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Physician Success Tool: Confidence, - a look forward to growing in confidence

Confidence is a beautiful thing. In December, we reviewed the typical way one gains confidence - growing competence over time by gaining experience. We also covered common saboteurs – perfectionism, the inner critic, impostor phenomenon, comparison, external validation, and projected judgment along with steps to combat them. And now, we are kicking off 2022 with ways to improve confidence further. 



The growth mindset is the basis of overcoming those previous sappers of your confidence and growing more. Carol Dweck has been the leading researcher and publisher on the topic. She defines individuals with growth mindsets as those "who believe their talents can be developed through hard work, good strategies, and input from others." They "enjoy challenges, strive to learn, and see potential to develop new skills." I suspect you all have had a growth mindset at some point. In medical school, you tackled new topics, skills, languages, and new types of interactions. You arose to the challenges. Even if this doesn't describe you now, it can! You are not permanently stuck in a fixed mindset. You can remember to strive for mastery rather than performance or perfection, exercise self-compassion, view mistakes as learning opportunities, find joy in progress, and rekindle fulfillment from learning. Be authentic and willing to admit mistakes. Collaborate and grow together. Become willing to put in effort and take on challenges without guarantees.  Reframe feedback.  Fail forward – instead of seeing failure as a reason you shouldn't be here, find the lessons, take them along and evolve your approach. If you've never read Carol Dweck's book, get it. Mindset: The New Psychology of Success. You can see how a growth mindset shifts the pressure. Dialing that down allows for your confidence to be present and helps move those barriers out of the way.


But what about when it's something new?


First, I want to offer Brené Brown's perspective on doing new things in her Unlocking Us podcast entitled "FFTs." She employs the strategy of naming the feeling when you are doing something new. We know that affect labeling (naming the emotion) alone disarms the amygdala to lessen the fight or flight response. Also, by becoming fully aware that the feeling results from a novel experience, we can then 1. Normalize it. "Of course, this feels uncomfortable. I've never had 40 instruments in my hands at once while using a Gomco." 2. Put it in perspective. Activities won't feel awkward forever. Remember when it felt strange to introduce yourself as Doctor? And before you knew it, you were calling Walmart at Christmas to find out if they have Tickle Me Elmo in stock and had to prematurely hang up when you realized you just said, "Hey, this is Dr. Caylor." (Just me?) 3. Reality check expectations for new things. You will not be an EPIC superuser after three months of use. You are not going to ace using POCUS until you've had several scans under your belt.



Okay, but still, how can you be confident in something in which you have no experience? <Insert coaching semantic> Self-confidence - In coaching, many of us use this term (instead of confidence) to delineate when you have no experience in a skill or position from your past to believe you can do it. Self-confidence is a wonderful blend of the growth mindset and Brene's new-things-perspective. When something is new, you can find confidence by believing in yourself anyway - not in some magical way while you click your heels. Rather, you develop the belief by knowing what you know, trusting yourself to figure out the rest, being willing to feel any feeling, having your own back, and being willing to learn.  This is a skill set that serves everyone, but especially those in rural practice. Several years back, one of our new graduates was on call for the first time in rural Alaska when a plane crash occurred. Now, she had never been the primary attending for a multi-trauma. She didn't spin in worry and insecurity. Instead, she accessed her self-confidence (and a lot of adrenalin). She knew she would provide the best care for the patients she could. She assessed what she knew. She knew her ATLS, had put in chest tubes and knew there were experienced providers and staff who would come in to help. She knew she'd consult the experts up in Anchorage, and she would figure things out. She was willing to feel the discomfort of an emergent situation as the first-time leader of a multi-trauma. They stabilized, consulted, and transferred. She had her own back. She was able to know she did the best she could with the knowledge, experience, staff, and resources she had on hand and was able to put her head on the pillow peacefully (a few hours afterward when the adrenaline declined). She was then able to look back and find the lessons that would be invaluable to her the next time this situation occurred. This is self-confidence – a first-time perspective with a growth mindset.


One additional helpful hint in furthering your confidence is Creating Progress.  Set yourself up to grow in confidence by setting regular, small incremental goals to observe the progress regularly.  Maybe close one chart in the middle of each clinic session for now. What do you learn? What thoughts help you stick with the goal? When you see the benefit, you can raise the challenge of two per session. This not only builds the habit slowly but also makes it achievable quicker than if you set the goal of closing all of your charts by 5:30 pm. Having a plan of teaching one pearl to someone on your healthcare team each week is very doable, even if it feels challenging. Once achieved, you get a little confidence boost. Next week, maybe you aim for two. Regular wins help build confidence.


Start 2022 with your growth mindset, new-things perspective, and by setting yourself up to create small regular wins and watch your confidence rise. You've got this!


Have a joy-filled year!



Now is a great time to see how I work with family medicine residency programs to help physicians enjoy their chosen careers. Learn more here. 


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