4 Strategies All of My Most Successful Residents Use
The strategies we learn in school don’t translate well to our careers
What separates the best residents from the rest?
As a physical therapy orthopedic residency program coordinator, I am often asked this question by applicants. Common answers from fellow faculty members include grit, experience, passion, intelligence, and emotional intelligence. While all important, these are not the sole differentiator.
What consistently separates the elite performers from the rest?
The best residents have a desire and ability to learn independently. The best residents are the clinicians who seek to understand. They are not satisfied with the information provided by educators and mentors. They embrace doubt and uncertainty, constantly seeking to update their beliefs.
“I can live with doubt and uncertainty and not knowing. I think it is much more interesting to live not knowing than to have answers that might be wrong. If we will only allow that, as we progress, we remain unsure, we will leave opportunities for alternatives. We will not become enthusiastic for the fact, the knowledge, the absolute truth of the day, but remain always uncertain … In order to make progress, one must leave the door to the unknown ajar.” — Richard Feynman
The best residents challenge their current viewpoints and the viewpoints of “experts.” They challenge their biases and seek information that refutes current beliefs.
The best residents read. They read academic journals, books, and articles on current events.
They seek to expand their mental models by reading outside their field. Not only outside their specialty (i.e. an orthopedic clinician reading a neurologic journal) but read outside their entire profession (i.e. a clinician reading about mathematics and economics).
“I work at it, I always advise my people to read outside your field, everyday something. And most people say, ‘well I don’t have time to read outside my field.’ I say, ‘no, you do have time, it’s far more important.’ Your world becomes a bigger world, and maybe there’s a moment in which you make connections.” — Arturo Casadevall
The best residents are not necessarily the ones who perform the best during the year of residency, but the ones who perform the best after graduating from the program.
They do not rely on having information spoon-fed but rather seek out information on their own.
They welcome provided information and feedback.
They are not cocky and resistant to help, rather, they are not solely reliant on learning from others.
These residents separate themselves from the pack because these habits of exploration and developing scientific curiosity are not the norm.
“Well, the first rule is that you can’t really know anything if you just remember isolated facts and try and bang ’em back. If the facts don’t hang together on a latticework of theory, you don’t have them in a usable form. You’ve got to have models in your head. And you’ve got to array your experience both vicarious and direct on this latticework of models. You may have noticed students who just try to remember and pound back what is remembered. Well, they fail in school and in life. You’ve got to hang experience on a latticework of models in your head.” — Charlie Munger
Transitioning from School to a Career Mindset
To succeed, you must embrace the mantra of ‘it depends.’ Our careers are full of unknowns.
Dichotomous thinking, perfectionism, and confirmation bias are powerful forces that resist curiosity. They encourage us to maintain the status quo and cling to one answer.
A new graduate’s lack of job experience is a major disadvantage. They lack intuition, which is nothing more than drawing on past experiences. As we build experiences, we build intuition. Our memory banks fill with experiences we can draw upon at a later date.
The lack of intuition places a greater demand on critical thinking and external influences. Throughout our careers, we learn to balance intuition with critical thinking.
We are emotional beings and our emotions tend to override logic. In short, we are irrational. Intuition can help with rapid decisions, but many of us lack enough experience for accurate intuition.
How new graduates make up for a lack of intuition? How do they move from an environment that feeds information to one in which information needs to be sought out?
Here are four strategies:
#1 — Understand The Influence of Bias
Bias comes in many forms. We cannot eliminate bias but we can learn to recognize it and act accordingly. Here is a list of the most common ones I have witnessed as an Orthopedic Residency Coordinator (I also experienced these when I was a new graduate):
- Availability: Judging frequency by the ease with which instances come to mind. Typically focus on the most recent information.
- Anchoring: Placing the greatest emphasis on the first piece of information received.
- Confirmation: Embrace and use information that confirms your beliefs while simultaneously dismissing any information that refutes your beliefs.
- Outcome: Evaluating the quality of a decision after learning the outcome. “The ends justify the means” bias
- Representative: The similarity of objects or events creates confusion about the potential outcome. Often results from base-rate neglect.
- Sunk Cost Fallacy: Continuing a behavior or endeavor as a result of previously invested resources (time, money, or effort), regardless of the outcome.
- Theory-Induced Blindness: Once you have accepted a theory and used it as a tool in your thinking, it is extraordinarily difficult to notice its flaws
#2 — Find Mentors
The Dunning-Kruger effect traps nearly every new graduate. Our confidence rapidly climbs early in our careers as we mount wins and receive praise from patients and colleagues.
Despite our lack of experience and only understanding of the basics, we ascend ‘mount stupid’ and plant the flag of the expert clinician. It then only takes a couple of miscues to tumble into the valley of despair.
The best way to minimize the fall and speed the climb out is through mentorship. A mentor is someone who maximizes your potential, not someone who only throws out advice and explains what they would do in each given situation.
Find mentors early in your career and soak up as many lessons as you can.
#3 — Build Perspective
Seek external opinions and read often. As I mentioned earlier, reading outside your field and embrace the multi-disciplinary path. By seeking the opinion and viewpoint of others, you can better combat the influence of bias.
We are limited by our experiences and interpretations of information surrounding us. Take advantage of the perspectives and lessons learned by those who have walked the path prior to you.
“If you skillfully follow the multidisciplinary path, you will never wish to come back. It would be like cutting off your hands.” — Charlie Munger
#4 — Embrace Failure and Opportunities to Learn
Failure is challenging to accept, particularly when schooling paints it in an exclusively negative light. Yet failure is often how we learn best.
To embrace failure, we need to abandon the need for perfectionism. As a physical therapist, I understand how hard this can be.
“The hardest thing about being a doctor is that you learn best from your mistakes, mistakes made on living people.” — Dr. Karen Delgado
While physical therapists may not be the difference between life and death as many physicians are for patients, we do influence a patient’s quality of life.
To minimize the negative impact of failure, focus on building relationships. By building relationships, you will have more wiggle room for mistakes. You may even receive valuable feedback.
Lastly, turn mistakes into advantages. This only occurs if you reflect on the interaction and why the poor outcome occurred. Some issues only reveal themselves after application, not during practice.
I started this article by asking who makes the best residents. I believe the answer also applies to the question ‘who makes the best professionals?’
To thrive, you must embrace doubt and uncertainty.
You must recognize your biases and your limitations.
You must foster cultures or scientific curiosity and mentorship.
I believe one of the most powerful mantras any professional can adapt comes from the mathematician Jordan Ellenburg in his book How Not to Be Wrong:
“No tool is undroppable.”
By embracing the dreaded ‘it depends’ philosophy students frequently resist, you can become a better professional and thrive in your career.