Well, hello, and welcome to today's webcast, Skills, Super Skills, and Ultra Skills. My name is Marjah Hevner, and I'm an Assistant Dean for Experiential Learning, Associate Professor for Critical Care, and Residency Program Coordinator for Pharmacotherapy in the Department of Practice Sciences and Health Outcomes Research at the University of Maryland School of Pharmacy in Baltimore, Maryland. A recording of this webcast will be available within five to seven business days. You can log into mysccm.org, navigate to the My Learning tab, and click on the Skills, Super Skills, and Ultra Skills course. Click on the Access button to access the recording. A few housekeeping items before we get started. There will be a Q&A at the end of the presentation. To submit questions throughout the presentation, you can type into the question box located on your control panel. And please note the disclaimer that the content to follow is for educational purposes only. And now I'd like to introduce you to our speaker for today. Dr. Sergio Zanotti Cavazzoni is the Chief Medical Officer at Sound Critical Care in Tacoma, Washington. And now I'll turn things over to our presenter. Thank you, Marjah, for the introduction. And I have no disclosures as well. And I would like to start with a quote from old Greek philosopher, Aristotle, who said, excellence is never an accident. And really, I believe that all of you present today strive to be excellent at the bedside when you're caring for critically ill patients. And that is not going to happen by default, but can only happen by design. And that's what we're going to talk about today. So what I want to cover in the next 40, 45 minutes is first start with a why. Why is this topic of skills, super skills, and ultra skills relevant to healthcare workers in the ICU and in the critical care space? Then I'm going to talk about the how, or what is really the framework of skills that I would propose or that we propose that you should be thinking about as you develop new skills throughout your career? And finally, with the what, what are things that you can do to move the needle and move forward, so more of a call to action of things that listeners can take back home to try to improve on their skills, their super skills, and their ultra skills. Before we get started with the topic, I also just want to acknowledge and thank Society of Critical Care Medicine for the opportunity to share these ideas with its members, but also to invite all of you to check out the lead or leadership empowerment and development committee in SCCM to participate, to look at what we're doing, because Moza and I are big believers that this is something that's been a gap in our society offerings in terms of opportunities to grow some of the skills that we're going to talk about today. So with that, let's go ahead and start. I want to start just by giving you an overview of where we are today. So mankind started as hunters and gatherers, and the skills that you needed then were very basic in terms of making sure you had sustenance and shelter, and that's how society has evolved. Over time, we became more of an economy-based, agriculture-based economy, and now cities started forming around the sources of food. Eventually, the Industrial Revolution came, and as you can see, each one of these economic stages in societies would imply that workers and humans needed to develop a special set of new skills to adapt and to succeed. Today we're on the knowledge economy, and the knowledge economy is a very interesting one because it really now brings the question, what are the skills that we all need to develop to continue to grow professionally, but also have an impact on other human beings? We're in the field of medicine, and one of the things that is fascinating to me is the evolution of medical knowledge. In the 1950s, it was estimated that every 50 years, the amount of knowledge we had would double. Today, it's months. I mean, you can just look at PubMed month after month, and the amount of knowledge that is being released just doubles at a pace that, quite frankly, is impossible to keep up with. So we need to recognize that just knowing facts is not going to cut it, and there might be other things that we should be worrying on in terms of developing skills, and it's not those who know certain things that are going to succeed, but those who know how to access those facts and apply them at the bedside. Game theory can also give us a little bit of an idea of where we are in healthcare. So I'm a big baseball fan. Baseball is a finite game. You have known players. There's fixed rules, and we agreed upon the objective. It's who scores more runs in nine innings, and they win the game. So basically, that is you're playing to beat the team around you and be the world champion, and joy comes from comparing yourself to how you did to other teams. There's also a set of games that are infinite, and that is where healthcare is a great example. There are known and unknown players. The rules might change every day, and the objective is to keep playing the game and coming better every day to show up. So you play to be better today than you were yesterday, and the joy comes from advancement, and that is where healthcare is. Every day that we show up, we try to do better than yesterday, and the true joy and fulfillment comes from seeing that we're making an impact on other people by improving our skills. There's many challenges in healthcare today. Some of them are really putting people first, and I used to say patients, but COVID has taught me that our colleagues and our team are also part of that group that we have to put first, and it's really about putting people first. A lot of healthcare institutions have the lip service that we're patient-centered, yet when we really look at what they do, it's not patient-centered. It's centered around the convenience of the people who are delivering the care sometimes. So really putting our people, our patients, and our team first is very hard, but it's, I think, a must. The second thing is embracing innovation. We saw the rate of change in healthcare knowledge where there's a lot of technology coming at us. How do we innovate in that world? How do we make things better? Innovation is not just about applying the latest and best technology gadgets at the bedside. It's about finding new ways of doing things we do every day. Even changing the way we round can be an innovation, and I think that that's what's needed today in healthcare. Grasping leadership. Leadership is not about positions. It's not about being assigned as a manager. Leadership is about having a vision for change and having followers. So how do we ingress that at every level of our ICU team? And then finally, the only way we can really impact the outcomes of our patients is by building better and better teams, and that's a lot of what we'll talk about