Welcome to January 2020 and our Q-Wave. Welcome to concepts that will hopefully help your clinical practice. I found that I’m shifting toward topics that I hope will also help you in your life. This month, I want to talk about getting better, about growth, about expertise. How do we become masters at any concept?

I’ve studied this a lot. I’ve looked at my own growth. I’ve looked at others’ growth and what the studies show about growth. What determines mastery? If a physician assistant or nurse practitioner graduated from school, and three years later you graded their competence, how good were they at their job, what determines growth?

Is it experience? Is it domain-specific training? Is it where they went to school? These were the categories they looked at. If you went to a really good school, would you be a really good clinician three years later? Clearly, they found that all of these elements contributed, but weren’t the determinant. The determinant was a concept called deliberate practice, which is also known as metacognition.

Metacognition is thinking about your own thinking. It’s really looking at your performance objectively and holding yourself to a very high standard. When you fall short, you call yourself on it. You set goals, and you look at your performance and say, “Wow, I dropped the ball here.” You look at where you are in life and then say, “Where am I falling short?”

Colleagues, I preach PIES for the four domains of our lives:

• P: PQ or physical intelligence
• I: IQ or mental intelligence
• E: EQ or emotional intelligence
• S: spiritual intelligence

I’m asking you, where in your lives are you really deficient? Where are you really falling short? That’s where someone who practices deliberately would set goals. They’d say, “I’m really going to try to grow in these domains.”

I also want to share another tool with you this month. I want you to Google this tool. Spend 10 minutes Googling the term and embracing it because it’s a really big concept. This concept is called the cycle of performance improvement. In any domain of your life there are four different ways that you grow and move: from skill to attitude to knowledge to practice. You start with a skill you want to learn (your goal) and move from attitude to knowledge to practicing it. This forms a circle, and the cycle starts over again.

When you look at the cycle of performance improvement, where should you start? You should start with the skill you want to achieve. That's the end goal. It's kind of like putting a puzzle together. I don't just start putting pieces together. First, I look at the picture on the front of the box, and that tells me where I want to go. Start with the skills you want to learn; it could be improving your 12-lead ECG interpretation or getting better at wound care.

Think about the skill you want to attain. Maybe this skill is more intimacy with God. It could be a closer relationship with your partner. It could be that you want to be more physically fit. It doesn’t matter what the skill is. The first thing you do is look at your intention, your goal, the skill you want to achieve.

Secondly, you need the right attitude. The components of attitude are need and want. You got to need it, and you got to want it. Need is something internal. Can you create the need within yourself? You can need to do a lot of things, but if you don't want to do it, you’re not going to do it. This makes the want really important. The doctor says, "You need to lose weight." But do you want to? So you need to need it. You need to want it. Then you need the proactive motivation to say, "I can do this. I can get this done."

Then it comes to action. You have to take that action. The third piece of the cycle is knowledge. You need the information. If your goal is to interpret a 12-lead ECG, you better find a tool that will allow you to learn that content. If you want to get more physically fit, you need the knowledge to do so with a trainer, specific meals, etc.

The last piece is practice. One of the things we preach in Dale Carnegie courses is that practice doesn't make perfect. Practice makes permanent. You have to practice reading 12-leads if you want to get good at 12-leads. If you want to get fit, you have to practice being fit. You have to eat right.

Welcome to 2020 – a new decade. How are you going to grow this year? What are your goals? It’s funny. I’ve asked audiences, “Who has goals?” People don’t raise their hands. And I’ll say, “Guess what? For those people who didn’t raise their hand, you have goals too. You have goals.”

If I said, “Raise your hand if you expect to be 350 pounds at the end of this year,” no one raises their hand. That means you have goals. Your goal is to not be that out of shape. You just are fuzzy on your goals. But the more concrete you make your goals, the more likely you are to achieve them.