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Physician Success Tool: Growing in Confidence Part 1

We all have areas we are more confident in than other areas of our lives. It's natural. Overcoming insecurities is a powerful thing that takes dedication and trust. In the coming weeks, we will uncover the issues that get in the way of this process and open a dialogue about having self-confidence when doing something new. Today we dig into the typical process of growing in confidence.


Merriam-Webster gives the essential definition of confidence as "a feeling or belief that you can do something well or succeed at something." It's a "belief in yourself and in your abilities and powers." A significant portion of confidence is based on past experience. You've done it before. You've done it often. You have evidence that you can do it. It's not a false belief where you decree that you can take on the CEO position of a multi-billion-dollar international company without knowing anything about business. There's a natural process.


Let's look at the example of learning to drive as a window into understanding the typical progression of learning any new skill or applying any new concept.


The first stage is unconscious incompetence. For a young driver, it seems so simple. You put your foot on the gas or the brake and steer the wheel.  They don't know what they don't know.  This is why they make learner's permits. Ignorance is bliss.


The second stage is conscious incompetence. They now realize it's more complex than they imagined. They are aware of the steps they need to change lanes, but their execution is flawed. There may be swerving, gasps, prayers, and lots of handle-gripping. (If you've ever trained a teen to drive, you know of what I speak.) Parents and instructors everywhere sigh great relief when this second stage is complete). Stress, anxiety or even "nervous-cited" is experienced. 


The third stage is conscious competence. They look in the rear-view/side mirrors, put on their blinker, look over their shoulder, and ease the car safely over to the next lane. It still takes full focus and attention, but they now have the skill set. It's can feel effortful and/or invigorating. Let me point out that had they stopped driving during the first or second stage of learning, they would have never arrived here. You must take action to grow and learn.


Last comes unconscious competence. Most experienced drivers can carry on a conversation with others in the car and safely look, signal, and change lanes safely with minimal effort. We are executing our skills well without being focused on every automatic detail.  This can feel like ease or boredom

I once was with a group of physicians - of a variety of specialties - when the facilitator who reviewed the emotions of each stage posed a question. She asked what percent of time in each stage do you prefer you spend your clinical days? I initially thought the last stage. And then - listening to the round robin of answers - it was facinating. EM physicians talked about liking to have some challenges and appreciated having a portion of their day in stages 2 and 3. The various specialties had different mixes. But it was helpful to notice and normalize that we are all in various degrees of competence with various issues that walk through our doors. 


Now, let's think back to med school  - remember those initial H&P's that felt like marathon sessions?  And by repetition and feedback, you became better and grew in skill. Pretty soon, you're touch typing or taking notes while talking to patients and processing the differential and plan almost automatically. 


How do confidence and competence relate? Many in medical education are familiar with the Dunning-Kruger effect. Often, but not always, there's a point of overconfidence on the learner's part while lacking competence which is why is progressive autonomy is in play. That is followed by the Valley of Despair, where confidence plummets even while competence rises.  The realization that it's not as straightforward as thought sets in.  As we continue showing up, trying, and learning, our competence and confidence then grow along the slope of enlightenment until we reach the plateau of sustainability, where our confidence rests high and steady even while we continue to learn. 

This Photo by Unknown Author is licensed under CC BY-SA


Take a minute and review your skills and abilities that are most important to you. Where are you in your confidence for each one? What's the truth about your competence? Often, we need to trust the process (as imperfect as it is) and keep showing up, reading, learning, and growing; then, we will see our confidence rise.


Interestingly enough, competence and confidence are not perfectly aligned. That plateau doesn't always emerge. Next week we will look at the common issues that interfere with our confidence.


Have a joy-filled and action-taking, confidence-building week! 



Our 12-week course for individual physicians walks you through detailed steps of ditching unnecessary suffering, protecting and increasing your energy, and fostering your ideal future and looks at growing in confidence.

Original post 12/2021, updated 2/2024


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