today. In critical care today, we must provide excellent clinical care. That's a must. It's the entry to all of this, but we also have to be able to improve care and improve the processes in our ICUs, and we have to learn from our failures and learn how to innovate in a changing environment around us. So with that, I also like to ask, what motivates clinicians? And there's three things that motivate clinicians, I believe, that are intrinsic. Purpose, autonomy, and mastery. Today, a lot of what we're going to be talking about is mastery. I have never seen somebody who's learning not be engaged. The question is, how do we continue to learn in our own careers, and how do we help those around us to continue to learn? There's this, Belle described the effect, the Dunning-Kruger effect, right, that really talks about people who know a little bit think they know a lot more than they do. And then they realize, oh my God, I don't know that much. And then the slope of enlightenment really is about recognizing as you become an expert that there's still so much more that you need to learn. And having that humility always present and sharing that humility with other people is, I think, what we're going to be talking about today in terms of developing and growing new skills. The other thing, which is very important, is that there's this concept known as the mastery asymptote. No matter how much you know about a topic, no matter, even if you're the world-leading expert of the topic, you never get to a point where you know everything. So there's always room to grow and always room for improvement. So no matter where you are in this curve, the idea that there's still things I need to learn is an important one to keep very close to ourselves. The last thing I want to talk about in the introduction is, what about AI, right? Is AI going to take our jobs? So last year, we saw that ChatGPT, it rumped it, and it's a large language model, and it basically was able to pass the USMLE, which is the licensing examination for physicians. And some companies and organizations are already replacing workers with ChatGPT, despite warnings it shouldn't be relied on for anything important. And I think that the pace of evolution of these large language models and other forms of AI is really staggering. And I don't think that we should be thinking of, okay, am I going to be replaced? What should we be thinking now is, how can we leverage these technologies to improve patient care? And the truth is that there's things that large language models and other forms of AI are going to be very good at, but there's also things that perhaps we can be very good at and use them together to potentiate not only our growth, but the impact we have on our patients. So with that, I think that, yes, we need to think about skills and growth. And what I'm going to propose to you is a different, maybe a little bit of a different way of looking at skills in terms of a skill framework. So what is a skill? This is from the Oxford Dictionary. It's the ability to do something well. It's expertise. Every single one of you, as members of an ICU or critical care team, as members of the healthcare worker group, have expertise. We have the expertise in things that overlap, and we have expertise in things that are different. But all of us have expertise. Doesn't mean that we can't keep growing our skills. And the question really is, are there, yeah, that just seems to happen with the Apple software that just gives thumbs up and explosions, I apologize. The ability to do something well can continue to evolve. And the question is, how should we think about our professional growth and the professional growth of others? People have traditionally talked about skills and hard skills and soft skills. So hard skills refer to things that people believe are teachable, are job-specific abilities that can be quantified or measured. Can I intubate? Do I know how to prescribe medications, right? Do I know how to set the ventilator? And soft skills have been referred to an individual's social ability and how they relate to and interact with other people. I think that this is unfortunately the wrong framework because it undervalues soft skills. Just by calling it soft skills, a lot of people are a little bit put off. Yet over and over again, what I'm learning as I get older, and you see the white hair coming up, is that hard skills are essential, but it's the soft skills that make the difference. That is what helps people succeed in critical care. That is what ultimately helps our patients have great outcomes. And I was always in trouble by this because whenever I talked to somebody about soft skills, it kind of puts them off. It says, I want to learn the hard skills, the ones that I can get better at. Soft skills, somehow people think are just things that people have or don't have. And really, you can acquire all these. So I propose that we think about things a little bit different. And I like to start from the bottom with skills that are job focused. I call them job skills or just skills. These are the skills required to be a critical care clinician in my case. But it might be the same skills that are required to be a critical care nurse, a critical care pharmacist, a critical care physical therapist, right? These are the things that we apply every day on our job. And they open the door for us to come into the ICU. And they open the door for us to take care of patients. But if we just got stuck there, it's going to be very hard for us to really go to the next level, to really grow professionally, and ultimately, to have a great impact on other human beings. So then we have super skills, which are also called intra skills. And these are self-focused. They are the skills that are required to foster your own professional and personal growth, right? And we can see that people who have super skills, so you have two, let's say, I'm going to talk about two physicians who finished critical care training, come into an ICU team. The one that has super skills is going to continue to grow at a faster pace than one that doesn't develop these skills. And obviously, that is very important for us as individuals. But ultimately, I'm a big believer that life and success are defined by our ability to have an impact on the life and success of other people, our patients, our colleagues, our students. And then we have ultra skills, or extra skills. These are focused on other people, and they're the skills required to make others perform at their highest level. People who develop these skills, I believe, are the most successful professionally, but also the most successful in life. And these are all skills that can be acquired, can be improved, and can be taught. So think about it. We all need skills. We should be working on our super skills, and ultimately, we should be developing ultra skills so that we can really have a