Growth Mindset and Wellbeing: Getting off of the Roller Coaster

 From the 2/5/2021 newsletter

Perspective

 

Growth Mindset and Wellbeing: Getting off of the Roller Coaster

 

David J. Cipriano, Ph.D.

 

 

Dr. Cipriano shares that developing a “growth mindset” can help learners smooth the bumps along the way, viewing setbacks as opportunities rather than signs of failure …

 

 

“Tell a story about you at your best.”  

 

“Now, tell a story about you at your worst.” 

 

For many, there would be a sharp decline in mood with the second part of this exercise.  But not for people with a growth mindset – for them, both outcomes would be taken in stride.  Both scenarios would be followed with, “What did I learn from this?” and the worst scenario would be followed by, “What will I do differently next time?”  Growth mindset – the belief in our capacity to change and grow our abilities, not just our skills or effort, but our supposedly innate abilities – is a natural self-esteem preserver.

 

 

Growth mindset v. fixed mindset 

 

For folks with a fixed mindset – the opposite of a growth mindset – failure is a sign that they are not up to the task; that it’s time to pack it up and move on to something else.  For these people, failure, as a New York Times article points out, has been transformed from a verb (“I failed”) to a noun (“I am a failure”) and, indeed, an identity.  But there is an almost equally dangerous attribution for success among those with a fixed mindset – that this is proof of my God-given talent and validates my awesomeness!  Here’s the problem in Dr. Carol Dweck’s words: If you’re somebody when you’ve succeeded, what are you when you’re not successful?  

 

Dr. Dweck is the originator of this concept and she’s been at it for a while now.  Back in the 1970s, she began asking third graders why they thought they were struggling in math.  This research, firmly grounded in attribution theory led to the discovery that, depending on your belief about how changeable the outcome is, you would be more likely to persevere – and even come to enjoy – math.  People with a growth mindset attribute their failures mostly to effort, but even when they attribute to ability, they have the belief that this ability can grow.  People with a fixed mindset almost always attribute to ability, and without the added benefit of believing this can change.  So their destiny is set, there’s not much reason to consider how they might develop from this.

 

I’ve been steeped in this stuff nearly as long.  Back in the 1980s, my master’s thesis was based on attribution theory and my doctoral dissertation touched on it, as well.  I never thought I’d use these concepts in psychotherapy, though.  Back then, I was going to be a social psychologist and do research like Dr. Dweck.

 

Fast forward to the new century and I find myself working with medical, pharmacy, and graduate students, a high-octane group, to be sure!  When they’re succeeding, they’re great.  But, when they’ve failed, they don’t feel so great.  For people with a fixed mindset, failure can even lead to depression.  Now, failure stings for all of us, but it doesn’t have to define us. In psychotherapy with these folks, I examine the self-talk occurring, which is almost always self-recrimination and self-demeaning.  When I challenge this, I hear, “Being so hard on myself is how I’ve gotten where I am today!”  To which I say, “Your ‘self’ can only take so much of this beating, before it freezes and stops trying.”  

 

 

The fixed mindset leads to a “roller coaster” of self-esteem

 

Imagine the roller-coaster that their self-esteem is on.  If you have a fixed mindset, you’re more concerned about the judgment of others and more worried about making mistakes.  When you’re succeeding, it is confirmation that you are the superstar you’ve always been told that you are.  Feels great – especially if you don’t have to try – because having to try negates the notion of having a ‘gift.’  But, when you’ve had a setback or a failure, it is confirmation of your worst fears.

 

 

Getting from roller coaster to journey

 

A good therapeutic outcome with people stuck in this cycle is for them to separate out their identity from their performance – to rid them of that notion that “I am my grade,” or “My worth can be measured in my performance.”  

 

Imagine, instead of being stuck on a roller coaster, they are enjoying the journey.  Learning is savored, and not a threat.  Mood is stabilized in the knowledge that mistakes are to be expected and will make one even better.  Self-worth is preserved in the belief that there is value in getting knocked down and getting up and trying again.

