As I sit on this old wooden pew, I rock side-to-side to ensure that blood flows to each part of my bottom. We’ve been at this rented church for 75 minutes listening to the sounds of my daughter’s violin class recital and now it’s time for the last piece.
A high school student with a large tattoo of a stanza on her left bicep stands up and begins to play. A beautiful and tenderly nuanced sound fills the hall. Siblings, who have been leaning against parents, drop their muted handheld gaming devices and listen. We sit with a hushed hunger as we are lifted by her musicianship.
The performance ends and we compliment the young virtuoso about her masterful display of advanced technique. The young virtuoso responds with a smile, “Thanks! And there are so many parts that I look forward to improving.”
The mind of an expert
This young violinist thinks like an expert. She loves what she does and yet she is even more excited about the possibilities of what she might accomplish.
Similarly, we as physicians are experts. We completed residencies and fellowships and yet there is so much to learn. There are so many things we can do to advance our expertise not only in medicine, but also in business, leadership, relationships, and anything else we set our minds to master.
We’ve seen some colleagues excel in one facet, but struggle with many others; and at the same time we work with colleagues who excel in virtually every aspect of their lives. This raises some questions: How do we stay experts? And how do we become an expert?
Here are 3 steps to become an expert
1. Think like a beginner. The beginner’s mind sees potential. It hungers to learn and to grow.
Expert physicians maintain the mind of a beginner. They think that their most basic abilities can be further developed through dedication and hard work.
This procedure that we have done for years, perhaps we can identify and eliminate wasted steps. These thoughts that we have when this occurs, perhaps we can change our cognitive approach. That reaction we have with a precious individual, perhaps we can nurture a deeper relationship.
Expertise is cultivated through learning. This is harvested from books, journals, Twitter feeds and blog posts, and the inspiration we gain at conferences. Experts think like a beginner. And then they practice.
2. Deliberate practice. Experts work their butts off. However, it is not just the amount of effort or the time spent. The effort needs to be smart and focused. The practice needs to be deliberate.
A guitar player who plays “Stairway to Heaven” for three hours each day is probably doomed to play in an awkward cover band; whereas, the guitarist who practices a solo that is just out of reach of current skills for one hour each day is more precisely on a path to expertise.
We are each part virtuoso and part cover band. Repeating a mediocre approach to a patient problem may be familiar and may get the job done, but it is not expertise.
Experts engage in deliberate practice. They dissect skills down into smaller and smaller chunks and work to fine-tune each skill one chunk at a time. They practice in a focused manner. And then they reflect.
3. Reflect. In between practice, experts reflect on their performance and elicit the feedback of others. This important step is a key driver towards expertise.
It is increasingly common for élite athletes, Fortune 500 CEOs, and physicians to work with a coach or a mentor to help them reflect upon what is working and what can be better.
Novak Djokovic is the top ranked men’s tennis player in the world. He strives to consider every detail, looks at every angle as being crucial, and seizes moments where he can gain an incremental edge to beat the best when his competition is already the best it has ever been.
Djokovic is the best in the world and yet he and virtually every other élite athlete travel with a coach. His coach helps him identify skill chunks to develop, create goals for practice, and most importantly to reflect upon results. Together they create strategies for future deliberate practice.
Eric Schmidt, Chairman of Google, recently remarked during an interview with Fortune Magazine that he works with an executive coach. This is a very common practice for Fortune 500 CEOs. His coach helps him see himself as others see him. His coach helps him identify his blind spots as he runs a multi-billion dollar business.
Atul Gawande, an endocrine surgeon, wrote in The New Yorker about his use of a mentor coach. He found that after residency he was getting better and better, until he didn’t. He worked with a retired surgeon who observed his surgical skills for wasted moves, made observations about operative positioning, and discussed strategies to reduce complications.
Look around to the mentors, colleagues, and coaches who can help you. Look for an outside observer to be an aligned confidant who can help you reflect and develop further brilliance and ability. Identify areas of your professional and personal life where you can develop and extend expertise.
Moving forward
We know that expertise is not innate and it is not luck. Instead, expertise is gained through hard work, it takes time to achieve, and it expires if not nurtured.
The old idea of “see one, teach one, and do one” is outdated. Physician experts prefer to “see one, practice one, reflect and improve on one.” They enjoy this process and they repeat it as part of their daily ritual.
The moment the expert physician becomes comfortable with their current skills is the exact moment that they begin their path towards mediocrity. Experts approach life with a beginner’s mind. They deliberately practice. And they reflect.
Richard Winters is an emergency physician, medical staff president, and IPA CEO. He blogs at his self-titled site, Richard Winters, MD.
