Cultivating Peak Performance: Incorporating Creativity and Adaptability in Health Care Providers

Abstract

Self-efficacy is an important factor of acquiring new skills as an individual is unlikely to apply a new skill if self-efficacy is low. In lifestyle medicine, health care providers (HCPs) are often trained to provide treatments that may be outside of their original expertise due to the varying and interrelated needs of their patients. Current models in training often do not intentionally incorporate self-efficacy. Additionally, as behavioral health becomes more integrated into lifestyle medicine, practitioners in this arena will need confidence to adapt their approach utilizing new skills and techniques. Literature on elite athletes can provide considerable insight into enhancing self-efficacy through creativity and adaptability for enhanced performance. Overall, this commentary draws from sport science literature that encourages HCPs to incorporate creativity and adaptability when attempting new skills for practice and enhancing their “performance” with patients.

“Actively training HCPs to be creative in their approaches has a high likelihood of increasing their adaptability with patients.”

Self-efficacy is a cornerstone to behavior change. The concept has demonstrated its value for an extended period of time. It was first introduced by Albert Bandura in 1977 ¹ and continues to be both implemented in skill acquisition and heavily researched. In this issue, Mouro et al ² discussed the need for deeper integration of behavioral health with lifestyle medicine. This deeper integration is likely to be achieved in multiple ways, and cross-training of individuals from different disciplines is one way to achieve integration. ³ However, interdisciplinary work is challenging because we are asking HCPs to work outside of their primary area of expertise. For example, a physician acquiring training in nutrition may find it difficult to transfer this new knowledge and/or skill(s) to clinical care. One of the barriers to this transfer is the lack of self-efficacy in the newly acquired training. Confidence (i.e., in a task or self-efficacy) and self-doubt are a continuum that greatly determines ¹ the likelihood that we engage in a behavior and ² our overall performance.

Typically, our trainings lack intentionality of increasing confidence and addressing self-doubt. Given the complexities of lifestyle medicine, it is highly likely that we are pushed out of our comfort zones by navigating multiple inter-professional areas (e.g., medical, nutrition, physical activity, and counseling) or constantly shifting our skillset to meet the dynamic needs of patients. When faced with unpredictable situations and changing conditions, self-doubt is likely to increase while confidence is lowered. As the goal is to provide a high level of care to patients, it is important to understand the factors that impact our ability to perform. In this commentary, a self-efficacy framework is discussed and draws upon unique comparisons to high performance athletes, which may inform us of ways to increase confidence and overall performance in HCPs.

Self-Efficacy

An individual’s belief in their capacity to execute a behavior has a profound impact on the likelihood of a behavior occurring both in the short- and long-term. Self-efficacy is one’s judgments of their abilities to organize and execute actions to attain designated types of performance. ⁴ Importantly, it is one’s beliefs, not necessarily their actual ability (or inability), that impacts both the likelihood of engaging in a behavior and overall performance. A slight overestimation of one’s actual ability can increase both effort and persistence.^5,6 Overall, low self-efficacy typically leads to the avoidance of behaviors whereas high self-efficacy typically leads to increased performance. ⁷ Stated differently, our confidence to complete a task helps to improve performance, whereas self-doubt about completing a task decreases performance. This may seem intuitive; however, we often do not directly attempt to address this in training HCPs.

Self-Doubt

Many individuals experience anxiety and self-doubt when attempting to apply newly learned skills.^8,9 Although low self-efficacy can be the result of many things, commonly, individuals either have a fear of failure or believe their skills are not adequate. ¹⁰ From a self-efficacy perspective, these feelings and thoughts significantly impact one’s potential to be successful. Self-doubt can greatly reduce ¹ the likelihood that they engage in the behavior and ² their overall performance.^11,12 Further, in newly acquired skills or skills that are less related to one’s area of expertise, self-doubt tends to be higher. In extreme instances, this self-doubt leads to imposter syndrome (e.g., feelings of being a “fraud”), which is shockingly high at nearly 30%, in health care students. ¹³ Additionally, physicians have an 80% higher risk of experiencing imposter syndrome. ¹⁴ In the case of HCPs who do not have a strong background in behavioral lifestyle medicine, it is less likely that these individuals will use newly acquired skills in this area even after training. This is precisely why it is critical to address confidence in the task.

