, and even fashion trends. Furthermore, contestants can reevaluate their musical goals with a professional to identify areas of weakness. Finally, it is up to the listener to show his or her listening skills by implementing the mentor’s words of wisdom. MAKING SOMEONE FEEL HEARD After listeners prepare to listen, actively listen, and determine whether they listened successfully, the speaker should feel heard. There are a few techniques that can be used to ensure the speaker feels heard and has said everything he or she desired to say. The listener can summarize what he or she heard, ask questions for more information, and then use the 2-second rule to let the speaker express all of his or her thoughts. Summarize Mentors may ask their mentees to summarize the event, which benefits both the listener and the speaker. For the speaker, it shows the listener actually heard and understood what the speaker discussed, whereas the listener is receiving feedback on his or her listening skills.6 Summarizing can be used in a small discussion between peers, between a research participant and research assistant, and in large meetings. For instance, when a time-out is called during a basketball game, players gather for a short meeting on the sideline with their coaches and fellow teammates. They are given feedback on their performance throughout the game, how they can improve, and which teammates they should collaborate with to ensure the maximum number of points are scored. Rather than responding to their coaches’ feedback with “Okay,” one may respond with, “Got it, stay outside the perimeter.” It is a quick confirmation of the plan for everyone listening. Ultimately, it is up to the listener to take the feedback received and apply it to his or her work to demonstrate an ability to listen.7 Guidance from the speaker and improved performance by the listener will open the door for more discussion and improve trust and communication between members.2,8 Probing A presentation or meeting is often met with time constraints and, in some instances, a stoplight as a warning system to limit speakers to specific information and prevent them from fully expressing themselves during their presentation. Asking questions, or probing, lets the speaker know that one was listening and provides the opportunity to further discuss the topic. Perhaps no one is better at probing than the main players in primetime television crime series, in which viewers can visualize the main characters’ internal dialogues alongside their verbal conversations as they piece together information throughout the episode. We can see how the characters process and expand on their team’s discoveries by asking deeper questions and integrating their ideas into the conversation. Avoiding questions that can be answered in a yes-or-no fashion and connecting past information to current evidence is how cases are commonly solved (in 60 minutes or less) in these shows. The way we can see a character’s entire thought process on television can be applied to our everyday lives when interacting with our friends, family, and co-workers. Through probing, we can learn a speaker’s thoughts and capture everything the speaker wanted to say. Following a discussion and taking the time to engage in conversation with those around you helps to clear up any confusion or misunderstandings. Similar to crime show investigators, listeners should steer clear of asking the speaker yes-or-no questions and instead strive to ask purposeful questions that are more likely to lead to a deeper conversation than a simply binary response that requires minimal explanation. Presenting options for answers prohibits the speaker from thinking freely; an alternative to “would you rather?” questions is to use open-ended questions with the five Ws: who, what, when, where, and why. This will provide space to engage in deeper conversations and ensure the listener met his or her goals, while letting the speaker know you were listening. Two-Second Rule Providing a space for the speaker to discuss is essential, but it can be difficult to know when someone is finished talking and when it is acceptable to respond, especially in virtual and hybrid environments. For example, if one responds too quickly, the speaker may not feel heard; by contrast, if the listener waits too long to respond, the speaker may feel as if no one is paying attention. One method to ensure adequate space for the speaker is the 2-second rule or waiting 2 seconds before responding to the speaker. In addition, waiting 2 seconds gives time for the listener to pause and think before asking the speaker a question or making a comment. Frequently, listeners will be preparing their answer before the speaker finishes the point, which further affects one’s ability to listen. The 2-second rule is commonly practiced without one’s knowledge. It is seen in game shows like Jeopardy and Wheel of Fortune when, after being asked a question, contestants are given at least 2 seconds to process what the host is asking before responding. This gives contestants the chance to ask the host to clarify any questions or statements that have caused confusion. By waiting 2 seconds after someone finishes speaking, one can be more confident that the speaker is finished, and the listener can take time to craft a response without rushing. Therefore, adhering to this rule benefits the communication between the speaker and the listener. CONCLUSIONS Listening is a skill that requires continuous evaluation and adjustments, especially with the influx of technology and other stimuli in the environment that can distract one from listening. It is a mutually beneficial relationship because both listener and speaker can exchange new ideas with one another. Ensuring proper preparation by establishing context and listening goals, along with recognizing listening biases and predicting the information that will be presented, will warm up the listener to be able to listen effectively. Once the listening event is over, the listener must determine whether his or her listening goal has been met and identify areas of strengths and weaknesses through peer and self-assessment. In addition, the listener should try to make the speaker feel heard by summarizing his or her understanding, asking questions, and giving the speaker space to finish his or her thoughts. Improving listening skills will assist with one’s ability to communicate effectively and build trust with other individuals. DISCLOSURE Dr. Chung receives funding from the National Institutes of Health and book royalties from Wolters Kluwer and Elsevier, and a research grant from Sonnex to study carpal tunnel outcomes. The remaining authors have no financial interests to declare. ACKNOWLEDGMENT The authors appreciate the peer review and edits from Mike Stokes, staff vice president of communications at the American Society of Plastic Surgeons.