Hey everyone, I'm Brandon Odo.
And I'm Brian Bowling.
And this is Critical Care Scenarios, the podcast where we use clinical cases, narrative storytelling
and expert guests to impact how critical care is practiced in the real world.
Yeah, all righty, welcome back everyone, this is Brandon Odo with another Turbo.
Today I wanted to give you a list, a list of five things.
And these five things are the things that I think are just about essential.
If you want to be excellent at what we do.
Now this could apply to an experienced clinician, but realistically this is mostly going to
come up for someone who is training or at least as early in their career because that's
really when you're deciding this sort of person you want to be in the clinical realm.
And I've made some lists before I can link to on the blog that I consider kind of rules
for doing critical care well or doing it at an advanced level.
But this really is focused on the definition of who you are as a clinician because, and
we've said it many, many times, there are many ways to do this.
And I'm not trying to be the one to judge what's a right way or a wrong way.
All I'm saying is that if your goal is to do this at a high level, to really excel,
to be the guy or girl who anyone around you sees in the room or looks at the work they're
doing, and they're going to say, wow, you know, he's really hitting it, he's performing
at a really high level.
That may not be what you want.
There are costs associated with it, but if there are, and for some people, that's what
they want, it's not completely obvious how you get there.
You could say things like, well, I should study hard and so on and all of that's true.
But there are some things that are not as obvious.
And yet I think they're good markers and also goals.
In other words, if this is you, if you're just starting out, you're coming out of school,
you want to get into critical care, that's your passion.
You know it's what you want to do and you know you want to do it at a high level.
These could be things that you shoot for.
I'm going to tell you, you should try to do them and they'll help get you there.
But also, you know, standing on the outside, if I'm going to look at you, I might look
for these things because I feel pretty good that if you have them, you are performing
well and are at least heading towards excellence.
And if they're not there, I have doubts.
You know, nothing's impossible.
The sensitivity and spes-ish, spes-ish, spes-ish, spes-ish are not flawless, but they're
pretty good markers.
All right, without more beating around the bush, what are the things?
I'm going to give you five.
The first one, I'll refer you to just, I think, two turbos ago when we talked about taking
notes.
You are learning so much, especially earlier in your career, but frankly, even late.
And I just, I absolutely know unless you are a literal robot that you're forgetting most
of it.
And at the densest times, like right when you're starting out training, you are probably
learning dozens of new things every day.
And if you are going to retain anything like the majority of them, you have to make notes
or you're going to lose them.
And as I watch people train, and as you teach some things, or they pick them up, and
they just kind of sit there passively, I just know that the portion of what they're getting
out of this high value, high expense training time, is just a minority of it.
They're wasting most of it.
Whereas if I see that every time they're learning something, they're writing it down.
They're standing there on rounds when they're teaching points, and they're writing them
all down.
There's a lecture, and they're writing things down.
And then we talked about putting it in some kind of a durable, maybe electronic system
that's searchable.
Ooh, I know that that person is going to have those things the next time it comes up.
And that way, instead of rehashing them and repeatedly getting through the same things
so that at the end of any block of time, they have just the bare bones of the things
that they managed to get through 10 different times until they finally remembered them, they're
able to build on them and learn more and more advanced things.
I mean, that's just so essential.
Take notes, no exceptions.
Number two, you need to be mentally simulating things, especially rare things, in order to
learn from them without having to actually see them.
People clinical exposure, particularly for uncommon things, the less common disease,
the uncommon situation or scenario, a particular flavor of unstable patient or complication
or situation or procedure, they don't come along often enough for you to learn from
them when they actually happen.
So you must learn before they happen, and then when you actually come across it, it
just confirms and reinforces it, it gives you a chance to demonstrate the competence
that you have acquired and solidify it, but you already knew.
That's the only way to really be excellent.
If you're just sitting there passively like a lump waiting for you to be dipped in hot
water and gradually soak up the flavors of what's around you, it's not enough.
It doesn't matter how high volume or high acuity the environment you're in is, it's not
enough.
You need to use your own brain to think through what you're going to do and what it's going
to look like.
Yes, you know, learn from the books and the lectures about the underlying content, but
then apply those things and say, all right, I've learned in theory how to do a cricothyroidomy
in a failed airway.
And I'm not going to wait until it actually happens because Lord knows when that'll happen
and that patient deserves better than to have me learning on them.
I'm going to learn it in my head.
I'm going to sit here and in my mind's eye, I'm going to imagine every single step starting
from a very realistic picture of the scenario.
We couldn't innovate them.
We can't auctionate them with a mask.
We can't rescue them with something else like an LMA.
Here's me making the decision.
Here's me finding the equipment I need, what are the things?
Where are they?
Where are they in my own setting?
Maybe I'll go physically look at them and then step by step, what am I going to do?
And discovering all those failure points where you don't really quite know how to do this
detail, even though you know big picture because you did that learning.
You're finding those smaller points now and then you're going to cycle through this over
and over until it's fluid and then iterate it.
Make changes.
All right.
We don't have that piece of equipment, then what?
All right.
The patient is a little different, the setting is a little different than what?
Then when the situation comes along, it's boring, it's like you've done it a million
times.
It's not just procedures.