significant impact. So let's dive a little bit more into this. So skills, again, are the things that are required for us to do our job. So I'm going to talk from the perspective of a physician, which is what I am. It's what I learned during medical school, residency, and fellowship. It's taking care of a patient with ECMO. It's doing a point-of-care ultrasound. If I do research, it might be applying statistics. If I manage in my unit, it might be understanding PNLs or balance sheets and making sure that I understand how to manage my unit from a financial standpoint. These are the things, obviously, that we learn through time. But as you saw, what you learn in your training is not enough 10 years from when you finish your training. We have to continue to acquire new skills, and that's why we go to conferences. We go to courses. We read journals, right, to stay afloat. And these are very important because without these, you're not invited to take care of patients in the ICU. So these will open the door for you, but they only establish the floor. Even if you had the best skills at your job, you're not going to be able to grow and lead others if you don't develop other skills. So then we talk about super skills, which are focused on my own personal growth. Examples of this would be my ability to focus on tasks. Multitasking is a myth, right? It is a myth that we can do more than two things at the same time. You can do maybe two things that are very low level, but try to have two complex conversations at the same time with yourself. Impossible, right? So those who can monotask relentlessly are going to exponentially surpass other people. Lateral thinking, my ability to take connections from what seems to be disconnected areas to create new solutions. And that's something that you can develop, right? And thinking, I mean, about bringing things from other areas. Communicating ideas, the ability to write, the ability to prepare a webinar like this one, the ability to prepare a talk, organizes your thought process. And yes, you might be delivering to other people, but the person who benefits the most from writing something or from presenting something is the person who put it together because they're the ones going to learn the most, right? So this is also a super skill that will help your growth. The more you write, the more you present, the more you'll learn. And finally, establishing priorities, right? You can't do everything. And by being able to say no to certain things, you can focus on the things that are most important. So in terms of going deeper on some of these, let's talk on focus on task. I said it before, multitasking is a myth. Everything we do at work is either deep work or shallow work. So deep work, and this is a concept that Colin Newport has put forward, deep work are the efforts that create new value, that improve your skill, and that are hard to replicate. It's what you do as a critical care pharmacist, is what you bring to the table as a critical care nurse for that patient during rounds and during their care, is what we do as intensivists. Shallow work are efforts that tend to not create new value in the world and are easy to replicate. Writing a note, crossing the dots, exiting a protocol, these are things that unfortunately we have to do, but are not that valuable and other people could maybe do for us. So the key here is when you're doing deep work, focus. Your ability to stay connected, right? When you are talking with a family about goals of care life, that is deep work. Not everybody can do that well. Who do you think is going to do better? Somebody who's fully present and focused on that conversation, truly listening, truly giving input, or somebody who gets interrupted by their phone every second, who's maybe getting a page, who's distracted, who's daydreaming. So building this muscle is a super skill. The second one I want to talk about is establishing priorities. We should do less things, but better, right? So if you're a non-essentialist, you try to be everything to everybody, you say yes to everything that they offer, and at the end, you don't get a lot of growth or satisfaction. An essentialist knows what's important for them. There are certain things that I am unique at providing for my patient and my team, I'm going to focus on those things. There are certain skills that really I enjoy doing and I create a lot of value, I'm going to focus on those things. You can't do everything, right? So when you really identify what are your priorities and what are your strengths, and you put time for that, and you're able to say no to other things that are distracting, you have a much better impact on life. And I think that's a skill, saying no is a skill. And it's very hard for us to say no, but you don't have to say yes to everything. If you know what are the things where you bring the greatest value, and that's where you should put your efforts on. So finally, let's talk about ultra skills. Ultra skills are about other people. It's about creating better teams. It's about helping other people be the best version of themselves. It's about saving patients. It's about improving the environment that we work in. And examples of ultra skills that I think are very important are team building. Nobody in healthcare provides care by themselves. Nobody in healthcare, right, can make a difference by themselves. We need a team. And over and over again, what the literature has shown is that if you just put a whole bunch of smart people together, you don't have a great team. Great teams are much more than the sum of the individuals that make it. And building that great team is a skill. You can take any team and make it better. That's an ultra skill. Helping others. Can you coach and mentor people, right? Can you help the new nurses in your unit become better quicker? Can you help a colleague find their own niche? That's an ultra skill. Setting and sharing a vision. Great leaders see a possibility that's different, and they can share that possibility with others. And what defines leaders is having followers. So if you can share that vision of a better way of doing things, people will follow you, and no matter what your title is, you will be a leader. And finally, change management. The most difficult thing to do. The most common thing that we encounter every day. Change is the only given in life, and is the only given in healthcare. Yet changing, despite that fact, is very difficult for all of us. So those who develop the skills to help others change, and change the ways we're doing things at our unit, are developing an ultra skill. And yes, some people might be better at some of these than others, but let's be very clear. These are skills, and as skills, they can be learned, and as skills, you can improve on them, no matter where you are in that mastery asymptote. So let's go into a couple of these in a little bit more