- Email: [email protected]
The Champion’s Creed: Shared Values of Athletes and Academicians
Current Problems in Diagnostic Radiology ] (2017) ]]]–]]]
Current Problems in Diagnostic Radiology journal homepage: www.cpdrjournal.com
The Champion’s Creed: Shared Values of Athletes and Academicians Laura M. Fayad, MD, MSa,b,c,n a b c
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD Department of Orthopaedic Surgery; Johns Hopkins University, Baltimore, MD Department of Oncology, Johns Hopkins University, Baltimore, MD
a b s t r a c t Although the pursuit of sports may be dismissed as unimportant by those in the academic fields, sports are pervasive, and in our society, elite athletes are revered. There are lessons to be appreciated from the training journey and ultimate achievements of such athletes, which parallel the development and sustainment of the academic radiologist on many fronts, including educational training, clinical work, the pursuit of research, and for some, the culmination of a career in a leadership role. & 2017 Elsevier Inc. All rights reserved.
I focus all my energy on the task at hand. I endure and persist. My goals are high and I am held to high standards. Who am I? On any given evening after a day of pursuing excellence at my tertiary care hospital, I can often be found watching my 11-year-old daughter swim laps at practice, for a high-performance swim team. Each swim stroke is deconstructed and practiced relentlessly, 6 days a week, and 2 hours a day. These small movements, when composed, create a smooth and perfect stroke, and are the foundation for success. As physicians and scientists in academic radiology, we have similarly dedicated ourselves to a long life of rigorous training, and are continually striving to improve our performance. Our goals are set high, as are the expectations for performance in our field, not so different in flavor from the high-performance athlete striving to be the state champion or the Olympic medalist. Often, the pursuit of sports is dismissed as unimportant by academicians in the scientific fields. However, sports are pervasive, and in our society, elite athletes are revered. There are lessons to be appreciated from the training journey and ultimate achievements of such athletes, which parallel the development and sustainment of the academic radiologist on many fronts, including educational training, clinical work, the pursuit of research, and for some, the culmination of a career in a leadership role.
This work received grant supports from GERRAF 2008-2010, Siemens 2011-2012, Sarcoma Pilot Program, Johns Hopkins 2012-2014, and SCBT/MR Young Investigator Award 2004. n Reprint requests: Laura M. Fayad, MD, MS, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Wolfe St, Baltimore, MD 21287. E-mail address: [email protected] (L.M. Fayad) http://dx.doi.org/10.1067/j.cpradiol.2016.12.012 0363-0188/& 2017 Elsevier Inc. All rights reserved.
Training Athletes to Training Radiologists Although methods are evolving regarding the training of physicians in residency and fellowship, it is widely known through adult learning theory that deliberate practice is needed to develop expertise, and only through deliberate practice is success achieved.1 Mastering any skill, in athletics or otherwise, requires intensity, persistence, and a willingness to fail. It is the latter element that has been missing traditionally from medical training, as training has focused on practicing specific skill sets, and developing critical thinking tasks over time, but often on real patients where there is no opportunity for failure. Hence, simulation has evolved as a potential tool for training future physicians, whereby trainees can focus on practicing a skill, and mistakes are allowed to happen (without the fear of harming a real patient). Simulation training is the backbone of athletic development. Interestingly, what is the effect of deliberate practice on performance improvement in people for different levels of skill? For the unskilled or young athlete, performance is more dependent on deliberate practice than for the elite athlete (who is already highly skilled).2 Perhaps a parallel can be seen with the training of a resident (who requires more deliberate practice) than a more seasoned fellow (whose expertise may be developed differently). Factors that can play a more important role in developing expertise at a very high level of athletics include psychological and psychosocial factors. In a meta-analysis of 35 studies regarding the usage of psychological interventions for improving the performance of athletes, it was concluded that interventions designed to alter a person’s thoughts and behavior were associated with a moderate positive outcome in performance. Specifically, psychosocial interventions that combined the use of a recorded account of an athlete’s performance with feedback from a coach were especially effective in improving performance, as was a concurrent
2
L.M. Fayad / Current Problems in Diagnostic Radiology ] (2017) ]]]–]]]
performance response.3 In other words, in medicine, an approach using direct and immediate feedback to the trainee regarding imaging interpretations or interventional skill sets probably offers use for improving a lagging trainee’s performance. Psychological training skills that have been explored in high-level athletes to improve performance also include self-suggestion, visualization, and methods of improving concentration4; such psychological skills have not been greatly explored in medicine, despite their emphasis and role in other professions. Could a trainee with weaker performance gain confidence and improve his or her performance through psychosocial interventions?
