Towards Excellence: 12 Habits for a New Year

“It’s remarkable what you can build if you just don’t stop. It’s remarkable the business you can build if you don’t stop working. It’s remarkable the body you can build if you don’t stop training. It’s remarkable the knowledge you can build if you don’t stop learning. It’s remarkable the fortune you can build if you don’t stop saving. It’s remarkable the friendships you can build if you don’t stop caring. Small habits don’t add up. They compound.” (1) — James Clear, author of “Atomic Habits”

We all aspire for change in one way or another and chances are, many of us have also come to understand exactly how complex this process can be – from finding the right motivation to adopting the right strategies to sustain growth. Since the medical field is constantly changing, our ability to change is a major factor in our professional success. However, some changes come easier than others. Evaluating and updating treatment protocols or mastering a new surgical technique, for example, are change processes that are engrained, especially in the field of surgery, and in some ways, this type of change is second nature. Focusing in on our own personal growth, however, can be a much more difficult thing to do. But if 2020 has taught us anything, it has made us all take a long —and sometimes difficult—look in the mirror. If we want to change, it’s the single most important action for the days ahead.

Insights

• Over the last century, some of the personal qualities of surgeons that have been emphasized in the speeches of American College of Surgeons (ACS) presidents have remained consistent while others have changed.
• Personal characteristics that have consistently been recognised include compassion, integrity, a commitment to lifelong learning and a willingness to shape the surgical field.
• However, we have seen the emphasis shift away from intellectual and technical abilities and towards interpersonal abilities such as humility, inclusivity and collaboration.
• Personal growth is fundamental to success but doesn’t always come easily.
• Establishing good habits, developing a strong desire to change, and making change an integral part of our identity can help in achieving our personal growth goals.
• Additionally, surrounding ourselves with a strong group of likeminded people, taking time to reflect, and valuing the entire change process can help make these changes lasting.
• We also provide a list of twelve areas towards personal excellence in the new year.

A Century of Change

The growing importance of a surgeon’s personal qualities is evident in the speeches of leaders in the surgical field over the past century. An analysis of 98 American College of Surgeons (ACS) presidential addresses given from 1913-2019 revealed two patterns in the personal characteristics that were emphasized. (2) First, some personal qualities have been consistently mentioned in speeches over the last one hundred years. These qualities include compassion, integrity, the commitment to lifelong learning, and a willingness to help shape the field at the international and national level. (2) Second, this analysis revealed a shift away from the more tangible characteristics of success, such as intellectual and technical ability, and towards less tangible interpersonal abilities, such as humility, inclusivity and collaboration. (2)

While the personal qualities of a successful surgeon have expanded to focus more on interpersonal skills – knowledge, surgical experience and technical skills have not become any less important. However, the ability to grow outside of our professional comfort zone (and into a more personal one), has been recognized as a critical skill in becoming an effective physician; it also happens to be a difficult process to master. After all, the process of mastering a new surgical technique, while very involving, is perhaps a change process that is more familiar and standardized compared to being more mindful, for example. Therefore, knowing where to start and addressing the factors involved in achieving personal growth can be a challenge.

Beginning the Change Process

The decision to make a change will of course vary from person to person. Taylor (2001) explains that for some, achieving growth in a certain area is motivated by an intrinsic desire to be better or to better help others. (4) For others, motivation is more extrinsic, like making changes to achieve a promotion, receive recognition or conform to social pressures. (4) While more intrinsic motivation is ideal because it comes from a place of security and strength, research has shown that all types of motivation have the potential to generate change (although not necessarily happiness). (4) Whether motivation is intrinsic or extrinsic, it begins with determining the directions you could take, deciding which direction to go, and dedicating yourself to that decision and the steps required to make the change. (4)

A 2001 qualitative analysis of the personal growth stories of physicians revealed a few common themes in the motivational process. (3) It was found that personal growth stories often began with a powerful experience or a helping relationship, or both, continued with introspection, and ended in a personal growth outcome. (3)

“Powerful experiences occur commonly in medicine but may lack optimal conditions for personal growth. To promote practitioner personal growth, medical settings may wish to explore methods to promote introspection, helping relationships, and the acknowledgment of powerful experiences when they occur.” (3) — Kern et al. (2001)

Making Change Stick

Being motivated to change is where personal growth begins, but keeping the process going is vital to transforming actions into tangible results. Helping us to understand the underlying mechanisms of change and personal growth, author James Clear has outlined many practical strategies to making improvements everyday in his book Atomic Habits. (1) Whether change is motivated by a powerful
experience or a helping relationship, establishing and maintaining real and powerful change comes down to a few key factors. A few of these key factors are outlined below.