detail. So building teams, like I said, the team is much more than the sum of the individuals. This is a list of things that actually help or identify high-performing teams. So Google, a couple years ago, was very interested in finding out what made Google teams better than other Google teams, and they called that the Project Aristotle. And what they did is, they took over 150 Google teams, and they looked at millions of data points, including team demographics and team dynamics, trying to figure out, okay, how do we build the most high-performing Google team? And what they found is that five things made a difference. First and foremost, psychological safety. Do team members feel safe taking risk and being vulnerable in one another's presence? That by itself had more weight than anything else. And in medical studies, the same thing has been found. Psychological safety is the most important component of a high-performing team. And those who understand how to build psychological safety are going to make the greatest impact on patients and on their teams. That is an ultra skill. And that is a skill that we should all be developing, no matter what your position says you are, because you are a member of a team, and you can lead that team from any chair. Other things that were found in the Google study that have also been replicated in other areas are dependability. Do team members accomplish things on time and meet with a high bar of excellence? Structure and clarity. Do team members have clear roles, plans, and goals? The work I do is personally important to team members and to others, right? Purpose. And then the impact, which is the team members seeing that their work matters and creates change. So those who can create environments and teams that identify and that have these elements are developing an ultra skill that ultimately has the greatest impact on our patients, but also has probably the greatest impact on an individual feeling fulfilled with what they do professionally. The other aspect of this is change management. And we've seen in every hospital and institution that we work that some change initiatives are more successful than others. And there may be many reasons, but change management is a skill. And we can all learn and we can all be better at it, right? This is just one framework that has been applied. I mean, by the Heap brothers in their book Switch, where they talk about directing the rider, right? How do we, I mean, we all, I mean, have an elephant that's very hard to control, but when we can direct that elephant, that rider, we can really move people in the right direction. So following the bright spots as we are changing, celebrate the victories. We talk about this all the time in the A to F bundles, right? How do we implement new bundles into our ICU? Look at the critical moves. So understand what are the things that we need to do to make that change happen. Point to the destination. We talked about setting the vision. That's what leadership's about, right? And these are all things that you can get better if you apply like a discipline to try to improve. And you think about, this is a neutral skill that I really need to develop. Motivating the elephant, right? How do we find the motion? I mean, a good story, right? So we've all talked about CLABSI and that all started with one young patient who developed a Lyme infection and died from that infection. How do we prevent that from happening? How do we create emotion and stories for people to understand why we're trying to change things for our patients? Shrink the change into smart chunks. If you have a big change ahead of you, you can't obviously change everything at once. How do you break that out into steps that we're going to do? And then how do you grow the people around you to help you move that change forward? And finally, shaping the path forward, which is how do we tweak the environment to make that change more sustainable? How do we build habits into our team? And how do we really rally the herd and move forward? These are all skills that you can develop and you should be developing because no matter what you do, you work with other people and you're going to have to change what you do over time. So the last part of this talk is really about moving to action. We talked about why we need to keep growing professionally, especially in critical care and medicine. We talked about a different way of looking at skills. So think about skills are directed at the job, super skills are directed at myself, high growth and ultra skills, which are the most valuable, are directed at other people. And with that framework, I think that you can start identifying, okay, for each one of these, this is something I want to work on, right? I need to learn to intubate better with new technology, that's a skill, I need to be better at focusing and monotasking a task or saying no to things that are not important, that's a skill, and I need to be able to build a better team around me because right now the atmosphere in my ICU does not feel safe for people. People are blaming others when there's a problem, they're not learning from their mistakes and I need to improve that, right? So that might be your list of three things that you want to work on after this webinar. So how do you start? Well, we love checklists in the ICU, so why not have a checklist for growing any skill, right? Whether you have a skill, super skill, ultra skill, you can use this checklist and this checklist will help you move forward. Number one, develop a growth mindset. Number two, take the time to reflect. Number three, identify your skills and practice them. Number four, seek coaching and mentorship. And number five, expand your horizons, read. You can expand your horizons in other ways. We'll talk about each one of these as a checklist that might be helpful. So Carol Dweck has done amazing research from Stanford over the years and really identified that there are basically two types of mindsets. And the reality is as more research has been done, it's not that you're one or the other, you go on a spectrum from one to the other. And at work, there's certain situations that might trigger you to go one way or the other. So for example, when you know you're about to be evaluated, right? When you receive critical feedback, when you see somebody else succeed in something that you have not succeeded yet, all of these can be opportunities to go to a growth mindset or can be opportunities or bad opportunities to push you into a fixed mindset. A fixed mindset believes that your abilities are innate, that either you're good or bad at something, right? So a lot of people in healthcare, a lot of people listening to this webinar, I'm sure were brought up with a fixed mindset. You celebrate being intelligent, you celebrate your A's, you celebrate getting great scores, and then you got into a great school and