When we learn and improve we usually need somebody with more expertise than we have. What works for us, and what stands in our way? What rules and assumptions do we bring? If you’re a medical trainee, think about the rules and expectations that are imposed by the medical profession and what the professional assumptions may be.
As an example, I love to dance. Ballroom dance. When the music plays and I dance a waltz with my dance partner, all thoughts of the outside world disappear, and I just am so much in the moment. However, I want to constantly improve my dancing, and consequently I have coaching. But it isn’t always easy. For instance, I believe I need to work on my top line and shape, but my coach wants to focus on my legs and feet. What I think I need to improve isn’t at all what my coach thinks I need to improve. Sometimes it reminds me that you just don’t know what you don’t know. Then I can get defensive, and the dance lesson can be hard work.
Learning is a process, and some elements must take precedence over others. So with my dance coach insisting that I need to focus on my legs and feet in order to get a better top line and shape, it makes me realize that I’m in a somewhat uncomfortable stage of conscious incompetence.
There was an interesting article called “Personal Best” in the 2011 issue (October 3) of The New Yorker. It was written by a surgeon, Dr. Atul Gawande, and he poses the question “top athletes and singers have coaches. Should you?” He talks about the four stages in learning: unconscious incompetence, conscious incompetence, conscious competence, and unconscious competence Think about your stage of learning as a hospital registrar.
So the stage I think I’m at, as a dancer, is conscious incompetence, and it’s probably the stage that most impedes learning. Like most people, I find honest criticism sometimes hard to take, even from an expert. In fact, what you say to yourself about how you learn really has an impact on how well you absorb and learn new material. I know I tend to berate myself, saying that I should have remembered that, surely I’ve been told that before. It’s quite likely that I have been told something repeatedly at earlier stages of learning. Coaches tend to say things over and over, in different ways or using different words. Finally it clicks with the learner, and there is insight. What I always find somewhat frustrating is that my brain and body weren’t at the time able to coordinate the learning, despite it being repeated over and over. I just have to patiently (or not so patiently) wait until that “moment of readiness to learn” occurs. When it does, it’s wonderful, like magic. I do the step or movement required, and everything just goes smoothly.
Like all learners, until we get to those stages of conscious competence and unconscious competence, we have to put in the time, and the hours of practice. This applies to medicine, to musicians, to performing artists, and all other highly skilled people. In order to develop expertise the popular belief is that one needs approximately 10,000 hours of deliberate practice. Deliberate practice is a sustained and mindful process of learning that involves the critique from other experts so that improvement and change takes place. Research also shows us that the more skilled you are then the more likely it is that many of your basic actions are automatic. Those automatic actions then free up your brain so that it can focus on your new learning. Arnold Palmer, the golfer, once said that at his level of performance it was 90% mental and 10% physical. Greg Louganis, who won four gold medals in two Olympics back to back in springboard and highboard diving, and was the top diver of his generation, has said something similar.
If we want to develop expertise it means we need coaching. What we as learners are not good at is knowing where to start, or how to proceed. Often we need to work on “stuff” we’re not good at. This takes discipline. Earlier I mentioned deliberate practice. By deliberate practice, I don’t mean just working on the stuff you like, but actually practicing repeatedly the stuff you don’t like, or where you feel you’re not competent. If you’re a musician and you dislike scales, well guess what, you better get used to doing lots and lots of practice on scales. Once you can do those automatically, you can move on to other material. It’s the same for hospital registrars preparing for exams. Don’t just focus on the topics you like, really study the topics you don’t like, repeatedly, until you understand them.
To be open to learning you need trust, respect and humility. You truly have to believe that your coach knows best, and can show you the way to improve, I’ve had to swallow my requests to work on top line in ballroom dance, and just listen and absorb what the coach wants me to do. If he says my top line will improve if I get the legs and feet right, then I have to believe it. If I keep questioning it, then I know I’m being defensive and my learning is impeded. I want to get to that next stage, conscious competence, so I better just shut up, stop arguing, listen, and do what I’m told. It works, as I trust and respect my coach.
So to sum up, these are four ways to improve your learning:
Be mindful – it’s worth it!
Dr. Patsy Tremayne