 

 

For further reading:

Dweck, C.S. (2016). Mindset:  The New Psychology of Success.  Ballentine Books:  New York.

 

 

 

David J. Cipriano, Ph.D. is an Associate Professor in the MCW Department of Psychiatry and Behavioral Health and Director of Student and Resident Behavioral Health. He is a member of the Community Engagement Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

 

The Power of Yet

 Invited Perspective

 

From the 2/5/2021 newsletter

 

The Power of Yet

 

 

Katie Dercks

 

 

 

In this essay, Katie Dercks, a fourth grade teacher, describes a thoughtful approach to fostering growth mindset that she and her teaching partner implemented in their classrooms …

 

 

 

“I can’t do this!” “I’m not good at this.” “I don’t get it!” These words have unfortunately found a common place within classrooms. They are a reflection of a child’s frustration and go deeper into the child’s own self-beliefs. I have been a teacher at St. Robert for nine years now, and I have watched as more students come into my fourth grade classroom with anxieties wrapped around tests, assignments and self-worth. Instead of putting the focus on learning and growing, these students are focused on “the grade” and looking “dumb” in front of peers. 

 

In an attempt to teach students their own worth and what they are truly capable of, my colleague and I decided to dig deeper into the idea of growth mindset. According to Carol Dweck, author of Mindset, people with a growth mindset believe that skills and qualities can be cultivated through effort and perseverance. Their goal is to grow their minds, embrace challenges and learn from feedback, a mindset we wanted for our students.

 

We decided to start with “The Power of Yet.” When we heard a child say, “I’m not good at math!” “I don’t know how to do that,” we would respond by reminding them that they haven’t mastered those things “yet.” For example, “You’re not good at this math yet; you just need more time practicing, thinking, and figuring it out!” We wanted students to understand that skills are acquired over time through practice and perseverance. We all have our strengths and weaknesses, and it is important we identify both in order to truly grow. 

 

Little did we know how much one phrase would change the culture of our classrooms and ourselves as educators. What seemed cheesy at first, commenting to students’ negative remarks with, “Remember the power of yet!” soon became echoed by students to themselves and their peers. It was a powerful realization that even if kids didn’t understand the deeper meaning of yet, they were beginning to play with the idea.

 

From then on, we decided to introduce more projects, activities and literature that highlighted each child’s strengths and weaknesses, using these as tools to help them grow. My colleague and I would model how to work through problems in front of the students, showing them that struggle is normal and working through challenges grows one’s brain and creates a feeling of success. As educators, we had to fight our instincts to jump in and help when a child was feeling challenged. We needed to allow them to struggle. When a child said, “This is hard!” our response would be, “Good. That means your brain is working. It is going to push you to find a new way of thinking.” When a child succeeded, we had to change our words of affirmation from, “I am so proud of you,” to “You should be so proud of yourself.” After all, validation has to come from within.

 

When a child really felt stuck, we would take a moment to stop and ask the class to come up with strategies their peer could use. It became normal practice to help one another and appreciate small victories. We had students explain how they felt when they improved and succeeded. We discussed the importance of positive self-talk; the idea of what we tell ourselves is critical to how we produce and succeed. 

 

By the end of the year, we saw that our efforts had changed the environment of our classroom. Students began to understand that every person faces his/her own struggle. One might struggle with math, while another student with behavioral issues may struggle with social interactions. Bullying decreased and the level of praise for one another was heightened. 

 

Do we think all students will walk out of fourth grade with total confidence ready to take on the challenges of the world? No, it’s a life process, but we have given them the skills and strategies of a growth mindset. One student, who has taken this to heart, writes at the beginning on top of her tests, “I’ve got this” and has encouraged others to do the same. That makes me smile…because they do. 

