Before you read further, take a moment to try the following exercise:
First, write down five weaknesses of someone close to you (e.g., your spouse, partner, significant other, close friend). Complete this task before going on.
Second, for the same person, write down five areas of unrealized potential.
Which was more difficult? Was it harder to list deficits or latent strengths?
Almost everyone finds it more difficult to do the latter. Identifying areas of deficiency seems to come naturally, while identifying areas of potential requires careful thought and reflection.
Many would agree that the same holds true for a student, resident, or faculty member. It is easier to note shortcomings than to articulate areas of unrealized strength. Yet, it is critical for those of us who work in medical schools and teaching hospitals to do both, especially if we are to create environments in which individuals can develop to their full potential.
We have well-developed systems for detecting deficiencies of knowledge, skill, or accomplishment (e.g., multiple-choice tests, objective structured clinical examinations, one-on-one observations, annual faculty performance reviews) and for determining whether or not an individual rises above a defined “bar” (e.g., standardized examinations, formal tenure reviews). We have good methods for remediating deficiencies and for mentoring and advising those who do not make it over the bar. However, to complement these approaches, we need better ways to design curricula, build programs, and create experiences that fully leverage individual capability.
My 2012 Question of the Year gets to the heart of this issue: What are the most effective ways to ensure that those who work and learn in medical schools and teaching hospitals can develop to their full potential?
We received a number of excellent responses to this question. The editorial board, professional editorial staff, and I—after careful review and thoughtful deliberation—selected 15 excellent essays that appear in this issue of the journal.
The authors of these essays offer valuable ideas and approaches to enable individuals to attain the highest levels of achievement possible. Some suggest theories that can inform new practices. For example, one group of authors discuss the use of self-determination theory to drive a process of providing learners with increasing degrees of independence. Another author commends “flow, deliberate practice, and renewal” to achieve peak performance. And yet other authors describe the importance of intrinsic motivation to high-levels of achievement.
The authors of some essays reinforce the important roles of insightful mentorship, guided self-reflection, deliberate practice, high-quality feedback, critical thinking, problem solving, and the culture of inquiry that permeates the academic setting. Other authors discuss the need to change the culture at academic health centers, for example, to support cognitive and emotional approaches that foster flourishing and fulfillment. And still others discuss the need for explicit outcomes for educational programs.
Important themes that weave their way through this collection of essays include training faculty in the use of professional coaching to attain peak performance of learners, the essential role of relational communication skills, and the use of the creative and performing arts to explore and develop aspects of the human experience not accessible via science, facts, and principles. In one essay, the authors emphasize the importance of teamwork and of tapping into the excellence that lies at the intersection of professions, disciplines, and other groups.
Several authors remind us that creativity, curiosity, and imagination are essential to attain high levels of achievement.
I thank the authors of these essays and all authors who submitted responses to the 2012 Question of the Year. The quality of the submissions was high, and so it was difficult to decide which essays to publish. I thank the journal’s editorial board members and the professional editorial staff for devoting significant time and effort to reviewing and judging the responses. As a collection, these 15 essays illuminate effective approaches and provide fresh insights to ensure that those who work and learn in medical schools and teaching hospitals can realize their full potential.
Steven L. Kanter, MD