Higher Goals: The Pursuit of Research The championship! Can I qualify? In the sport of swimming, for example, there are national time standards and cuts that describe where the swimmer’s time falls compared with the national average in a particular stroke. To qualify for a championship meet, the swimmer may have to achieve a time that is in the top 5% of the country, a so-called “AAA standard.” Such time standards offer measurable and clear goals for the athlete. (Every medical student would enjoy a AAA!) As clinician-scientists, we are also goal-oriented and fixed in our pursuits the way an athlete is, in an individual sport. Rather than solely performing our clinical duties based on available knowledge, we strive to improve practice, by discovering new or improved imaging biomarkers or new methods of intervention. Why do some physicians continue the pursuit of research goals whereas others lose motivation? Setting goals initiates a series of motivational processes in a person that ultimately supports achieving the desired goals.5 How much effort a radiologist invests in pursuing a research goal depends on the perceived value of the research, and whether the increased effort is justified by its instrumentality for goal attainment. When the research goal is perceived as unrealistic (“I will need an R01 to do this!”), or the invested effort does not appear to increase the likelihood of achieving a goal (“the metabolic profile of these tumors is all over the place”), a person may choose abandonment, rather than the path of relentless pursuit of research. Conversely, the motivational intensity for pursuing a goal increases as the distance to the goal decreases. The more significant articles we publish on the topic, the greater the enthusiasm for pursuing the research avenue. Although the complex psychological interplay of motivation, effort investment, and goal pursuit are beyond the scope of this article, “instrumentality” is considered as one of the essential determinants of motivational intensity and the willingness of a person to invest effort in pursuing a goal. Generally, humans will invest effort when it is necessary or when there is a return on investment.6 Humans also often believe that setting harder goals are worthwhile (more likely to be associated with a sense of achievement and competence) than setting easier goals,7 which may explain why physicians find themselves embroiled in longterm pursuits with delayed gratification. And what about team sports? While swimming is an individual sport, soccer, for example, is a team sport that requires collaboration. Athletes with different skill sets come together to make the team successful, an obvious analogy to a successful collaborative research team. It is widely recognized at this time that most important research endeavors in medicine require a team effort, and are not individual sports.
Leading Champions Although athletes are encouraged to pursue their sport for the love of the activity and to enjoy the process of athletic development, the win-lose mentality remains a central theme in sports. Cues related to athletic supremacy are well recognized in the human brain.8 Winning is desirable in any environment, including medicine, and the sense of the game often crosses over to every relationship. People are encouraged to define their relationships with others in domination, and these interactions can be played out on the field, in the pool, or at work. Who is the right leader to manage a group of individuals who seek such success? In medicine, leadership styles have evolved over the years, and there are lessons to be learned from leaders in other disciplines, especially athletics. In “The Little Book of Talent,” Daniel Coyle surveyed master coaches from the world’s greatest talent “hotbeds” to identify the ingredients necessary for making world-class athletes and professionals. Not surprisingly, methods of training, motivational activities, and coaching styles were common to all athletic, artistic, and academic areas that develop potential and cultivate talent. Coyle9 settled on 52 actionable tips for achieving success, many of which are centered in promoting deliberate practice as a method of achieving success. In addition, fundamental to any good leader is the ability to inspire. Bob Bowman, the head coach for the Olympic swim team, offers several motivational statements designed to inspire hard work and reaffirm the requirement for an investment of effort to achieve success, “Don’t ask to be deprived of tension or discipline, these are the tools that shape success” and perhaps my favorite, “work on your weaknesses until they become your strengths.”
