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0:00Hi. I'm Atul Gawande.
0:01I am a surgeon, a public health leader
and researcher,
0:05and a writer. I'm the author of
0:084 New York Times bestsellers,
0:13"The Checklist Manifesto,"
0:16One of the things that's interesting to me
is how different professions
0:21people improving their skills over time.
The common approach in a field like
0:26is what I call the pedagogical approach.
You are going to
0:30go to school forever.
0:33You're going to get your 10,000 hours
of practice
0:36in internship and residency,
0:38in some apprenticeship or training, in one
way or the other.
0:42And then you're going to be set loose on the
world. And part of being a professional is
0:47that you will improve yourself,
0:49that you own responsibility now for the
fact that the technology will
0:54change, the skills will change, and you
will go about the task of getting
0:59to better performance yourself.
1:02And then there are fields that take an
entirely different view of this.
1:11Roger Federer was my hero. And
Roger Federer —
1:15number one player in the world —
1:18And sports is the classic example — but
hardly the only one —
1:23where the very top people in the
profession, at every step of the way, not
1:28only did they have someone they hired and
paid for
1:39where they've fallen short, and
1:43help them get to improvement
1:45on the assumption that you cannot
improve yourself.
1:50I was midway through my surgical career. I
had been
1:54assiduously tracking my
1:57surgical complications
1:58and other measures of how I was doing as
a surgeon.
2:02And I'd seen year on year
2:06And at about 10 to 12 years
into practice,
2:10I found that I'd flattened out. I'd
reached a mid-career point where I wasn't
2:17I wasn't really getting better at all.
2:20It struck me that I might consider getting
a coach.
2:24It was because of my tennis.
2:29in my tennis game as well, and I thought
nothing of paying some college
2:34kid coming off of a tennis team
2:37200 bucks an hour — alright, not
that much, but still, it was expensive —
2:43to pick up my game. And they regularly
found ways
2:47that I could do better.
2:50And I thought, "Why don't we do this
in medicine?"
2:54There are lots of other fields where it's
the case.
2:56I happened to have a chance to interview
Itzhak Perlman,
3:00the greatest violinist of his generation.
3:04"Why don't violinists
3:08And he said, "I don't know,
3:11but I always had one."
3:12I said, "What?" "Yes."
3:17a professional violinist
3:20from Juilliard where they were in school
together: his wife.
3:29to sit in the audience
3:31and give him feedback
3:33after every performance.
3:35And that was, he said, critical
3:38to how he became the violinist that he is.
3:46That ability to have someone providing
3:55is such an important part of changing
your mindset.
4:01a surgeon. I asked one of my
former professors
4:05to come to the operating room and observe
me. It was doing one of the operations
4:12a couple thousand of these
4:17in the past. It had gone extremely well.
4:21about just over an hour. I was kind
4:25of feeling pretty high on myself. He'd
been sitting in the corner
4:30when the patient had been
woken up and left the room, and we had time in
4:37He had 20 minutes of things to tell me
about. "Did you notice that the light
4:42that was shining in the patient's wound
4:45had drifted off course, and you were only
getting indirect light?"
4:54was struggling with the blood pressure
for about 10 minutes during the
4:59and wasn't telling you about that?"
5:02"I noticed your elbow goes
5:05up in the air. And if you move your feet a
little to the left,
5:09that'll allow you to keep it down on your
side so you're always in full control."
5:20based on ongoing feedback. I had him come
in once a month,
5:28lower complication rates,
5:32and I was learning again, which I loved.
5:37like how could I be a better teacher
and coach
5:43the micromanager in me,
5:45if there was bleeding, and they did not
control the bleeding immediately,
5:50I would reach in and do it for myself.
5:54I needed to let them struggle a
little bit.
5:58so, he taught me to count to 30
6:06I don't think I ever quite got
to 30,
6:11getting to the point that I would let them
6:17was part of also improving how I was
6:21as a professor of surgery.
6:28The purpose of a coach
6:32be the one to set the goals for a surgeon,
6:36"Here are the kinds of goals we can work
our way through. We can improve technique.
6:40We can improve teamwork. We can
improve leadership.
6:43We can improve teaching.
6:44Where would you like to start? What would
you like to accomplish
6:48over the next 3 months?"
6:50That gives you a shared basis for saying,
6:54"We now agree on what I'm going to
6:56observe and help you with."
6:58I have an executive coach as well.
7:02You know, he's asked me to record
7:06so that he can — and get permission for him
to listen to a recording of the meetings —
7:12so that he could give me feedback. "Did
you know
7:16more than 70 percent of the time
doing the talking in this meeting?"
7:20"No. There's no way."
7:25So what's your goal on how much talking
you want to be doing next time? How can
7:30get to that point? Can you start
the meeting
7:35instead of statements?
7:37Can you make sure you set
7:40at the end of your meeting?" And that's the
difference between a teacher and a coach.
7:46is going to make deposits of knowledge
or skill,
7:52see your performance in an ongoing way
7:57Circling back and helping you walk through
the process of change and improvement
8:04the role of the coach.
