Professional Development: Skills, Super-Skills, and Ultra-Skills

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Examine professional development through a new framework to succeed in today’s complex ICU clinical environment.

The growth of medical knowledge continues to accelerate exponentially. It is estimated that the doubling time of medical knowledge dropped from 50 years in 1950 to about 70 days in 2020.¹ Medical knowledge is expanding faster than we can assimilate and apply it effectively. Furthermore, the rapidly evolving sophistication of artificial intelligence (AI) platforms, such as ChatGPT, which recently passed the U.S. Medical Licensing Examination, has raised questions about the best use of this technology and the actual value humans will bring to the bedside in medicine.²
 
Every member of the critical care team, regardless of primary discipline, comes to the intensive care unit (ICU) after rigorous education and training, which are heavily focused on the knowledge and skills required to care for critically ill and injured patients. With patient lives at stake, a focus on clinical knowledge and skills makes sense. However, are these skills enough to succeed in today’s complex ICU clinical environment?
 
Cultivating the Right Skills
Traditionally, organizational experts discuss professional skills as being either hard or soft skills.³ In this framework, hard skills are teachable, job specific, and measurable. Soft skills are abilities to interact with and relate to people. This dichotomy, however, undermines the value of soft skills—the most essential skills to develop and skills that AI will have a much more difficult path to develop. Every skill can be learned, and every skill can be improved. Let us examine professional skills through a new framework. Instead of hard and soft skills, let us think of skills, super-skills, and ultra-skills.
 
Skills (job skills) are job-focused skills required to be a healthcare professional and are obtained through formal training. They open the door and establish the foundation for our professional success. Examples include the clinical management of septic shock, performing procedures such as placement of central vein catheters, titrating vasoactive drugs at the bedside, preparing vasoactive drugs for infusion, and changing ventilator settings.
 
Super-skills (intra-skills) are self-focused and emphasize improving yourself and fostering professional and personal growth. Super-skills push you forward in your professional journey. Examples include focusing on tasks (monotasking), creative problem-solving, communicating ideas, and establishing priorities.
 
Ultra-skills (extra-skills) are other-focused, concentrated on other people’s growth, and required to help others perform at their highest level. They are transferable skills that determine your professional ceiling and impact. Ultra-skills are the most valuable for leaders since they significantly impact and change others. Examples include team building, developing psychological safety, developing others professionally, setting and sharing a vision, and change management.
 
Super-Skills
Skills learned in school and training as a nurse, clinical pharmacist, physician, respiratory therapist, or other healthcare discipline are essential for the clinical care of critically ill and injured patients in the ICU. These skills are required to join the critical care team. However, not everything needed to practice medicine successfully is learned in school or during clinical training. Super-skills are needed to continue to meet challenges, grow, and develop. Examples are:
 

• Focusing on the task. Our world is full of distractions, and it is easy to mistake busyness for productivity. We herald multitasking, but it reinforces the notion that busyness is better. When you focus on what you are doing, you have the opportunity to focus with intent, learn and grow, and produce something meaningful.
• Thinking laterally. Also known as horizontal thinking, this creative form of problem-solving uses indirect and unexpected means to figure things out. This kind of innovation or creativity can help us grow.
• Communicating ideas. Ways of communicating ideas that benefit others, such as writing an article or hosting a webcast, can help crystallize thinking and understanding. Both are paths to share ideas with large groups.
• Establishing priorities. This works in tandem with focusing on the task. You cannot focus if you say yes to everything, which is why saying no is a super-skill. As clinicians, we understand what it means to be spread thin. Work by design—be deliberate. Practice the disciplined pursuit of less rather than the undisciplined pursuit of more.

 
Ultra-Skills
While super-skills help you grow personally and professionally, ultra-skills are learned to help others flourish. Some important ultra-skills are:
 

• Team building. A team is more than the sum of its parts. Focusing on dependability, structure and clarity, meaning, and impact can bring cohesion and raise the bar on overall performance. Cultivating a group of people who trust one another, feel safe to take risks, and feel vulnerable around one another is a skill that takes intentionality and practice.
• Developing others by teaching new skills, coaching, and mentoring. Like team building, developing others is a way to help someone better trust themselves to grow and lead.
• Setting and sharing a vision. Aligning everyone’s vision on care—for example, what better care and outcomes look like for patients—and instituting actionable steps can help your leaders and teams move in unison toward positive change.
• Change management. Despite the constant change in our daily lives, people are often poor at dealing with it. Learning how to prepare people for change and helping them move through it is an essential ultra-skill.

 
Putting It Into Action
How do you put it all into action? Here is a checklist to help you develop and improve any of these skills in your everyday life.
 

1. Develop a growth mindset. This can be summed up as getting out of your comfort zone. Self-worth is not about your ability to succeed, but your ability to grow, and believing that you are good or bad at something stunts growth. Everyone can learn new skills, which includes learning from making mistakes and failing too. It is all growth.
2. Take time to reflect. Recently, our team lost a young patient to cardiac arrest. After doing all we could to save the patient, we paused to reflect on the patient’s life with a moment of silence, on how we cared for the patient, and on what we could do differently in the future. Without reflection, you are unlikely to improve.
3. Practice your scales. Piano players understand that mastering musical scales is a way to improve their technical performance. What is the equivalent of scales in your line of work? How can it help you master your performance? Practice is key to improving.
4. Seek coaching and mentorship. Rafael Nadal is a world-class professional tennis player. He is at the top of his game and yet he has a coach. Why? Coaching and mentorship help us improve. While coaching is task oriented and performance driven, mentorship is a long-term, development-driven relationship. Both can help you become better at what you do.
5. Expand your horizons. Brand-new ideas are rare and do not usually drive innovation. Instead, innovation is more likely to come from adopting an idea outside your field and applying it to solve a problem in your work domain. I am always looking for inspiration and insight from books outside my immediate world of medicine. Some suggestions are offered at the end of this article.

 
It is challenging to convince adult learners in critical care who are eager to grow professionally that they should value soft skills over hard skills. However, when we apply the framework of skills, super-skills, and ultra-skills, it becomes evident where the gaps exist and, more importantly, what ultimately has the most significant impact on patients and professional success. We should continue to learn and develop new skills as knowledge of critical care medicine advances. We also need to develop super-skills to enhance and accelerate our growth. Finally, we must develop ultra-skills to impact the team around us and help every team member become the best version of themselves. This will lead to the ability of high-performing ICU teams to learn together despite the changing and complex healthcare environment.
 

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Posted: 7/10/2024 | 0 comments