Parting Thoughts Elite athletes are held up as role models in our society, and deliver inspiration through their achievements in sports. The path to their success is one that hopefully parallels the path of many in medicine. Although our identity is linked to a long-term vision of ourselves as “educator,” “clinician,” “researcher,” or “chairman” rather than a gold medal, our motivation should be derived from enjoyment during the pursuit of excellence. References 1. Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993;100:363–406. 2. Macnamara BN, Moreau D, Hambrick DZ. The relationship between deliberate practice and performance in sports: A meta-analysis. Perspect Psychol Sci 2016;11(3):333–50. 3. Brown DJ, Fletcher D. Effects of psychological and psychosocial interventions on sport performance: A meta-analysis. Emerg Med Australas 2016;28(5): 607–10. 4. Lauria MJ, Rush S, Weingart SD, et al. Potential role for psychological skills training in emergency medicine: Part 1—Introduction and background. J Comp Physiol Psychol 1948;41(6):450–65. 5. Brown JS. Gradients of approach and avoidance responses and their relation to level of motivation. J Comp Physiol Psychol 1948;41(6):450–65. 6. Brehm JW, Self EA. The intensity of motivation. Annu Rev Psychol 1989;40: 109–31. 7. Mento A, Locke E, Klein H. Relationship of goal level to valence and instrumentality. J Appl Psychol 1992;77:395–405. 8. Furley P, Schnuerch R, Gibbons H. The winner takes it all: Event-related brain potentials reveal enhanced motivated attention toward athletes’ nonverbal signals of leading. Soc Neurosci 2016:1–10 [Epub ahead of print]. 9. Coyle D. The Little Book of Talent. New York, NY: Random House; 2012.
Current Problems in Diagnostic Radiology journal homepage: www.cpdrjournal.com
The Champion’s Creed: Shared Values of Athletes and Academicians Laura M. Fayad, MD, MSa,b,c,n a b c
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD Department of Orthopaedic Surgery; Johns Hopkins University, Baltimore, MD Department of Oncology, Johns Hopkins University, Baltimore, MD
a b s t r a c t Although the pursuit of sports may be dismissed as unimportant by those in the academic fields, sports are pervasive, and in our society, elite athletes are revered. There are lessons to be appreciated from the training journey and ultimate achievements of such athletes, which parallel the development and sustainment of the academic radiologist on many fronts, including educational training, clinical work, the pursuit of research, and for some, the culmination of a career in a leadership role. & 2017 Elsevier Inc. All rights reserved.
I focus all my energy on the task at hand. I endure and persist. My goals are high and I am held to high standards. Who am I? On any given evening after a day of pursuing excellence at my tertiary care hospital, I can often be found watching my 11-year-old daughter swim laps at practice, for a high-performance swim team. Each swim stroke is deconstructed and practiced relentlessly, 6 days a week, and 2 hours a day. These small movements, when composed, create a smooth and perfect stroke, and are the foundation for success. As physicians and scientists in academic radiology, we have similarly dedicated ourselves to a long life of rigorous training, and are continually striving to improve our performance. Our goals are set high, as are the expectations for performance in our field, not so different in flavor from the high-performance athlete striving to be the state champion or the Olympic medalist. Often, the pursuit of sports is dismissed as unimportant by academicians in the scientific fields. However, sports are pervasive, and in our society, elite athletes are revered. There are lessons to be appreciated from the training journey and ultimate achievements of such athletes, which parallel the development and sustainment of the academic radiologist on many fronts, including educational training, clinical work, the pursuit of research, and for some, the culmination of a career in a leadership role.