then you got into great residency, right? But what happens when you face a challenge and you fail? All of a sudden you feel, well, maybe I'm not that smart and it's hard to grow, right? So when things get difficult, when we fail, we don't learn. We kind of get frustrated. And what does that eventually make you do? You stick to what you know. You stay in your comfort zone. So one of the things that we should always avoid is praising young kids, especially, for their abilities. We should praise them for their effort and for learning, right? It's not, oh, you're good at math because you're smart. It's you're good at math because you worked hard at that problem. And studies have shown that when you use that setting for fifth graders and then you give them math problems, as the math problems get harder, those who were told they were very smart, give up earlier. Those who were told they work very hard, keep working and get more of those correct, right? That's the growth mindset. Failure is an opportunity to grow. Anything that I do is not innate. It's acquired. I'm not good at this, but I can get better, right? I can learn to do anything I want. Challenges help me grow. Feedback is constructive. Give me feedback that helps me get better. I want that, right? I don't take that in a negative way. My effort and attitude determine my abilities. I like to try new things. I like to step out of my comfort zone. That's how I grow. So, the first thing is you should always have a growth mindset and a beginner's mindset, right? If you're thinking this is helping me grow, mistakes are just an opportunity to get better. If you think I'm either good or bad at this, you're not going to grow and it's very hard to evolve. So, work on that growth mindset and that would be a great starting point. Number two on the checklist, pause and reflect. One of my favorite stories is there is a very, very accomplished CEO of a multi-billion dollar enterprise. It's a conglomerate of luxury brands and she became CEO at a super young age, right? And she's like a superstar. And they asked her what she thought was the most important thing that she had done to get where she got. And she said, for as long as I can remember, at the end of every day, I have a little notebook and I would figure out what did I learn today? What can I do better? And every day, this person would take time to reflect, what did I learn today? What can I do better? And if we don't take the time to do that, it's very hard to grow, right? There's always something coming at us, right? I mean, it's the world of the urgent and healthcare. But if we don't take time to pause and think, right, how are we going to get better? So, think about why do we encourage people to debrief after a cardiac arrest? Because that's the only way to get the team better. If we just go to code, after code, after code, after code, and we never pause, reflect on what we did, we're never going to get better, right? But when we debrief, it's pause and reflect. What did we learn today? So what? How is this connected to what we're trying to do and the meaning of our work? And then the question is now what? What can I do to improve that? Do I need to take a course? Do I need to do this next time? Do I need to talk with somebody else? So take the time to reflect, right? You can do it in micro doses every day as you drive or walk back home or take the train back home. Think about what was good and bad. What could you do better? What did you do well? I mean, it's not all about, I mean, sometimes I said, I did a really good job with that family. Why? Oh, because I listened to what they were saying. I didn't talk so much. Maybe I should work on that, right? So really pause and reflect. That is, I think, a key element of any skill development. Identify their scales and practice them. So you may have heard about the 10,000 hour rule that was popularized by Michael Gladwell and outliers. But the real research of that comes from Erickson, who actually studied what's called deliberate practice. It's just not doing stuff that actually makes you better. It's doing the right part, the right things that do you better. So why do I have a piano player here? Because most accomplished piano players, which I'm not one of, will actually understand that one way of getting better is practicing scales. If they can manage their scales, then they can play more and more complex music as they go forward. So great piano players will spend time practicing scales. Same thing when you look at highly accomplished violin players. Those that only go through the motions every day don't improve as much as those who identify hard pieces of music and try to play that very, very well. So there's two things about identifying scales. They should be challenging, right? And they should be aspects of a skill that actually make you better. So how do you become world-class? Is you identify what are the micro skills that make up a specific skill, which are the ones that are most difficult and important, and you practice that. So if you have ever seen somebody have a masterful end-of-life discussion with a family, you can probably break up what they did into small pieces. They walked into the room. They introduced themselves. They made sure everybody there introduced themselves. They made sure everybody was on the same page. They listened before they talked, right? And you can then, okay, these are the key elements. You can practice that. If you're going to do an intubation, you have micro skills that you need to learn. How to pre-oxygenate, how to position the patient, what drugs to give, how do I use the glide scope, how do I hold my ET tube, right? And you can then practice the ones that are more difficult. That's what practicing your scales are. So any of the skills that you identified, break it up into a couple of micro skills and say, okay, these are the ones that I'm going to be more attentive to. Next on our list is coaching and mentorship. So coaching and mentorship are not the same thing. Now in medicine, a lot of us might have mentors or mentor others, but I think very few of us are using coaches. And that is very interesting. Atul Gawande has written about this as a surgeon. And the truth is that we should all have coaches. The best tennis players in the world have coaches. So if they need one, why would I not need a coach, right? I mean, I'm not Rafael Nadal or Roger Federer or Djokovic. So why should I not need a coach? Now the difference is that coaches are focused on task and it's the performance that's really important. And mentoring is more global and it's about general growth, right? So coaching usually has a set duration. It's task oriented. It might be more short term. It might be a formal relationship. Sometimes it might be performance driven, focused on achieving certain goals. So if you want to learn a new technique, you might ask a colleague who's