 

There are students who will always struggle with their inner anxieties and fixed mindsets, but we want our classrooms to be a start. We want students to remember as they move on in their education and life that the little things add up. The goal each day isn’t to win or lose, pass or fail, but just be a little better than they were yesterday. I, myself, still struggle with self-confidence at times, having to stop negative self-talk and the temptation to give up. And it’s important that students know this -- that even the teacher doesn’t have it completely figured out… yet.

 

 

 

Katie Dercks teaches fourth grade at St. Robert School in Shorewood WI.

Teaching is Love

 From the 1/29/2021 newsletter 

 

Teaching is Love

 

 

Megan Schultz, MD, MA 

 

 

Dr. Schultz, who taught Spanish in an urban Baltimore high school before going into medicine, shares the story of the student who inspired her to become a doctor …

 

 

Before I was a doctor, I was a teacher. I taught Spanish at Frederick Douglass High School in Baltimore for two years before I decided to go to medical school. It was one of my students, Torreantoe Smalls, who inspired me to become a doctor. Torry was mischievous, with a quick grin. He played the trumpet like nobody’s business and tried, sweetly and patiently, to teach my clueless, clumsy feet how to step dance. He once got a B+ on a Spanish exam, and even though he was just beside himself with pride, he made me swear up and down I wouldn’t tell anyone he had had actually studied for it. During his senior year, Torry was shot multiple times in the abdomen during an attempted robbery. He would ultimately spend two years and three months of his life in the hospital, enduring dozens of surgeries and losing nearly two feet of bowel. It was in his hospital room, staring at his small frame in the bed, surrounded by the clicks and beeps of machines, that I resolved to be a doctor. 

 

Fifteen years later, here I am: a doctor, yes, but also still a teacher. Instead of high school students, now I teach medical students, residents, and fellows. Instead of teaching people how to speak Spanish, now I teach people how to be doctors. This is a tall order; sometimes it’s hard to know what to prioritize. When I was in medical school myself, I often felt impatient and restless, like none of my professors really understood the point of being a doctor at all. They talked way too much about things like the Henderson-Hasselbach equationand not nearly enough about how to save the life of someone like Torry. And the way they taught! PowerPoint slide after PowerPoint slide, crammed with text in tiny font that I was expected to regurgitate on command. I have often thought that medical school would be far more interesting and effective if it were taught by good teachers who know nothing about medicine as opposed to good doctors who know nothing about teaching. But how to be a good teacher for medical trainees? How to balance the need for basic physiologic knowledge with broad themes of compassion and empathy? I decided to ask the person who inspired me to be a doctor in the first place: I decided to call Torry.

 

Torry is not Torry anymore; he is Mr. Smalls. He is now a teacher himself; he teaches percussion at Mervo High School in Baltimore. He is also father to three children and runs an entertainment company called TORKO ENT. He still has the mischievous grin – but the speed at which it appears has been tempered a bit by age and wisdom. I asked Torry what makes a good teacher. His answer was arrestingly simple: love.

 

Torry described the importance of love by telling me the story of Mr. Burton, his music teacher at Douglass High. Torry had met Mr. Burton when he auditioned for the Douglass Marching Band as a skinny 8^th grader – and from the beginning, Mr. Burton believed in him and acted like a father figure to him. “He was the first person to see who I really was,” Torry says. After he was shot, Mr. Burton regularly visited Torry in the hospital. One of the days Mr. Burton was visiting, he was asked to step out so the nurses could give Torry a bath. (For months, Torry could not move his legs, stand, or walk. As a result, he had to rely on nurses for sponge baths in bed, which he describes as a singularly humiliating experience. “You know, I’m cool, so I don’t want nobody giving me a sponge bath. But I didn’t have NO choice!” he says with that old grin.) 

 

Torry said, “This was when I knew Mr. Burton loved me as a son… After my [bath], after my visitors came back in, I was sitting there in bed trying to lotion myself. And I was so mad that I couldn’t move my legs, that I couldn’t reach my feet. The man took the lotion – I didn’t even ask him – he just saw me struggling.” And Mr. Burton knew what to do. The memory of Mr. Burton empathizing with him in that moment, selflessly helping Torry with such a basic need, still moves Torry to tears fifteen years later. “He made me feel that I was loved,” Torry says. 