This work received grant supports from GERRAF 2008-2010, Siemens 2011-2012, Sarcoma Pilot Program, Johns Hopkins 2012-2014, and SCBT/MR Young Investigator Award 2004. n Reprint requests: Laura M. Fayad, MD, MS, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Wolfe St, Baltimore, MD 21287. E-mail address: [email protected] (L.M. Fayad) http://dx.doi.org/10.1067/j.cpradiol.2016.12.012 0363-0188/& 2017 Elsevier Inc. All rights reserved.
Training Athletes to Training Radiologists Although methods are evolving regarding the training of physicians in residency and fellowship, it is widely known through adult learning theory that deliberate practice is needed to develop expertise, and only through deliberate practice is success achieved.1 Mastering any skill, in athletics or otherwise, requires intensity, persistence, and a willingness to fail. It is the latter element that has been missing traditionally from medical training, as training has focused on practicing specific skill sets, and developing critical thinking tasks over time, but often on real patients where there is no opportunity for failure. Hence, simulation has evolved as a potential tool for training future physicians, whereby trainees can focus on practicing a skill, and mistakes are allowed to happen (without the fear of harming a real patient). Simulation training is the backbone of athletic development. Interestingly, what is the effect of deliberate practice on performance improvement in people for different levels of skill? For the unskilled or young athlete, performance is more dependent on deliberate practice than for the elite athlete (who is already highly skilled).2 Perhaps a parallel can be seen with the training of a resident (who requires more deliberate practice) than a more seasoned fellow (whose expertise may be developed differently). Factors that can play a more important role in developing expertise at a very high level of athletics include psychological and psychosocial factors. In a meta-analysis of 35 studies regarding the usage of psychological interventions for improving the performance of athletes, it was concluded that interventions designed to alter a person’s thoughts and behavior were associated with a moderate positive outcome in performance. Specifically, psychosocial interventions that combined the use of a recorded account of an athlete’s performance with feedback from a coach were especially effective in improving performance, as was a concurrent
2
L.M. Fayad / Current Problems in Diagnostic Radiology ] (2017) ]]]–]]]
performance response.3 In other words, in medicine, an approach using direct and immediate feedback to the trainee regarding imaging interpretations or interventional skill sets probably offers use for improving a lagging trainee’s performance. Psychological training skills that have been explored in high-level athletes to improve performance also include self-suggestion, visualization, and methods of improving concentration4; such psychological skills have not been greatly explored in medicine, despite their emphasis and role in other professions. Could a trainee with weaker performance gain confidence and improve his or her performance through psychosocial interventions?
Higher Goals: The Pursuit of Research The championship! Can I qualify? In the sport of swimming, for example, there are national time standards and cuts that describe where the swimmer’s time falls compared with the national average in a particular stroke. To qualify for a championship meet, the swimmer may have to achieve a time that is in the top 5% of the country, a so-called “AAA standard.” Such time standards offer measurable and clear goals for the athlete. (Every medical student would enjoy a AAA!) As clinician-scientists, we are also goal-oriented and fixed in our pursuits the way an athlete is, in an individual sport. Rather than solely performing our clinical duties based on available knowledge, we strive to improve practice, by discovering new or improved imaging biomarkers or new methods of intervention. Why do some physicians continue the pursuit of research goals whereas others lose motivation? Setting goals initiates a series of motivational processes in a person that ultimately supports achieving the desired goals.5 How much effort a radiologist invests in pursuing a research goal depends on the perceived value of the research, and whether the increased effort is justified by its instrumentality for goal attainment. When the research goal is perceived as unrealistic (“I will need an R01 to do this!”), or the invested effort does not appear to increase the likelihood of achieving a goal (“the metabolic profile of these tumors is all over the place”), a person may choose abandonment, rather than the path of relentless pursuit of research. Conversely, the motivational intensity for pursuing a goal increases as the distance to the goal decreases. The more significant articles we publish on the topic, the greater the enthusiasm for pursuing the research avenue. Although the complex psychological interplay of motivation, effort investment, and goal pursuit are beyond the scope of this article, “instrumentality” is considered as one of the essential determinants of motivational intensity and the willingness of a person to invest effort in pursuing a goal. Generally, humans will invest effort when it is necessary or when there is a return on investment.6 Humans also often believe that setting harder goals are worthwhile (more likely to be associated with a sense of achievement and competence) than setting easier goals,7 which may explain why physicians find themselves embroiled in longterm pursuits with delayed gratification. And what about team sports? While swimming is an individual sport, soccer, for example, is a team sport that requires collaboration. Athletes with different skill sets come together to make the team successful, an obvious analogy to a successful collaborative research team. It is widely recognized at this time that most important research endeavors in medicine require a team effort, and are not individual sports.