Incorporation of Self-Efficacy and Reducing Self-Doubt into Training

Self-efficacy, or the confidence to perform a task, can be acquired through multiple avenues. For example, overlearning a topic, engaging in multiple repetitions, and/or developing high competency and proficiency can all lead to increased self-efficacy and overall confidence.^15,16 Although we provide training and multiple techniques (eg, sleep, nutrition, physical activity, and behavioral) for lifestyle clinicians, we rarely address confidence explicitly in the ability to use these techniques. Currently, we have a dearth of models that inform how to intentionally train HCPs to be confident in their skills.^17,18 We often assume that education, certification, and standard training protocols for providing treatment are sufficient for high-level care. This is not enough for most individuals to feel highly confident in providing any specialized treatment. Finding effective and novel ways to improve confidence and reduce self-doubt (ie, enhanced self-efficacy) in those who provide health care is clearly needed.

Taking a Page from Elite Athletes

In elite athletes, confidence is shaped by environmental forces and situational factors in which the person finds themself. If an athlete is not trained on assessing and interpreting the situational factors, they are more likely to perform poorly.^19,20 For example, a soccer player must be able to read the opponent’s style of play and that of their teammates to make the appropriate tactical decision. Each game becomes a completely unique situation. However, athletes are trained in similar situations to build technical skills and tactical awareness that allow them to transfer acquired skills and knowledge into real-game situations.^21-23 Further, these situations are dynamic, unique, and complex as a sport game is fluid and evolving constantly. The ability to perform tasks and adapt to environmental constraints that are rapidly changing is crucial to their level of performance. ²⁴ Because of this situation, they must be able to make decisions that solve complex problems with novel solutions if they are likely to have improved sports performance. The technical skills and tactical abilities that are learned and built in these athletes enhance creativity and adaptability.^25,26

This is not unlike what happens with someone providing a novel skill, like behavioral health, in lifestyle medicine. Although patients are not our opponents, they share unique, dynamic, and often changing characteristics that HCPs need to account for to have “improved performance” with the patients. Similarly, HCPs often need to quickly solve problems to complex situations with novel approaches to be most effective. ²⁷ Although we have firm scientific standing in our approaches, the way in which we use and implement these approaches needs to be done in creative and adaptive ways that best meet the needs of our patients. This is the art of our science in lifestyle medicine that often is overlooked.

Creativity and Adaptability

Creativity for sport athletes is a highly prized asset or ability that can spark novel solutions to complex problems or situations. ²⁸ High performance athletes are inundated with situations that require quick thinking, multiple skill sets, and the ability to read the evolving, dynamic environment around them “on the field of play.” It’s not enough to be highly skilled, trained, and knowledgeable; rather, an athlete must respond with the right skill/knowledge/decision that matches the demand of the situation, often complex.^29,30 Then, we may label or identify that athlete as “creative” because they adapted correctly and achieved enhanced performance. Clearly, the preparation for the individual athlete before the on-field adaptation is critical to meeting the demand. Perhaps more importantly, the environment in which they feel the freedom to act in creative ways must be cultivated. In other words, the overall environment (eg, training, day-to-day routine, performance expectations, and coaching styles) often impedes the creative process of the athlete. An over-emphasis on winning, risk averse tendencies, and socio-cultural norms of the participants (eg, hyper-competitiveness) may limit the potential of athletes when responding to situational demands.^31,32 Creativity is critical at both the individual level training and fostering it at the environmental level, as it leads to adaptability and is strongly linked to high levels of performance. ³³

HCPs can also be risk avoidant and/or hyper-competitive. In addition, many compare themselves to others or feel judged by others in a highly criticized setting. ³⁴ Similar to athletes, these factors decrease the likelihood that creative approaches are used. Indeed, this lack of creativity inevitably supports the inability to adapt to the unique needs and wants of clients that need specialized care. Actively training HCPs to be creative in their approaches has a high likelihood of increasing their adaptability with patients. ³⁵ Unfortunately, the practice of training creativity for adaptive solutions is rare and not cultivated enough in lifestyle medicine.^36,37 However, these factors should increase self-efficacy (or confidence) in their ability to help. In the case of counseling individuals in lifestyle medicine, creativity and adaptability are significant missing components that separate those who are “providing treatment” from those who are “providing a technique.”

Conclusion

Clearly, HCPs (or at least most of us) are not elite athletes. However, considering ways in which we can become more “elite” in our care has significant implications for our patients. Allowing trainees and practitioners in lifestyle medicine alike to have the freedom to explore creative ways to implement counseling, nutrition, or coaching skills that align with their strengths can have significant benefits for our patients. Addressing issues of self-doubt, imposter syndrome, and fear of failure should also be fundamental to lifestyle medicine. Ultimately, allowing well-trained individuals the freedom to have an adaptable and creative approach will increase self-efficacy, which has substantial and long-reaching effects. Training the individual HCP is important, but fostering and designing an environment in which the training takes place that emphasizes creativity and adaptability in future situations separates good treatment from elite performance.