done it multiple times to coach you a couple of times, right? That's not really a mentor. They're teaching you a specific task, like using a new device. It's focused on specific development areas and instruction, and really it leads to transformation from a behavioral standpoint. You learn to do something a little bit different. So we should all have coaches for different skills that we're learning, that you can have coaches for a skill, a super skill, or neutral skill. Mentoring is more of an ongoing relationship. It's relationship oriented, not task oriented. It's long term. It's usually an informal relationship. You don't sign a contract usually with your mentor. It's more development driven, right? It's more focused on supporting guidance, focused on professional and personal success. Mentors usually listen as opposed to giving you instruction, and it ultimately leads to personal transformation. There's a lot to be gained from being coached and from coaching. There's a lot to be gained from being mentored and from mentoring. And yes, coaching and mentoring ultimately fall. I mean, it's kind of like a catch-22. They are ultra skills, but you can only develop them by having other people help you. So think about who can mentor me, who can coach me, right? How can I be a coach for somebody else? What makes a good coach? What makes a good mentor? And you can actually not only develop these skills, but use others to develop them themselves. And finally, I'm a big believer that innovation rarely comes from somebody having an idea that nobody else in history has had. Maybe sometimes, but usually what happens when we innovate at the bedside is we're adopting a solution from another type of problem to the problem that we're faced with that day. And how do you do that? You expand your horizons. So I'm a big reader. I read a lot. Every one of these books, research and findings from this book has been applied to this particular framework and lecture. Now, there's other ways to expand your horizon. It might be a big video person and TED Talks or looking at YouTube. You might follow podcasts, right? There's a lot of ways of expanding your horizons, but the point is if you're a critical care physician and all you read is critical care literature, it's hard to innovate. All you can do is what other people have done in critical care. Sometimes the solution comes from somewhere else. So find ways to expand your mind, find ways to look at different horizons and make the connections. The more dispersed your points that you can connect are, the more creative you can become. And creativity is not exclusive to art. Creativity is needed in the ICU to innovate. Creativity is needed to solve problems for which we don't have an answer that we can just Google up, right? So make sure that you're expanding your horizons. So in summary for the checklist, develop a growth mindset and should always be working at that, right? When you face a new challenge or when you fail, do you see that as, oh my God, I'm not good at this fixed mindset? Or do you see it at, I can be better at this next time. This is what I need to do to get better growth mindset. When somebody comes and says, like if somebody came in today and said, Sergio, your skills, super skills and ultra skills webinar really sucked. I would first feel defensive, but now I'd say, well, tell me one thing I could do to make it better. I want to grow on this, right? I want to, next time I talk about this, I want to do it in a better way. That's the growth mindset. When you get negative feedback, be more curious and ask them, okay, you didn't like it. I get that, but can you tell me one thing I could do to make it better, right? And puts you in the growth mindset. Take the time to reflect. Every time you finish a day or after you have a bad outcome, but even when things go well, what did I learn? What did we do well? What can I do better? How do I get there, right? If you don't take that, if you don't make that a habit, you're just living by default. It's very hard to grow and you want to do that. And that's one way to do it. Identify your skills and practice them. And I'm not saying that you break up everything you do in a day into micro skills, but if there's a specific skill, super skill, ultra skill that you want to learn, you want to get better at, break it up into a couple of steps. Figure out which one the most important and start by practicing there. That's deliberate practice. That's what ultimately accelerates learning and expertise. Seek coaching and mentorship, right? So ask people to show you things. I mean, and remember regarding coaching, every person in your ICU knows something that you don't know. They can teach you something. They can coach you on something, right? It can go across disciplines. It can go across, I mean, generations, right? As I get older, I might teach some people about their career, but they might teach me things about technology and how to leverage technology to impact other people. So coaching can go both ways. And mentorship is more of a long-term relationship. And you don't have to know the mentor for somebody to be a mentor. I always say that one of my biggest mentors is Marcus Aurelius. He was a Roman emperor who died thousands of years ago, but he wrote a book in his journal called Meditations. And I read that every year. And it humbles me to think that the most powerful man on earth thought like that. And yet sometimes I behave the way I behave. So it's always a reminder, right? That if he could do it, I probably could do a little bit better. So you can find mentors outside of people you know. They're giving you more of a guidance for your growth overall, but also it's nice to have real people as mentors. And I've definitely had wonderful mentors in critical care and now try to pay it back by being a mentor to other people. So make sure that you do both. And finally, expand your horizons. For me, it's reading, but it can be in many other ways that you expand your horizons, right? It's really exposing yourself to things that are outside of the sphere of what you do every day. That's how you innovate. That's how you're going to bring new solutions to the same problems that you face every day. So as we close, we talked about the why. We are in a fast-paced knowledge economy. Technology is accelerating at a rate never seen. And we have to figure out what are the skills that ultimately help others the most and help me fulfill myself as a professional in critical care. Let's throw away soft skills. Let's not talk about them anymore, right? Let's talk about skills, super skills, and ultra skills. And I'm sure all of you as being type A, very engaged and motivated people want to have those ultra skills, right? And those are the hardest to acquire, but they have the greatest impact. The point here, which I think is a point that we have not understood maybe for