Tag: expertise

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Anesthesia Education Leadership in Emergencies Preparing for Grad School/Residency

#33 – Flow and the Can-O-Calm

In this episode, I tell you a story about whitewater paddling and unpack the concept of flow described by psychologist and author Mihaly Csikszentmihalyi, PhD. I also present the Can-O-Calm for the first time on the podcast. This secret, magical, weightless and even sterile (when you need it to be) tool will help get you through the most dire of circumstances with your head right, your vision clear and yes, your voice calm. The concepts of flow help us understand how to prepare for emergencies, train for challenging cases and design specialty teams, fellowship programs, board examinations, continuing education as well as primary residency programs.

Below are images of Dr Csikszentmihalyi’s flow concept as well as the quote by Elaine Scarry presented in the podcast.

Mihaly Csikszentmihalyi’s Flow Concept.
Mihaly Csikszentmihalyi’s expanded Flow Concept

“What occurs in an emergency is either immobilization, incoherent action or coherent action…  If we act, we act out of the habitual…  If no serviceable habit is available, we will use an unserviceable one and become either immobilized or incoherent.”

– Elaine Scarry, Thinking in an Emergency

Sources

Csikszentmihalyi, M. (1997). Flow and the psychology of discovery and invention. HarperPerennial, New York, 39.

Scarry, E. (2012). Thinking in an Emergency (Norton Global Ethics Series). WW Norton & Company.

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Anesthesia Education Clinical Tips Leadership in Emergencies Preparing for Grad School/Residency Wellness

#32 – Harnessing the power of deliberate practice

This podcast discusses deliberate practice, a concept developed by renowned cognitive psychologist Anders Ericsson, PhD. Deliberate practice is the kind of practice that top performers employ in order to reach the very highest levels of excellence across domains. Ericsson studied countless musicians, athletes, dancers, chess players, medical professionals and others to uncover the secrets and power of deliberate practice.

Malcolm Gladwell popularized some of Ericsson’s work in his 2008 book, Outliers, as the 10,000-hour rule to expertise, stating that on average, it takes about 10,000 hours to develop as an expert. But it’s not as easy as that. It’s not that simple. It’s not just about being on the job for 10,000 hours. And you know what I’m talking about. You’ve worked with people who are very experienced yet not the best – not even great – perhaps even mediocre, at their jobs. What Ericsson saw is that it takes top performers around 10,000 hours of deliberate practice – a concentrated, effortful, focused kind of practice, with feedback from a coach, to achieve the top level in any field.

Check out the podcast and links in the show notes for a quick break down and some examples of how to harness deliberate practice to improve your anesthesia career.

Resources:

Ericsson, K. A. (2008). Deliberate practice and acquisition of expert performance: a general overview. Academic emergency medicine, 15(11), 988-994.

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81.

Ericsson, K. A. (2015). Acquisition and Maintenance of Medical Expertise: A Perspective From the Expert – Performance Approach With Deliberate Practice. Academic Medicine, 90(11), 1471. doi:10.1097/ACM.0000000000000939

Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt.

Weinger, M. B., Banerjee, A., Burden, A. R., McIvor, W. R., Boulet, J., Cooper, J. B., … & Torsher, L. (2017). Simulation-based assessment of the management of critical events by board-certified anesthesiologists. Anesthesiology: The Journal of the American Society of Anesthesiologists, 127(3), 475-489.  

Young, J. 5 May 2020. Researcher Behind ‘10,000-Hour Rule’ Says Good Teaching Matters, Not Just Practice. (podcast). EdSurg Podcast.  Retrieved from https://www.edsurge.com/news/2020-05-05-researcher-behind-10-000-hour-rule-says-good-teaching-matters-not-just-practice. 

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Anesthesia Education Clinical Tips Leadership in Emergencies Preparing for Grad School/Residency

#31 – Expertise in Anesthesia with Denham Ward, MD, PhD

This episode originally released on From the Head of the Bed in February of 2017.

Denham Ward, MD, PhD joined me to talk about expertise in anesthesia. At the time of this recording, Dr Ward was the director of the Academy at Maine Medical Center Institute for Teaching Excellence and professor of anesthesiology at Tufts University School of Medicine. He is Emeritus Professor and Chair of Anesthesiology and Emeritus Professor of Biomedical Engineering at the University of Rochester.