1. Habits. Habits determine many of our actions every day. People believe that in their everyday lives they are actively making decisions to behave in certain ways, however, research shows that 40 to 50 percent of our actions (and likely even more) are actually done out of habit. (1) Clear writes, “We like to think that we are in control…The truth, however, is that many of the actions we take each day are shaped not by purposeful drive and choice but by the most obvious option.” (1)

With this in mind, in order to change we need to understand what triggers our behaviour and then work to change the context. Clear suggests that individuals who are disciplined are simply “better at structuring their lives in a way that does not require heroic willpower and self control.” (1) Therefore, when redesigning our lives, it is important to make the actions we want or need, the actions that are easiest to do. (1) Exhibit 2 lists a few of the strategies Clear recommends for harnessing the power of our habits, including using existing habits to establish new ones.

Habit Tracking
·Useful for measuring progress
·Provides a visual reminder to act
·Is inherently motivating and satisfying because progress
is visually shown
Implementation Intention
· Planning when and where to act in a new way
· I will [specific behaviour] at [time] in [location]’
Habit Stacking
· Stacks’ a new habit on top of a current habit
· After [current habit], I will [new habit]
Temptation Bundling
· Connecting an action you want to do with an action you need to do.
· After [something I need], I will [something I want]
Exhibit 2. Strategies for habit planning. (1)

2. Desire. “With a big enough why, you can overcome any how.” (1) Along with this powerful statement, Clear also submits that knowledge and experience are meaningless without a desire to grow and improve. (1)

“Being curious is better than being smart. Being motivated and curious counts for more than being smart because it leads to action. Being smart will never deliver results on its own because it doesn’t get you to act. It is desire, not intelligence, that prompts behavior. As Naval Ravikant says, ‘The trick to doing anything is first cultivating a desire for it.’” (1)

3. Group Behaviour. The normal behavior of a group or ‘tribe’ can greatly influence the desired behavior of the individual. (1)

Clear goes on to explain that this may be because we tend to copy the habits of successful, highly effective people in our environment since we also desire success ourselves. (1) Due to this, it is important to

“join a culture where your desired behavior is the normal behavior and you already have something in common with the group.”(1)

4. Identity. Achieving lasting change and personal growth means making the change you want to see a part of your identity. (1)

“True behavior change is identity change. You might start a habit because of motivation, but the only reason you’ll stick with one is that it becomes part of your identity.” (1)

“Your habits contribute most of the evidence that shapes your identity. In this way, the process of building habits is actually the process of becoming yourself.” (1)

5. Reflection. Find ways to regularly reflect in order to gain big-picture perspectives on where you are and where you want to be. (1)

“Reflection can also bring a sense of perspective. Daily habits are powerful because of how they compound, but worrying too much about every daily choice is like looking at yourself in the mirror from an inch away. You can see every imperfection and lose sight of the bigger picture. There is too much feedback. Conversely, never reviewing your habits is like never looking in the mirror. You aren’t aware of easily fixable flaws—a spot on your shirt, a bit of food in your teeth. There is too little feedback. Periodic reflection and review is like viewing yourself in the mirror from a conversational distance. You can see the important changes you should make without losing sight of the bigger picture. You want to view the entire mountain range, not obsess over each peak and valley.” (1)

6. Systems-First Mentality. Focus on the process itself and not just the end goal so you can enjoy every step of your personal growth journey. (1)

“A systems-first mentality provides the antidote. When you fall in love with the process rather than the product, you don’t have to wait to give yourself permission to be happy. You can be satisfied anytime your system is running.” (1)

With the key factors in mind, the following are twelve habits to consider in your personal growth journey during the new year. Having a clear and specific goal can not only begin to mobilize your behaviour in the direction of your goal, but can help to sustain this momentum by guiding you towards the next step. (5) Personal goals can also help to align your focus, build character and reveal what is truly important to you. Not to mention it is a major stepping stone towards developing a sense of self mastery and becoming the type of person who can achieve goals; changes that will undoubtedly inspire progress in many other areas of your professional and personal life. (5)