that long, is that no matter where you are in that curve, you can get better if you work on it. So choose like a skill, an ultra skill, a super skill that you want to work on and go with it. And then in terms of moving in action, there's many ways you can do it, but I think the checklist is a good starting point, just a nice reminder. Okay, I'm going to apply this to this thing I want to get better at, and I can guarantee you that you will. You will get better. So with that, I think we're at time, and we're going to go to hopefully some questions. And again, I want to thank SECM for inviting us to do this, but also on behalf of LEAD, I want to invite all of you to participate with the offerings and with the committee, because we do think that as the world is changing, we definitely need to evolve in how we think about skills. Great. Thank you so much, Dr. Cavazzoni. So if the audience members want to continue to type in any questions into the question box, I'll keep an eye on that and make sure that we get to your questions. We have about 15 minutes or so left of our discussion, so I definitely want to make sure to address anything that you have on your mind. I'll jump into a few questions that I have for you. So you talked a little bit about maybe generational nuances and how you learn from generations other than yours. I'm curious, is there literature on differences across generations in how we perceive super skills and ultra skills? And then also, are there different maybe strategies that would be more effective for different generations? Yeah, that's a great question. And I think that the generation topic is obviously itself another webinar, right? But the interesting thing is that generational differences have been noted for thousands of years. This is not new, right? And it's just basically what people are exposed to when they're in their formative years. So I believe that in some respects, younger generations are much more exposed to the importance of emotional intelligence. They're much more exposed to the value of ultra skills because they, at a very early age, have figured out that they can ask chat GPT to solve a formula, that they can find answers to things that older generations had to memorize, right? And really, yes, I mean, there are differences in terms of how people perceive. If you talk with boomers, maybe emotional intelligence is like, ah, that doesn't really matter, right? I mean, but younger people realize that how they impact others is something very important because they can find the other stuff very quickly, right? Now, in terms of how you get to them, I think really the idea is not necessarily how, I don't know if people have talked about different types of learners. Yeah, maybe, but there's really different types of consumers. People consume knowledge in different ways. And trying to reach people by different mediums is really the way to go. So I do believe that when you have an idea, you write about it, you talk about it, you do a webinar, you do a podcast, you find different mediums to try to reach the same idea, but you always go back to the same to the same point. And it's where do you meet the different learners, right? Some people are big on meeting one-on-one, some people are big on just looking at TikTok. And I think it's how do we leverage ideas that are worth spreading through different mediums, but yeah. So continuing kind of on that theme of differences across generations or ages. So for those of us who maybe lead teams that are composed of newer practitioners, it sounds like generally the newer practitioners are probably on board with these concepts, but if we're having a hard time engaging them in growing their super skills and ultra skills, what advice would you offer for how to get that engagement and kind of sell the importance of that? Yeah, I would ask them. So one of the big things that I do think is a generational issue is the myth of multitasking, right? And I would identify, what you need to identify is what is interesting for the individual, for the individual learning. What do they want to learn, right? We're all adults here. I mean, I think that when people, when you identify where they want to grow, you can help them grow maybe in a way that they're not even aware. So for example, I said that, let's talk about one example from skill to ultra skill. So you have a clinician who's very interested in ARDS. So there's things they can learn of managing ARDS that would be considered part of their skillset, right? They're job related. You invite that person in your program. Why don't you teach this to the rest of the team? How they present that presenting, for example, the most important point of managing an ARDS patient and rounds in five minutes is very different than I'm going to do a lecture where I'm just going to kill you with PowerPoint slides, right? But you can then work on a super skill, which is for them to condense the information, right? And explain that one of the hardest things to do is to write a 500 word abstract of what you want to say. That takes a lot of effort. It's a lot easier to do a one hour PowerPoint presentation with tons of studies, right? But if you really want to distill your message and you want to be the expert, force them to, I want you to present this in five minutes, right? And help them. So that's a super skill now, communication. And then the question is, okay, how do you make the whole team take better of a very sick ARDS patient? You have to create a better psychological safety for the RT, for the clinical pharmacist, for the nurse, for the resident, right? And how can you be a leader in developing those skills? And again, forcing them to read about it, forcing them to think about how can I show up? How can I move the needle? That's the way that you can really show them the benefit. But at the end of the day, what they learned if they went through that process is that knowing a lot about ARDS doesn't change the impact of a patient as much as having a team that really works together in a safe environment to provide that care. And that's, I think, what exemplifies this journey of going beyond skills to the ultra skills and going to ultra super skills in the middle. So I loved your analogy about the practicing skills. And there's a great question in here about when we're working on or we're practicing the skills when we're working on the areas where we can continue to grow, is it more beneficial to focus on one skill at a time? Or is it more or is it more effective to work on multiple skills simultaneously? Yeah. So I think that you can be developing depending what you call by time. I think that when you are doing something, one task, be fully present at that task and give it enough time. So if I practice for five minutes here, five minutes here, five minutes here, different things, it's not the same as I'm going to practice this for the