high score screen

In praise of being a generalist

There’s something undeniably alluring about being highly accomplished at something. Being the best. Being at the top of your field, your game, your performance. But there’s an opportunity cost to this kind of excellence— the time and focus you dedicate to one thing, you are not dedicating to anything else. Can single-minded focus actually undermine your effectiveness? It depends on what you are doing. . .

Let’s think about this through the lens of running for a moment. We are not all 100m sprinters, even though that’s impressive, and you can win cash and medals and huge endorsements and titles like “the fastest man in the world.” But is Usain Bolt, impressive as he is, better at everything than you are? Is he a better human than you are? His speed is truly amazing, but it’s just speed. This is why obstacle course races are cool— you have to be fast, but you also have to be tough, have power, have strength, have skills. Even the crossfit games (as mixed as my feelings are about crossfit) are a good example of testing a broad set of competencies rather than a narrow one.

I’ve been thinking about this a lot because I am not, shall we say, a highly focused individual. I am curious, a bricoleur, a person who loves to say yes and follow side trails. My grandmother once wrote a poem about my twin sister and me, where she was the arrow and I was the hummingbird. She was a smart lady, my grandmother.  Continue reading

On Alignment

What do you think of when you hear the word alignment? The wheels on your car? Your body position in a yoga pose? I bet it’s not online education. . . but hear me out.

Because I believe breakthroughs come from cross-pollination among disciplines, I’m going to borrow this concept from Quality Matters— which is a system for evaluating the quality of online courses. In this context, alignment refers to the relationships among course objectives, unit or module objectives, instructional materials, learning activities, and assessments. Are the outcomes measurable and appropriate, at both levels? Are the course components aligned with those outcomes? This sounds basic, but it can be surprisingly challenging to achieve. Mapping out these connections can be difficult– and enlightening. I’ve done it as both a course instructor and a peer reviewer for other courses, and found it enormously valuable.

So let’s distill this idea down to the basic components: set high-level goals, set smaller goals to support the big goals, and choose actions and assessments that align with those goals.

Where else can we use this simple structure to improve things?

  • Clinical management. The patient’s “big-picture” goals are surprisingly frequently absent from the conversation. But patient-centered care demands identifying goals for health and for life. A care plan that doesn’t include an assessment of goals is in peril before it even gets off the ground. And I don’t mean goals like “get A1C less than 7%”. I mean goals like “extend my healthy lifespan so that I can travel in retirement”. That might be a radical shift and it might alter management. Or it might mean the same basic management plan is perceived very differently by the patient. I’ve written about the concept of concordance in healthcare before– it’s similar. Aligning our plans to treat, follow-up, and assess our patients with our shared goals, both long-term and more immediate, is crucial to effective care.
  • Career trajectories. I recently wrote about the challenges of focus in an academic/clinical career.  What if, instead of a single-minded focus on a narrow area, each opportunity is considered in terms of alignment with “big-picture” goals? This approach allows for more bricolage (which, BTW, can make work relevant and grounded), more cross-pollination, more serendipity, more diversity– without falling into a scattered mess. I have a couple of broad interest areas and goals, and I find that rather than continue to narrow into extreme sub-specialization, I prefer to exist as a practicing member of the communities I’m a part of, and participate in projects that align with those areas.
  • Self development. This is what tools like the Passion Planner promote– making big goals, identifying smaller pieces of those goals, and taking steps to move towards them. The act of identifying goals, and identifying small steps, is enormously powerful in making progress. It takes deliberate thought and reflection, but the outcomes of small actions over time that are all aligned with a goal can be mind-blowing.

So there you go. Take a simple principle, and see how powerful it can be in different contexts. Think about how Atul Gawande used a checklist strategy from aviation to improve surgery, and think about what big ideas might disrupt your regular practices.

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Advice beyond “focus” for academics

I’m an early-career academic and clinician. As such, I need– and receive– a lot of guidance. I have mentors, I have bosses, I have colleagues. Everyone says to focus. Which is nice, but is it helpful? Certainly focus is critical to build a solid and impactful program of scientific research. Does it capture the goals of a long career for someone like me, with varied interests and broad educational preparation? Does “focus” give me the opportunity for impact across different areas or on different levels? Does this idea of “focus” get me to a place where I want to be? The use of the term is so pervasive, it got me thinking. I’m not a photographer, so forgive any technical errors, but what if we thought about an academic career with a more nuanced set of variables?

  • Depth of field. Can you have multiple objects in focus, even if they aren’t right next to each other? If you adjust the aperature, you can let in more or less light, and along with changing the exposure, this can make your focus shallow or deep. Often in a PhD world, you are compelled to bring sharp focus to a tiny part of an image (big aperture) and blur the rest. This can be a good thing, but it’s not the only way. Say, hypothetically, that you want a career with research and clinical practice both, and you also want to be a policy voice. Change the aperture to a smaller size and see— multiple object can be in focus at once. It’s not better or worse, but it brings a different quality to the image.
  • Shutter speed. So you’ve adjusted the aperture— to keep the exposure right, you need to think about how long the shutter is open. A smaller aperture means you need more time. That’s OK, but you have to be aware of it. You want more things in focus? You need to spend a little longer letting light in.
  • Composition. What’s in your shot? How is it framed? Is it a close-up, or a landscape? Is your subject in the center, or are you more interested in a rule-of-thirds kind of thing? The key here is that THERE ISN’T A RIGHT WAY. It’s all about what you want to show and how you want to show it.  That said, some institutions like certain kinds of images more than others. Does your picture fit into their album?
  • Frame rate. Are you shooting a single, perfect image, or a series? Do you want a smooth, seamless progression through a moment, or do you want to capture discrete pieces over time?

varied interests

you want me to pick just one??

So, what’s the upshot? Should we just throw out the advice to “focus” when it doesn’t suit us? No. . . but I do think we should consider it in a broader context and check to see whether our goals are aligned. I may not want to get on a rocket ship to the moon– I might rather be on a cruise ship through different ports.  Well, now that I’ve thoroughly mixed my metaphors, I suspect it’s time to sign off. What are your thoughts on the ups and downs of focus?

who’s the expert?

It sucks to be sick. Full stop. A UTI sucks. Pneumonia sucks. Cancer sucks. People who have chronic illnesses, though, have an additional set of challenges to face. Some of these challenges are summed up in the idea of self-management, which is complex in and of itself. The definition of self-management that I like comes out of academic work* and it has three parts:

1. Medical managment

2. Role management

3. Emotional management.

I like this definition because it recognizes that there’s more to having an illness than remembering to take your meds and go to your appointments **. Continue reading