This podcast focuses on developing and maintaining expertise over a career in anesthesia.  Highlights range from defining expertise, specialization in anesthesia, types of problem solving and clinical decision making, deliberate practice, grit and how to teach and coach the development of expertise in trainees as well as experienced clinicians. We touch on Ericsson’s ideas on deliberate practice and the 10,000 hour rule for expertise, Dreyfus’ conceptions of skill acquisition from novice-advanced beginner-competent-proficient-expert, Kahneman’s System 1 and System 2 ways of thinking, Moulton’s “when to slow down,” Gawande’s ideas on the benefit of getting coached to improve our performance even well into our careers and more.

“The difference between medicine and music is… musicians practice, practice, practice and then they go to Carnegie Hall for one evening…  We’re essentially at Carnegie Hall every day.”  Denham Ward, MD, PhD

“Most professionals reach a stable, average level of performance within a relatively short time frame and maintain this mediocre status for the rest of their careers.” Anders Ericsson

References:

Benner, P. (1982). From novice to expert.  The American Journal of Nursing, Vol. 82.  Retrieved from http://www.healthsystem.virginia.edu/pub/therapy-services/3%20-%20Benner%20-%20Novice%20to%20Expert-1.pdf.

Dreyfus HL, Dreyfus SE. (2005).  Expertise in Real World Contexts. Organization Studies, (26)5: 779-792. Retrieved from https://www.pdx.edu/sites/www.pdx.edu.unst/files/UNSTArticleDreyfus.pdf

Duckworth, A. (2016). Grit: The power of passion and perseverance (Vol. 124). New York, NY: Scribner.  Retrieved from http://www.simonandschuster.com/books/Grit/Angela-Duckworth/9781501111105. Screen shot by author.

Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc..  Retreived from https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/9780345472328/. Screen shot by author.

Ericsson, K. A. (2015). Acquisition and Maintenance of Medical Expertise: A Perspective From the Expert – Performance Approach With Deliberate Practice. Academic Medicine, 90(11), 1471. doi:10.1097/ACM.0000000000000939

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81.

Gawande, A. (2011). Personal best. The New Yorker, (30). 44.  Retrieved from http://www.newyorker.com/magazine/2011/10/03/personal-best.

Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux.

Kaminski, J. (Fall, 2010). Theory applied to informatics – Novice to Expert. CJNI: Canadian Journal of Nursing Informatics, 5 (4), Editorial. Retrieved from http://cjni.net/journal/?p=967.

Moulton, C. E., Regehr, G., Mylopoulos, M., & MacRae, H. M. (2007). Slowing down when you should: a new model of expert judgment. Academic Medicine: Journal Of The Association Of American Medical Colleges, 82(10 Suppl), S109-S116.

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Anesthesia Education

#1 – Anesthesia Guidebook Origin Story

the go-to guide for anesthesia providers

Welcome! You made it! This is episode 1: the origin story, the backdrop, the context to who we are, where we’re from and where we are headed. Check out the podcast in your favorite player or right here on the website to hear our story, which is all about YOUR STORY!

You’re on a path to becoming an expert anesthesia provider… we’re here to help guide you.

Everything we do is designed to help you master your craft. 

Anesthesia providers hold their patients’ lives in their hands during every case. You never know when you will face crashing hemodynamics, a lost airway or a life-threatening surgical problem… and each of these emergencies can be complicated by your patients’ pathophysiology, suboptimal systems of care that surround you and/or your individual preparedness for the moment.

Anesthesia Guidebook will help you deepen your practice so that you can come through for your patients when it counts.

If you’re just starting to explore the absolutely fascinating world of anesthesia, maybe as a critical care Registered Nurse, medical student, anesthesia resident or SRNA, we have stories, guides and resources specifically designed with you in mind.

Anesthesia Guidebook is also for those seasoned providers who are looking to level up, dig deeper, stay fresh and develop new skills. We’ll bring you the latest on evidence-based medicine and emerging trends & techniques in the anesthesia community, so you can stay sharp and give your patients and students your best.

Renowned psychologist and best selling author on human performance & expertise, Anders Ericsson, has said:

“Most professionals reach a stable, average level of performance within a relatively short time frame and maintain this mediocre status for the rest of their careers.” (Ericsson, 2004)

Ericsson’s words throw down the gauntlet for anesthesia providers. And the stakes couldn’t be higher. The most vulnerable times in our patients lives often begin when we say “hello.” We have an esteemed responsibility to meet the demand for clinical expertise & assure high functioning systems of care that our patients expect, deserve and entrust their lives to.

Anesthesia Guidebook will bring you compelling stories, e-books and other resources built around pathophysiology, pharmacology, airway management, human performance and team dynamics, all tailored to the high stakes environment you work in.  Your path to becoming an expert anesthesia provider – to mastering your craft – will be the focus of everything we do.

Sources:

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81.

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