next 30, 40 minutes. Now, it doesn't mean that tomorrow I don't focus on something else. I think that as long as your blocks of practicing for a given skill, super skill to skill are meaningful, right? And you're fully present while you're doing that. It's okay to later or the next day do something else because that's just life, right? The reality is that learning is not sequential. It's not like I learn A, then I learn B, then I learn C, right? It's you do A, A, C, then A, A, then you do B, right? It's more like intermixed, but you need a certain amount of presence and time for a given practice, for sure. And maybe you practice like, let's say, making the team better is a super skill. It's a neutral skill, right? I practice that when I'm with my team. When I'm not with my team, I practice something else, right? It's about being intentional. Today I'm rounding and something I can do to improve the psychological safety, right? Build my team is to invite people to participate. So the new clinical pharmacist is very quiet during rounds. So I say, John, we really want to hear, we value your opinion. Could you tell us what you think of how we're using this drug? You invite people to participate. Now, if you are busy and you're trying to get through rounds, you might not do that. But if you are really trying to improve your skills, you might say they're very intentional. When somebody is not speaking, you call on them in a nice way and you tell them, we value your opinion. Can you please share with us, right? That's inviting people to participate. That is part of building a great team. Now, the more you do that, it becomes a habit and you become better at it, right? So I think that's you can be practicing all of them on a given day. It's just that when you are doing something, being fully present is really key. I think you touched on this next question a little bit with that example. But I want to bring it in because I think a lot of times we focus so much on the skills and the day-to-day tasks and the very technical things and separate that those are what goes into the medicine and then the super skills and the ultra skills are something else. But this question is, how do you incorporate ultra skills into the high-stakes decision-making process, like directly at the bedside? Yeah. So over and over again, the data has demonstrated that for complex decision-making, teams that operate in an environment of psychological safety and communicate well will make better decisions. And over and over again, we have seen that in high-stakes complex environments, such as the ICU, there is a lot of people who don't feel safe. So that's the single most important thing that we should be doing in critical care, improving the psychological safety of our teams. The other thing that I want to mention is that there's this concept of team versus teaming. So teams are fixed-bound entities with known players. That's like an analogy would be a sports team. We know who the players are and they practice together. Our teams change. Yes, we have people who work every day, but every time I show up to work in the hospital, I might get called to a code on the floors. I'm going to be with people I never met before. Maybe I know one of the nurses, right? So my ability to calm people down and help people organize themselves, that's an ultra skill. And how do I practice that? By reflecting after the code, what went wrong, encouraging everybody to share, and then thinking, next time I'm actually going to do A, B, and C, because I didn't do that this time. And next time I do it, I have other things to do. So I think that not only do we have to incorporate these ultra skills into the decision-making in a complex situation and high-stakes, not only we should, I mean, we absolutely have to be thinking that this is what's going to create the best outcomes for our patients. And I don't think that we do that enough in critical care, to be honest. We don't do it enough in other areas too. So that's part of the call to action to this whole discussion. I think this might be our final question. So I think many of us appreciate the book list that you provided. We're all constantly looking for recommendations from those who have, you know, kind of grown in this area and maybe are leaders in what you would recommend spending our time reading. I think many are probably like me, where I have a stack of those books next to my, on my bookshelf that I intend to read but haven't gotten to. So do you have any just simple tips to folks like me who, how do you prioritize that or how do you, how have you managed to get through that list? So, well, I think that the way you can get through a list is, I always, it's always having something to read around you. So I always have something on Kindle, something on Audible and something in physical form that I'm reading, right? And I carry with me and there's always, there's more time than you think, right? I know I try to avoid what they call the doom scrolling because we all get hit with dopamine. So I'm not saying that you shouldn't be on social media, but do it intentionally. Say I'm going to check, I'm going to be on social media for the next whatever minutes and then stop, right? And the same thing, that's a, if you focus, I'm going to read for the next 20 minutes. It's amazing how much you can read if you take chunks of 10 minutes, 20 minutes a day to read, right? And if you do it every day, eventually you finish a book. Same thing with podcasting. I just think that you have to find things that are interesting for us. I think when something's interesting to you, you'll find the time. And the question is just to explore and not everything is interesting, but definitely, I think we all have things that we find interesting and if we can learn about those things and then think about it, how to apply this to my day-to-day, you'll be surprised. Even going to the museum can give you an idea, art museum can give you an idea of how to improve something in your ICU. So I think it's forcing yourself to try to make those connections. I love all those suggestions and I'll definitely try to be more intentional with my time and less of the doom scrolling and more of the reading. So I think that that concludes our Q&A session. Thank you so much, Sergio, for your time and for your wisdom. And thank you again to the audience for attending. Again, this webcast is being recorded. The recording will be available to registered attendees within five to seven business days. You can log into mysccm.org, navigate to the My Learning tab, and click on Skills, Super Skills, and Ultra Skills course, and then on the Access button to access the recording. And that concludes our presentation today. Thank you. Thank you.

Skills

Super Skills

Ultra Skills

Healthcare

Critical Care

Professional Growth

Psychological Safety

Mentorship

Growth Mindset

Team Performance