This is for so many clinical things.
I think you have to be doing this or you're not going to be excellent.
Number three, you need an interest, or interests, but at least one.
Yes, early on you're focused on achieving basic competence in many things.
Yes, that's important.
But that is such a low bar and well, you can hit that and be adequate and competent.
If we're talking about excellence, you need to go farther.
You're not really going to become excellent in everything.
Even if it were theoretically possible to do that, you need a different mindset, which
is that you're going to pursue something extra above and beyond in certain areas, which
should be things that interest you.
You're going to develop specialties, in a sense, areas of focus and interest, and it
could be areas where you're clinically, particularly excellent.
You could have excellence in clinically adjacent areas like research or quality or education
or things like that.
But in some ways, you have a niche.
You have something that you're focusing on that you're going to bring to the table in
a clinical setting, which is more than everyone else.
If we put 10 clinically adequate competent people in a room, I don't want to see that
they're all the same.
I want to see that person A brings some particular extra tools to the table.
Person B does too, but they're probably different and so on, so that together as a group
and a team, they have some really phenomenal things.
Look at a superhero team up like the Avengers.
They're all strong, indurable, and smart, and brave, but if that's all they were, they
would not only be kind of boring, but they wouldn't be all that capable because what makes
some particularly excellent are the unique abilities and powers of each one, which are
all different.
Find your powers.
Number four, you need to be interested, excited.
You should be having fun with what we do.
Not every day, there are poor minutes hours or days or heck even weeks, but by and large,
you should want to be practicing critical care.
It should excite you that you should be having fun when you come and do these things,
and partly because it's going to provide the motivation to do all these other things
that we've talked about, to give you that impetus to do those mental simulations and to seek
out your particular interests and so on, but also because this is just not worth doing
otherwise.
This is one of the easiest tests that I can apply to someone by just standing across
the room and looking at them.
You have those people who are just kind of grumpy every day and they seem happy or not
even happy to do the minimum and show up.
You have those people who are like, yeah, let's practice the medicine.
Let's do some critical care.
Isn't this cool?
What about this fact?
What about trying this new thing?
Did you hear about this other idea?
Hey, there's a cool case down the hall.
You're always interested in what's going on, how it can be broadened, how it applies
to what we know about disease and physiology, new techniques, new approaches, and they're
just fun to be around and interact with.
I'm not going to say you have to do this because we all know there are thousands of people
who walk among us who are not this, but we're talking about excellence.
I don't think you can get to excellence and certainly not sustain it without this.
You could get there and then get burned out and then kind of maintain where you're at
writing on your previous laurels, but you're not going to get any farther.
I don't think you would have gotten there if you at some point you hadn't cared.
Finally, number five.
You need to assume and believe that you have weaknesses, flaws, points where you're not
as strong as a clinician and probably as a coworker, as a person, and look for them
and try to improve them.
This is an active process.
It starts with assuming that you're not perfect, which is hard enough to begin with, and
then it's an active search for what those things are, which can be difficult because we tend
to have blind spots for our weaknesses.
You're going to hunt them out and then finding the ways to strengthen them, to build them
up, bridge those weak points and correct them.
This is the flip side to finding those areas of interest and honing those.
It's no good to be excellent at one thing and so poor at a handful of others that you're
hurting people.
It's not just about those clinical things, right?
Your weakness could be interpersonal.
Your excellent, but everyone hates you.
Your weakness could be professionalism.
You're excellent, but you're always half an hour late to work.
There's a lot of things that could be your weakness, and again, they're hard to find
without really making efforts to find them, but you need to look because otherwise you're
not going to develop.
Often times, there's much more room for growth in those areas.
It gets harder and harder to strengthen things the more advanced they get.
You end up looking for that last 1%, and then half a percent and logarithmically tapering
off.
You know what?
If you have something you suck at, you can double your aptitude there with a modicum
of effort.
It's slow hanging fruit.
It's there for the taking, and yet so many people never even look.
Again, if you're not doing this, I don't think you're ever going to really get to that
point of excellence, but if I see someone who is trying to find their weaknesses and
then heaven forbid actually improve them, and I'm pretty sure that person is going to
be excellent.
So take notes, do mental simulations, find your own area of interest and excellence.
Be excited and interested and have fun with what you're doing, at least most of the time.
Look for your weaknesses.
Those are the five.
I'll give you one little bonus one that I don't, maybe you don't absolutely have to do,
but it just falls short of absolutely, and that's to teach.
Something helps so much with a lot of what we just talked about, that it's a tool.
It's like a turbo booster that helps you get to these things.
Even if you don't care about teaching, it helps you learn, it helps you find your weaknesses
and develop your strength.
All the stuff we talked about.
So I think it's right up there as a bonus, sixth point.
Guys, those are what I think you should be doing.
And yes, there are other things that apply in more specific cases of excellence, but I
think these are the kind of universal ones.
Think about the people you consider excellent, and consider if they have these things, you
may have to ask them if they're doing some of them.
And then think about people who you don't and consider, are they doing any or all of these?
And I think you'll start to see the correlation.
And then you can apply that to your own life, however you want, but I think it's useful,
especially when you're early on.
And we know what you think.
I'll talk to you guys next time.