Coaching

Could a good surgeon use a coach? Dr. Atul Gawande thought he might. He'd reached a performance plateau and so went out looking for help from one of his former teachers, a retired surgeon. Result?

That one twenty-minute discussion gave me more to consider and work on than I’d had in the past five years. It had been strange and more than a little awkward having to explain to the surgical team why Osteen was spending the morning with us. “He’s here to coach me,” I’d said. Yet the stranger thing, it occurred to me, was that no senior colleague had come to observe me in the eight years since I’d established my surgical practice. Like most work, medical practice is largely unseen by anyone who might raise one’s sights. I’d had no outside ears and eyes. Osteen has continued to coach me in the months since that experiment. I take his observations, work on them for a few weeks, and then get together with him again. The mechanics of the interaction are still evolving. Surgical performance begins well before the operating room, with the choice made in the clinic of whether to operate in the first place. Osteen and I have spent time examining the way I plan before surgery. I’ve also begun taking time to do something I’d rarely done before—watch other colleagues operate in order to gather ideas about what I could do.

In a Hansonean turn, Gawande then considers why coaching isn't used more often:

Osteen watched, silent and blank-faced the entire time, taking notes. My cheeks burned; I was mortified. I wished I’d never asked him along. I tried to be rational about the situation—the patient did fine. But I had let Osteen see my judgment fail; I’d let him see that I may not be who I want to be.

This is why it will never be easy to submit to coaching, especially for those who are well along in their career. I’m ostensibly an expert. I’d finished long ago with the days of being tested and observed. I am supposed to be past needing such things. Why should I expose myself to scrutiny and fault-finding?

I have spoken to other surgeons about the idea. “Oh, I can think of a few people who could use some coaching” has been a common reaction. Not many say, “Man, could I use a coach!” Once, I wouldn’t have, either.
...
“Most surgery is done in your head,” Osteen [the coach] likes to say. Your performance is not determined by where you stand or where your elbow goes. It’s determined by where you decide to stand, where you decide to put your elbow. I knew that he could drive me to make smarter decisions, but that afternoon I recognized the price: exposure.

For society, too, there are uncomfortable difficulties: we may not be ready to accept—or pay for—a cadre of people who identify the flaws in the professionals upon whom we rely, and yet hold in confidence what they see. Coaching done well may be the most effective intervention designed for human performance. Yet the allegiance of coaches is to the people they work with; their success depends on it. And the existence of a coach requires an acknowledgment that even expert practitioners have significant room for improvement. Are we ready to confront this fact when we’re in their care?

“Who’s that?” a patient asked me as she awaited anesthesia and noticed Osteen standing off to the side of the operating room, notebook in hand.

I was flummoxed for a moment. He wasn’t a student or a visiting professor. Calling him “an observer” didn’t sound quite right, either.

“He’s a colleague,” I said. “I asked him along to observe and see if he saw things I could improve.”

The patient gave me a look that was somewhere between puzzlement and alarm.

“He’s like a coach,” I finally said.

She did not seem reassured.

Every now and again, universities think it would be a good idea to send all of their profs off to take coursework in teaching. A former classmate of mine had to complete such a degree when he took a job teaching economics at Monash University several years ago; Canterbury talks about similar requirements. I would be very surprised if there were any positive return on the time investment.

But few of us seek out colleagues for constructive criticism. Exposure's not comfortable. Perhaps universities keen on improving teaching quality would do better in identifying standout teachers to assist as coaches rather than mandating completion of tertiary teaching degrees.

HT: @Isegoria

Signaling and GRE scores

Bryan Caplan writes:

Back in 1995, I attended an IHS seminar for graduate students. We heard some lectures, practiced our public speaking, and did mock interviews. The last activity was pretty traumatic. It's hard for a second-year grad student to role-play someone who's wrapping up his dissertation.

Part of the process was writing up a mock c.v. - which led to a moment I still remember. One of the students wrote his GRE scores on his c.v. During the denouement, the mock interviewers raked him over the coals:

You don't put your GRE scores on your c.v. It's makes you look like a grad student! It doesn't matter how high your scores are. Schools want to hire creative assistant professors - not stellar grad students.

Good advice, no doubt. But why is it good advice? As usual, the signaling model sheds a lot of light. If the average candidate who puts his GRE scores on his c.v. is professionally clueless even given impressive scores, it's a bad idea to include them. So only professionally clueless candidates do so, reinforcing the equilibrium.

I got exactly the same raking at the same IHS seminar, albeit five or six years later. If I recall correctly, I'd used Robin Hanson's CV as model. Now, his scores are instead on his personal page. So I'm not sure if my memory is wrong, or if Robin's taken the signal.

Strategic incompetence

The ever-wonderful Scott McLemee today provides a wide-ranging review of Gambetta's work on signalling and crime (and academia). For the mafia, signalling incompetence at running a business credibly shows the subject of the protection racket that the mafia just wants to keep extracting money that way rather than take over the business fully. In academia, at least in Italy, something similar happens:

"Being incompetent and displaying it," he writes, "conveys the message I will not run away, for I have no strong legs to run anywhere else. In a corrupt academic market, being good at and interested in one's own research, by contrast, signal a potential for a career independent of corrupt reciprocity.... In the Italian academic world, the kakistrocrats are those who best assure others by displaying, through lack of competence and lack of interest in research, that they will comply with the pacts."

Kakistocracy: government by the worst. Love that word.

Gambetta's book has now moved onto my "must read" list.