Filling the gap between new grad and expert

“Fix the hip extension,” he said nonchalantly.  The ease of his answer frustrated me.  I had struggled to improve a patient’s dorsiflexion for two weeks and his answer was too quick.  I was convinced he hadn’t listened to me and pressed further.

“I don’t think you understand.  I can get the ankle better and restore the range of motion with manual treatment, but it doesn’t stick,”  I repeated.  

“Yes, so fix the hip extension and the dorsiflexion will stay without needing to mobilize it every session,” he stated confidently.  

I knew the SFMA and I understood the concept of regional interdependence, but there were many other things I would try and improve on this patient before I’d think about fixing hip extension. But, he wasn’t changing his answer.  So I left to improve hip extension, prove that wasn’t the problem and then come back to get a different answer the second time around.

 Except it did work.  In fact, I worked on the hip extension and the ankle motion improved without me even touching the ankle.  He wasn’t surprised when I told him that it worked and we spent the next twenty minutes talking about why.

I get to talk to a lot of students, a lot of new grads and a lot of residents about what they want in their career.  The most common statements have to do with becoming an expert.  Things along the lines of, “I want to be THE person people come to,” or, “I want to know everything possible about sports,” or “I want to specialize in orthopedics.”  

So, how do you become the best at what you do?

You find people to help you get past the two biggest barriers to becoming the best: 

We Don’t Always Know What We Don’t Know

For the patient with decreased DF, I don’t know how long it would have taken me to decide to work on the hip.  I also don’t know if I’d understand why it was successful if I did ever get there.  So, there is a gap between what we know and what we need to know, but that gap is not always apparent to us.

We Don’t Always Know How To Get To The Next Level

At the time of this patient with the restricted ankle, I was good at using the SFMA, but I wasn’t great.  If you had asked me then what I needed to do to get better, I would’ve told you more practice.  But, I don’t think more practice with my limited knowledge would have produced where I am now.   That’s because the hardest thing about filling this gap is figuring out what to do to get better.

Getting to the next level is not simply accomplished through time in the clinic and the random continuing education course.  I wish it could. While continuing education is extremely important, it needs to be coupled with a strategic plan and high quality clinical and professional mentoring.  

Being the best within your profession takes help from people who are where you want to be.  People that can offer an integrated perspective.  Those that can be a sounding board when you’re stuck, expose things you aren’t able to see, and who can offer high level connections.  If you read Anthony Renna’s Be Like The Best, you will not see a single story of someone going it alone and that’s how they got to be the best.

 If you are looking for some ways to gain expertise from most to least intensive:

1) In-person structure (residency, fellowship)

I fell in love with residency life pretty quickly.  It was the right fit for me.  I was immediately surrounded by peers, with mentors, and a structured way of doing things.  Any time I didn’t know something, I had a group of people to help fill the gap and I had people that exposed a gap when I didn’t even know there was one.

2) Distance (or blended) structure  

I don’t blame you if you don’t want to pack up and move to the Midwest (or wherever a residency is) and work long hours for less pay.  There are other options that are structured for you.  A fellowship like Functional Movement Systems connects you with a structured plan and a network of people to help with your growth.  

3) Create your own through a clinical and professional mentor

If structure isn’t your thing, you can create your own.  You can have systematized learning without a preset structure.  The difference here is that a lot of the growth is on you.  You need to find these two people (both a clinical and professional mentor)  and you need to work with them to create the system.

The best of the best had people along the way.  They had peers they can talk to that are going through the same challenges as they are, they had mentors that can give them a more comprehensive perspective, and they have a way to see whether or not they are making progress.

The best of the best had people around them to challenge them, push them, and support them through the process.  People that get to the top have a high quality professional group, a mentor, and a systematic way of doing things.