Twelve Habits Towards Excellence

1. Schedule time for yourself. It may not feel productive to take time away, especially during really busy times, but finding ‘you time’ can actually lead to many positive changes. According to a Harvard Business Review article, strategically planned time off can actually result in greater success at work, lower stress, and increased happiness. (6) Of course, it is also important that scheduled time off is well planned and thoughtfully executed in order to make the most of it. (6)

2. Get places early. By losing the rush, you will also be ditching the stress that is associated with it. Not to mention you will also be giving yourself extra time to collect your thoughts and spend time on relaxing rituals before your day even begins. By arriving early, you have the opportunity to plan ahead and this planning time increases your chances of making decisions that set the rest of your day up for success, such as eating a good breakfast or spending extra time on other tasks that need your attention. (7) Starting the day off with a success, such
as arriving early, has also shown to boost motivation and productivity. (7) Research has also shown that later start times were associated with lower performance ratings. (7)

3. Choose presence and gratitude. Changing the past and predicting the future are two things that we can’t do. Instead of spending time dwelling on things that are out of your control, spend time focusing on the things that you can. For example, instead of revisiting mistakes, learn from them and move on. By choosing to be present in the moment, you will be giving your full attention to the things that are most
important. (8)

Don’t forget to also take time to appreciate yourself, others and the things you have. By doing so, you will be creating positive vibes that also have the power to affect others moods and be focusing on developing the most positive aspects of yourself. (8)

4. Focus on quality connections. Spend time nurturing your relationships and developing the skills necessary to build healthy and positive social connections. After all, healthy relationships have been shown to reduce stress, boost healing, provide a sense of purpose, set the tone for other healthy behaviours and can even add years onto your life. (9)

5. Limit obligations. Whether it is through delegation or simply prioritizing what is most important for you to tackle, limiting your number of obligations is not only efficient but can help you to eliminate unnecessary stress. By limiting the number of tasks on your list and focusing on fewer things, you will also be allowing yourself to get great at those things instead of being mediocre at many.

6. Lose the fear. Overcome your fear of failure by learning to take risks. We learn valuable lessons from taking risks and these lessons often lead us down new paths and provide us with unforeseen opportunities. Most importantly, have faith and confidence in yourself to accomplish big things. After all, success doesn’t just fall into your lap, you have to pursue it. (10)

7. Take initiative. Like arriving places early, this is one habit that really makes people stand out from the crowd. Research has shown that individuals who take initiative are better performers, contributors and innovators than their more passive counterparts. (11) Of course, don’t forget that proactivity is only successful when channelled in ways that consider others and align with the overall vision of the team. (11)

8. Be patient. Be patient with yourself and others. Don’t forget that good things come from long term efforts.

9. Be more honest, open and vulnerable. More often than not, the things we hide are the things that have the greatest potential to connect us with others. Letting your true colours shine through might be exactly what you, your team and this world need. Recent research has shown that feeling able to take interpersonal risk at work can help you to perform better, be more creative and solve problems more
effectively. (12)

10. Take time to reflect. Taking the time to reflect can help individuals to see things from different perspectives, and helps in increasing confidence in decision making and extracting value from experiences. (13) Taking the time to practice mindfulness (an active and deliberate regulation of your attention) everyday has also shown to reduce anxiety, regulate emotional reactions, increase empathy and compassion, and promote a sense of connectedness with others. (13)

11. Bring out the best in others. Being more aware of others, showing empathy, and being curious can help us to identify and highlight the abilities of others and, in turn, help to develop a genuine desire to see others succeed. (14) Being open minded, generous with the time we give to others, persistent, and clear can also help us to bring out the best in others. (14) As a bonus, helping to bring out the best in others can also help to bring out the best in ourselves.

12. Seek mentorship. Seek mentorship and knowledge from people who are different from you. By surrounding yourself with and learning from those who have a different perspective or skill set, you will also be expanding on your own range of skills.

Contributors
Mohit Bhandari, MD, PhD
Dr. Mohit Bhandari is a Professor of Surgery and University Scholar at McMaster University, Canada. He holds a Canada Research Chair in Evidence-Based Orthopaedic Surgery and serves as the Editor-in-Chief of OrthoEvidence.

Ellen Scholl, B.Ed
Ellen Scholl has a degree in Physical Education and Kinesiology from Brock University and a B.Ed from the University of Ottawa.

References
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3. Kern DE, Wright SM, Carrese JA, et al. Personal growth in medical faculty: a qualitative study. West J Med. 2001;175(2):92-98. https://doi.org/10.1136/ewjm.175.2.92
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