 

To love our students – it’s not often something we talk about as teachers. But maybe it is love that’s the foundation of any successful student-teacher connection: to believe in our students, to know what to do when they are struggling, to help them without being asked. Maybe if we start from a place of compassion and empathy, all the basic physiologic knowledge will follow.

 

Without Torry, I don’t know if I would be a doctor today. I certainly wouldn’t be the same type of doctor. All my students in Baltimore taught me far more than I ever taught them – Torry is the perfect example of that. There is such beauty in knowing that he is a teacher now, seeing his students for who they really are, believing in them, loving them. Torreantoe Smalls: once my student, always my teacher. 

 

 

Megan L. Schultz, MD MA is an Assistant Professor of Pediatrics (Emergency Medicine) at MCW. 

 

Assessment of Communication Skills in Medical Education

From the 1/29/2021 newsletter

 

 

Assessment of Communication Skills in Medical Education

 

 

Mary Ann Gilligan, MD MPH

 

 

Dr. Gilligan, who has an interest in communication in medical settings, shares how she and colleagues are developing teaching methodologies and measurements of effective communication skills for medical students …

 

 

Expertise in communication skills is one of the essential components of clinical competence for doctors. Medical schools are required to include training in communication skills in their curricula. Historically, training has primarily occurred in the early years of medical school and the skills have not been consistently reinforced later in the clinical environment. Fortunately, we now have decades of research to help guide development of a successful program in communication skills training.

 

Assessment of communication skills is one key component of a successful program and is the focus of this article. However, in order to appreciate the role assessment plays, it is important to understand the other components. Core communication skills have been identified and models developed to facilitate teaching of the skills (e.g., Calgary-Cambridge, Three-Function, Smith). There is not one best model but, rather, each one has strengths and weaknesses. For a given program, it is important to choose a model on which to base the program that will provide a common language for both teaching and assessment of skills. There should be progressive building of skills across the curriculum, beginning with core skills in the early years with introduction of advanced skills (e.g., breaking bad news, motivational interviewing) in the later years when learners will be more likely have a chance to use them. The final component to a successful program is the “how” or methods used to teach: communication is a behavior and is best learned using active strategies with opportunities for practice and feedback.

 

 

Communication skills training at MCW

 

Improving communication skills training at MCW begins with changes in assessment, because assessment can drive curriculum change. A robust assessment program will provide the data needed to inform what and how communication skills are taught. Currently at MCW, one important method of assessment of communication skills has been the Objective Structured Clinical Examinations (OSCEs). In the last year, we used a validated communication skills checklist for M3s based on the Three-Function Model for the OSCEs with plans to expand usage to all OSCEs in the near future. Use of the checklist across all years of the curriculum will allow students to track their progress on skills over time. I have been working with Dr. Tavinder Ark and the Kern Institute Data Lab on expanding use of the checklist, analysis of data, and generation of reports for students. 

 

Assessment of communication skills on clinical rotations could serve as another important source of data on competence in communication skills but will require investment of time and effort, especially for faculty development.

 

We are on our way to developing a program that achieves the goals of assessment in medical education as defined by Kalet and Pusic: 1) to motivate and guide [learners] to continually aspire to higher levels of expertise, 2) to identify [learners] who are not competent to practice safely, and 3) to provide evidence that the [learner] is ready for…unsupervised practice.

 

 

For further reading: 

 

Kalet A, Pusic M. Defining and assessing competence. In Remediation in Medical Education: A Mid-Course Correction, Kalet and Chou, eds. Springer. 2014.

 

 

 

Mary Ann Gilligan, MD MPH is a Professor in the Department of Medicine (General Internal Medicine) at MCW. She is a member of the Curriculum and Faculty Pillars of the Robert D. and Patricia E. Kern Foundation for the Transformation of Medical Education.