Effective Self-efficacy.

I coached a ride for my mindfulness/cycling fusion class Tuesday night called "Triumph Over Adversity." The idea was to inhabit a moment in the near or distant past in which one truly felt accomplished, after completing SOMETHING that meant something to them. After identifying that moment, I coached my riders to re-experience the reasons they were even undertaking that particular challenge and to channel, through each of their senses, a connection with what it felt like to pull it off. What they learned. How they changed. What they now felt uniquely qualified to do.

I was to present this ride the night after my final exam of my first year of medical school. Yet when I was preparing for it, the "moment" I selected to 'process' myself was NOT what one would expect me to have chosen. Why not? Because I hadn't accomplished it. Deep down, without the confirmation of a grade, I believed that I hadn't pulled it off. I rehearsed coping mechanisms for how to respond to being presented with the news that I'd failed. I expected to fail. In my next entry on what I learned this year, I'll talk about the appreciation that expectation is everything. And my expectation was completely inconsistent with the pursuit of success; my entire mindset was that of avoidance vs. failure to avoid failure.

So today, I got that grade on which my determination of "completion" was to be based. I not only passed, but I rocked it. And when I saw that confirmation, that validation of some of the toughest, most discouraging 8 weeks of my life -- to culminate 10 months of the intellectual and emotional roller coaster that is the first year of medical school, I cried.

But as I sat there crying for 20 minutes, I DIDN'T think: "Holy shit, I didn't fail."
I thought, "Holy shit, I did it." Because I did.

It's been a pretty maladaptive, dysfunctional few months marked by more self-pity and poor coping mechanisms than I'd like to admit. After a month of subtly waning motivation and not-so-subtly growing frustration (partially attributed to micronutrient deficiency, partially attributed to pure distaste for most of the brain), I had the sub-ideal experience of incurring a concussion. So on top of my vague physiological/cognitive deficits, I stopped being able to read/articulate sentences longer than a few sentences (before I'd forget how they began). My 23-day headache was also sub-ideal. 'Really?' I kept asking myself. 'No. Really?'

My self-pity ran deeper than my pulled trapezius. I didn't want to DO anything, be anywhere, learn anything. I just wanted to wallow and sleep and eat and think about all the things I was supposed to be but was absolutely not. I stopped riding my bike, distracted by my anticipatory anxiety, and got quite proficient at rationalizing my avoidance. Nice way to engage one's favorite hobby.

I met with my course director after BOMBING an exam. She crunched the numbers for me and identified what sort of grades I'd need to pull on the last exam in order to pull this off. Somehow the sheer act of inspiring HOPE -- it made the difference. The haze cleared, the contexts settled. I believed it was within the scope of my control that I WOULD 'do' this.

This was an exercise in learning the difference between living a life of self-efficacy and living a life without it. As much as I talk and think and write about this construct within my physician-in-training and coaching lives, while I've absolutely appreciated and been grateful for the fact that I possess it, I don't think I really processed it deeply enough. In forensics, we speak of context being everything. Competency is task-specific (i.e., one can be competent to draft a will but not competent to stand trial) -- turns out, so is self-efficacy. I absolutely 100% believe that I will excel at many things: I can write, I can coach, I can listen, I can interpret, I can carry a decent conversation. But I do NOT believe that I can do the perfect eye or lung exam, master neuro physiology, create the perfect patient education program. I really don't. And that's why I become a clumsy, blubbering idiot when I'm doing ANY physical exam, taking an anatomy practical, and all of the other things I absolutely suck at.

Is there even such a THING as global self-efficacy -- that thing I was supposed to study next, after I wrap up my first-round HRM study next month? Now I'm not so sure.

What I did learn, however, is that I don't think it matters. If I want to be good at something, I really just need to do it enough times to believe that I can do it. I can suck at it over and over and over and over and over again -- and then, eventually, I won't suck at it. Not "I might not suck at it." I won't suck at it. EVERY beginning starts like that. I don't know why I ever expected this to be differently.

Last week, I had to introduce the director of the clinic to speak before my class -- a talk I'd organized, about which I was INCREDIBLY anxious. I wrote a beautiful introduction. Got up there, deep breaths, all the stuff I talk about ad nauseum... and then I blanked. Words just didn't come out. I felt my heart rate rising faster than my breath could control, the sweat dripping, my chest tightening -- it felt so familiar, as though I hadn't NOT had a panic attack in TWO YEARS. 'Really?' I asked myself. 'No. Really?'

I managed out a few words and sat down to properly complete my panic attack. Really.

I was beyond discouraged. I do NOT have a problem with public speaking. I addressed my college graduating class and their families at graduation with no problem --thousands of people. I espoused the cheesiest, most emotionally gushy stuff imaginable before over a hundred people just three months ago. I speak before 25-40 people almost every day. But my goal wasn't to speak, in that moment. My goal was to impress this guy who has inspired me so much, and I did NOT possess self-efficacy to do it. I did not believe that, deep down no matter what, that this guy would like me. Validation as a deficient pre-requisite for 'self-efficacy to impress?' A fascinating construct. It's NOT ok -- but it's a fascinating mechanism to explain a phenomenon that strikes me far too often. So I'm rollin' with it.

This summer, I am investing in context-specific self-efficacy development:
1) Self-efficacy to perform two basic physical exam skills that make me anxious and really need to not make me anxious: blood pressure and fundoscopy
2) Self-efficacy to ride my bike without hitting my head on concrete
3) Self-efficacy to control my physiological response to perceived self-inefficacy.

This entry wasn't supposed to go like this. It was awkward to write, awkward to re-read. I almost just deleted it all. But this blog isn't supposed to be about cheerful rainbows and sunflowers and whatever. It's supposed to be about the important subtleties of what I appreciate during my training. The appreciation that one can recognize when one absolutely sucks at something and can formulate a plan to address it -- I'll take that over a rainbow any day.