In 2005, David Foster Wallace addressed the graduating class of Kenyon college with this brief vignette:
“There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, “Morning, boys, how’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, “What the hell is water?”
Recently, I had two 4th year medical students on my inpatient ward service.
Due to the quirks of the schedule I would be rounding with them for 2 weeks, but would not be assessing them for a grade – that task would be left to the attending after me.
Given this, I told them that I represented no risk to their grade, and spent some time discussing Carole Dweck’s work on Growth Mindset.
In her work, Dweck has explored the power of our beliefs. She has found that those with a Fixed Mindset believe that our intelligence, creativity, and even our character, are static, and cannot be changed. Success (when it comes) is simply an affirmation of our innate abilities. People with a Fixed Mindset often avoid challenges because failure would indicate that they lack innate ability, and therefore failure becomes personal (they are a failure, not that they failed at a task). Those with a Growth Mindset believe that intelligence, creativity and character are fluid, and with hard work, can grow over time. As a result, they seek challenges, and see failure as a growth opportunity.
Educational learning structures often cause a Fixed Mindset. When grades are at stake, the goal of training becomes the grade (get Honors!), but not necessarily to learn or grow. Whenever formative assessment represents risk, learners feel pressured to show what they know and hide their weaknesses.
I promised the students during their two weeks with me that we would reverse this. I’d be more interested in what they did not know than what they did, and we could work together to move from Fixed to Growth mindset.
At one point during the rotation we had a septic patient who needed a few hours of norepinephrine in the ICU. I asked the students if they knew how norepinephrine worked and what the potential side effects were. One of the students gave an amazing answer. It was clear she knew a lot about the physiology of sepsis. The other student was silent.
I praised the first student for the answer.
And then, I asked — what was the value of this moment? My praise? What did this student learn? She already knew the answer.
In the Fixed mindset, praise was the goal, and she achieved it. What was the other student thinking? Mad that he got scooped and didn’t get the chance to shine like the other student? Glad he wasn’t called on because he didn’t know the answer? A little of both?
If the students worked within a Growth Mindset they could have (would have?) asked the next question instead of stopping with the right answer. On reflection, they told me that in ‘real life’ they would never do this. When grades are the goal, why would you keep going after you got something right?
We also reflected how easily we fell into our roles.
Attending asks a question, student answers well, attending gives praise, other learners feel angry or relieved. And we move on to the next patient. Nothing of true value was gained.
Water? What the hell is water?