Leading Champions Although athletes are encouraged to pursue their sport for the love of the activity and to enjoy the process of athletic development, the win-lose mentality remains a central theme in sports. Cues related to athletic supremacy are well recognized in the human brain.8 Winning is desirable in any environment, including medicine, and the sense of the game often crosses over to every relationship. People are encouraged to define their relationships with others in domination, and these interactions can be played out on the field, in the pool, or at work. Who is the right leader to manage a group of individuals who seek such success? In medicine, leadership styles have evolved over the years, and there are lessons to be learned from leaders in other disciplines, especially athletics. In “The Little Book of Talent,” Daniel Coyle surveyed master coaches from the world’s greatest talent “hotbeds” to identify the ingredients necessary for making world-class athletes and professionals. Not surprisingly, methods of training, motivational activities, and coaching styles were common to all athletic, artistic, and academic areas that develop potential and cultivate talent. Coyle9 settled on 52 actionable tips for achieving success, many of which are centered in promoting deliberate practice as a method of achieving success. In addition, fundamental to any good leader is the ability to inspire. Bob Bowman, the head coach for the Olympic swim team, offers several motivational statements designed to inspire hard work and reaffirm the requirement for an investment of effort to achieve success, “Don’t ask to be deprived of tension or discipline, these are the tools that shape success” and perhaps my favorite, “work on your weaknesses until they become your strengths.”
Parting Thoughts Elite athletes are held up as role models in our society, and deliver inspiration through their achievements in sports. The path to their success is one that hopefully parallels the path of many in medicine. Although our identity is linked to a long-term vision of ourselves as “educator,” “clinician,” “researcher,” or “chairman” rather than a gold medal, our motivation should be derived from enjoyment during the pursuit of excellence. References 1. Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993;100:363–406. 2. Macnamara BN, Moreau D, Hambrick DZ. The relationship between deliberate practice and performance in sports: A meta-analysis. Perspect Psychol Sci 2016;11(3):333–50. 3. Brown DJ, Fletcher D. Effects of psychological and psychosocial interventions on sport performance: A meta-analysis. Emerg Med Australas 2016;28(5): 607–10. 4. Lauria MJ, Rush S, Weingart SD, et al. Potential role for psychological skills training in emergency medicine: Part 1—Introduction and background. J Comp Physiol Psychol 1948;41(6):450–65. 5. Brown JS. Gradients of approach and avoidance responses and their relation to level of motivation. J Comp Physiol Psychol 1948;41(6):450–65. 6. Brehm JW, Self EA. The intensity of motivation. Annu Rev Psychol 1989;40: 109–31. 7. Mento A, Locke E, Klein H. Relationship of goal level to valence and instrumentality. J Appl Psychol 1992;77:395–405. 8. Furley P, Schnuerch R, Gibbons H. The winner takes it all: Event-related brain potentials reveal enhanced motivated attention toward athletes’ nonverbal signals of leading. Soc Neurosci 2016:1–10 [Epub ahead of print]. 9. Coyle D. The Little Book of Talent. New York, NY: Random House; 2012.