Changing Your Mindset

I know what many of you are thinking looking at this site. I can’t learn to do most of these techniques. I was never taught this stuff in residency. When I was a resident we used a nerve stimulator to do blocks and a finder needle for central lines. When I was a resident the surgeon just infiltrated local in the skin. I just can’t.

I’m going to let you in on a little secret. If I can do it, you can too! While I may have trained in an era where using the ultrasound was much more ubiquitous, I also trained in an era where there were roughly only 8-10 routinely used ultrasound-guided nerve blocks. No one used the ultrasound for arterial lines or difficult PIV access. TAP blocks were just hot off the press. Nearly every single newfangled block that has come out in the past 10 years I have self-taught, cobbling together images from case reports, questionable videos on the intrawebs, and cross referenced with my trusty edition of Netter’s. I used what little you had at my disposal and made the best of it.

I can still remember the first time I tried a QL (back then there were only two!), a serratus, an ESP, a deep parasternal with the needle tip millimeters from a beating infant heart, or performed a rectus sheath block in a 1kg child NICU baby. This was all relatively uncharted territory at the time, and obviously I had no one to stand behind me and guide my hands. And while not every single block worked, I tried to learn from every experience to refine my understanding and technique, and to help our whole group push our clinical practice forward. For me, clinical deficiencies or uncertainties were areas for improvement, and insatiable learning and dedicated practice were tools for success.

In full disclosure, I did need the inimitable Natalie Barnett to teach me pudendals—thanks again, Natalie! I just couldn’t wrap my head around the sono-anatomy with the limited images available, and I didn’t want to blow our chance to integrate it into our collective practice by having mine underwhelm our pediatric urologists. As one would expect if you knew her, Natalie saved the day and taught us all how to do pudendals and forever more nary a hypospadias would go without one.

Fixed vs. Growth Mindset

One of the most basic beliefs we hold is how we view ourselves. Noted psychologist Carol Dweck, author of Mindset: The New Psychology of Success, argues that people can be placed on a continuum according to their views about where ability comes from. There are those that feel ability is something innate, something you are born with, while there are others who feel ability can be cultivated with time and effort. Not only do they have different views on the source of talent, they also have differing reactions to challenges, setbacks, and failure. Dr. Dweck classified these people as having either a fixed or a growth mindset.

Fixed Mindset

For those individuals with a fixed mindset, they believe skill is innate, something you are born with. It is immutable and static. It cannot be changed in any meaningful way. As such, they do not expend effort for self-improvement. In fact, effort is seen as a bad thing. It, like failure, means you’re not smart or talented. If you were smart or talented, you wouldn’t need to put in any effort! Because they feel that there is no possibility for improvement, they only seek out activities they know they’ll succeed in. They also shy away from criticism, a valuable tool for reflection and self-growth. They avoid challenges, as they interpret failure as a lack of the basic, necessary tools for success. In fact, they also feel threatened by the success of others, as it serves as a reminder of their own personal shortcomings. Individuals with a fixed mindset tend to plateau early and never achieve their full potential.

Growth Mindset

On the other hand, individuals with a growth mindset have a much different view of life. They believe that intelligence, skill, and talent can be developed, it can be improved upon, it can be cultivated. This leads to a desire to learn and a tendency to embrace challenges. They persist in the face of obstacles or setbacks and see effort as the path to self-improvement. They also learn and find inspiration from the success of others. Overall, individuals with a growth mindset achieve higher levels of success, giving them a greater sense of free will.

In one of her early experiments, Dr. Dweck ran a workshop for 7th grade children. Half the students were given a presentation on memory and effective studying, while the other half were told their intelligence largely depended on their own effort. Their teachers were unaware of the difference between what the students had been taught. Remarkably, over the course of the school year, the students from the second group developed a growth mindset and became higher achievers than the students from the first group, who retained their fixed mindset. These results have been replicated across different locations, age groups and subjects with notable degrees of success.

Our mindset is fundamental. It’s more important than inherent ability in learning performance and has a huge impact on the other areas of our life, such as our career and relationships. All learning strategies, tools and techniques are almost useless if we don’t combine them with a strong, growth-based learning mindset — the simple belief that the power to improve our learning abilities lies in our own hands. In fact, having a growth mindset creates a passion for learning, rather than a hunger for approval. It also helps us on our journey towards self-actualization, one of our core psychological and physical needs. Most importantly, a growth mindset can be learned, so it is never too late.

While I can only speak for myself, I embrace my clinical deficiencies, my failures. I see these not as mistakes, but as opportunities to learn and grow. I gain way more personal and professional satisfaction using my time improving my clinical practice and learning novel techniques than trying to fly under the radar or pin titles to my chest. So pick up a probe and come join me in the deep end. The water feels great.